Small Ani. Med 2- Cardio 2

wilsbach's version from 2016-01-30 23:49

CHF part 2

Question Answer
Which valves are you listening for on the R? on the L? approx places?RIGHT: P-A-M 3-4-5. LEFT: T 5
where on the chest would you ascult a PDA?Patent ductus arteriosis is when there is still the vessel connecting the aorta and the pulmonary artery. The aorta has a higher pressure so the blood goes from aorta to pulmonary artery and causes turbulence which you hear. The pulmonary outflow moves over to the L and the pulmonic valve is more on the L side of the heart so this is where you hear the murmur
where on the chest would you ascult a VSD (ventricular septal defect?)there is a hole in the vent. septum, pressure higher on L side, so it shoots blood over into the R ventricle and hits the wall so you hear the turbulance on the R side
not going to ask Qs about this chart but we should understand it remember the electrical impulses (P, QRS, T) happen before the actual physiological even takes place-- like the QRS happens and then the vents start to gain pressure and THEN push out the blood
what is a holosystolic/pansystolic murmur like? When does it occur? (akas?)Consistent level of sound which occurs during systole. "regurgitation or plateau" murmur.
what is a crescendo-decrescendo murmur like? When does it occur? (akas?)a quiet getting louder and then getting quieter again sound. Happens during systole. "ejection" murmur.
what is a diastolic decrescendo murmur like? when does it occur? (akas?)during diastole, starts loud and ends quietly.
What is a continuous murmur like? when does it occur? (akas?)it is crescendo during systole and during diastole it is decrescendo but it is always happening. "machinery murmur"
which murmur would you say "lub sha dub" is?mid systolic plateau
how you should describe a murmur (in general) is...first say if systolic or diastolic, then describe sounds (is it flat, like sounds the same through the murmur, or does it crescendo and decrescendo)
most mitral and tricuspid regurgitation tend to be which murmurs?systolic and plateau
most pulmonary and aortic stenosis tend to be which murmurs?systolic crescendo-decrescendo
what is happening at first red arrow (L) at the R arrow?L= lub= S1. R= dub
murmur grading is from _ to _1-6 aka I-VI
******what is a Grade 1 murmur?Very soft, intermittent
******what is a Grade 2 murmur?Soft murmur, can hear consistently in a quiet room
******what is a Grade 3 murmur?Moderate intensity murmur
******what is a Grade 4 murmur?Loud murmur
******what is a Grade 5 murmur?Loud murmur with a precordial thrill
******what is a Grade 6 murmur?Very loud murmur, can hear with stethoscope off of the body wall
what murmur grades have precordial thrills?5 and 6
*what diagnostic should you basically always start with for suspected heart problems?ALWAYS START WITH RADS!!! Echo won't tell you about CHF fluid in the lungs or belly, etc....she also said in class that BP always good answer for something to do first-- do if stable and calm. wanna do BP before mess up readings with doing other tests.
****how should we ascult the patient??when auscultating pt- ascult both sides, all valves, sternum, and palpate femoral pulse at same time!!!! she will take points off if you don't!!
what does RADS vs ECHO tell you about CHF?you DX the CHF with the rads (see the fluid build up, etc). The EChO tells you what specific valve problem lead to the CHF
what are some different ways you can do ECG on the patient?Rest, post-exercise, vagal maneuver (massage carotid sinuses or press on eyes to lower HR), In-house continuous
what is a Cardiac marker, what is an example, what does she think about them?ex is nt-pro-BNP, or cardiac troponins. She says they're not helpful for animals/dogs (nt pro BNP is prolly the best, troponins are most likely useless. But it's not completely useless- if shes torn to whether or not cat has resp or cardiac dz...nt pro BNP can prolly tell you cat has cardiac hypertrophic cariomyopathy (but if hear a murmur, dont need a blood test to know you need to work up a heart)
what is the monitor you can use to constantly monitor a dog's ecg over the course of a week or so? What about if it just records if something weird happens?holter monitor, event monitor, respectively.
5 big things thoracic rads can tell you diagnostically about the heart?Cardiomegaly (chamber enlargement), vascular abnormalities, CHF (see the fluid), lungs, plural space
where might you see pulmonary venous distension on rads?
what does holosystolic mean?murmur lasts for entirety of systole
easy way to differentiate the diff murmur gradesone: expert can hear, not you. two: can hear in v quiet room. Three: hear on one side. Four: hear on both sides. Five: you can feel the turbulence with your fingers. Six: can hear with steth off the body wall
why might you want to know if the pt has anemia if they have a murmur?physiological murmur bc thinner blood sloshes more
endocardiosis vs endocarditis?Endocardiosis= degenerative valve dz. Endocarditis= valve infxn
If there is a murmur, do chest rads first! (or maybe BP if theyre calm). If there is an ARRHYTHMIA, what should you do first?ECG
What lung patten would you see with CHF?alveolar pattern (air bronchogram)
what are the bad things going on in this pic?HUGE L atrium at top, L vent big bc sternal touching and the trachea is pushed up, Interstitial lung pattern
on a lateral rad, what is the order of the tubes?ABV-- artery bronchus vein
why might you see artery or vein distension on thoracic rads of a heart pt?any dz where too much blood going to lungs-- for artery AND vein distension, PDA (and some septal defects) can do this b/c half the blood from the aorta is going back into the pulmonary circulation (preload to L side inc and afterload to R side inc in a PDA)
what's this "fissure line" about?basically you're seeing sthing fill up the spaces between the lung lobes

CHF part 3

Question Answer
ECHOcardiography--> what does this awesome dx tool let you know and see and do?It is a NON-INVASIVE way to image the heart and see the chambers, vessels, and valves. It allows you to take measurements of the heart, and you can use the doppler setting to evaluate flow and pressure (hence eval valve health). There is also the 2D M-mode which helps you take very good measurements and look at the movement in the heart in real time.
what does this image show?M-mode on a ECHOcardiography
hey dipshit, don't confuse ECHOcardiography with ELECTROcardiographythey are totally different 'aite
there is a super round circle you see in the middle of the heart when you are doing a echo (ultrasound!) what is it?aorta!!
what does ELECTROcardiography allow you to look at?PQRST complexes, Evaluation of wave forms and patterns, RHYTHM disturbances
diff between a segment and an intervalsegment is when there is no electrical activity happening from point X to point Y. And interval includes or starts with electrical event
when doing ELECTROcardiography, where are these measurements?: P-R segment, S-T segment, P-R interval, QRS interval, S-T interval
what is NT-pro-BNP, what does it tell usThis is a cardiac marker which you can detect on a serum test. It's full name is "N-terminal of the prohormone brain natriuretic peptide". Detecting this tells us about levels of ventricular stretch. "Stretch" refers to.... stretch in heart--> seen as too much volume--> naturetic peptide--> pee out water is normal control mechanism. Cardiac troponins are not considered useful for vetmed right now. best cardiac marker is NT pro BNP. more useful in cats than dogs. in dogs, if resp dz, renal dz, or GI (maybe) dz, all will inc NT pro BNP. Will inc with renal dz in cats too so be mindful.
Cardiac Catheterization is very useful for which two diagnostics?Complicated congenital abnormalities, eval pressures
two situations where Cardiac Catheterization can be used as a therapeutic method?(1) Presurgical/ballooning (2) Pulmonic stenosis in bulldogs (for checking for aberrant vessel, more on this in another card)
WHY do you want to use cardiac cath before you decide to balloon for a pulmonary stenosis in a bulldog?Pulmonary stenosis is super common in bulldogs. Bulldogs also sometimes have a aberrant coronary artery. So there is only one vessel that goes to right side of heart and just happens to live right near the pulmonary valve...if blow up valve, shred artery, no blood to r side of heart, they die. so these guys cant be ballooned. So always do cath prior to ballooning to make sure they DONT have that artery.
Cardiac remodeling--> Size, shape, and stiffness can change in response to what kinda things going on in the heart? Exmaples?pressure, volume, neurohormones, cytokines. Examples of remodeling are: Myocardial cell hypertrophy, Myocardial cell apoptosis, Interstitial matrix formation, Fibrosis, Collagen destruction (leading to dilation)
******WHAT TYPE OF HYPERTROPHY IS CAUSED BY inc PRESSURE? Which is caused BY INC VOLUME? (Explain how the fibers are arranged differently in these two cases)(1) Inc pressure leads to Concentric hypertrophy where the fibers are added in PARALLEL, so the heart is bigger because it is THICKER. (2) Increased volume leads to Eccentric hypertrophy where Fibers are added in series leading to a bigger heart with thin walls
when/how does Neurohormonal Activation of the heart happen? (3 situations).This is part of the compensatory mechanisms of the heart (1) Increased sympathetic tone (2) Decreased parasympathetic tone (3) Activation of RAAS and ADH/VP
what does ACE do?angiotensin converting enzyme.. converts angiotensin 1 to 2
*(she loves pimobendan) what are the things pimobendan does? what are it's big benefits?improves contractility AND is an inodilator. This dec afterload AND doesnt inc O2 demand on the heart.
*she said shes def gonna ask a Q about enalapril and furosemideenalapril: is an angiotensin-converting-enzyme (ACE) inhibitor used in the treatment of hypertension, diabetic nephropathy, and some types of chronic heart failure (dec afterload). Furosemide: powerful Diuretic... use to dec preload
Cardiac Disease-- what are the Anatomic diagnosis? (6)could be pericardial, myocardial, valvular, endocardial, vascular, or electrical
Cardiac Disease—what are the Physiologic diagnosis? (9)could be CHF, shock, hypotension, syncope, arrhythmia, shunting, Valvular disease (regurg or stenosis!), hypertension, Myocardial failure (systolic or diastolic failure)
MOST COMMON valvular INSUFFICIENCY dz's (2) and what their murmur sounds like?mitral and tricuspid insufficiencies most common, and their murmurs are systolic and flat (plateau)-- difference is what side it's on (Mitral on L and Tricuspid on R)
MOST COMMON valvular STENOSIS dz's (2) and what their murmur sounds like?aortic and pulmonic stenosis most common. crescendo decrescendo, or ejection type murmur. and SYSTOLIC. Could be aortic or pulmonic if high left side systolic ejection murmur
If there is an aortic insufficiency, WHEN do you hear the murmur and what does it sound like?Insufficiency is a holosystolic plateau murmur, for an AORTIC valve it would be during DIASTOLE though
explain why hypertension and heart dz go hand in handHeart patients tend to be hypertensive. this is because the heart is failing and not enough blood is perfusing organs, including the kidney, so the RAAS system is turned on to inc BP
why might a hypertrophic cardiomyopathy cat have tachycardia?walls very thick (concentric hypertrophy) so less volume getting out-->DEC CO. heart speeds up to try to get more out (remember CO= SVxHR). But Diastole is when heart gets it's blood and inc HR shortens beta blockers to slow down heart
when does the heart receive blood for itself? what implications does this have?DURING DIASTOLE-- so if the heart is beating very fast, there is shorter and shorter diastole, which means less perfusion of heart
why does a dilated heart have a high heart rate?cant contract much if dilated--> low stroke volume--> heart rate inc to compensate (CO=SVXHR)
(said in class) if you see a bunch of pink foam coming out of a dog's nose, what do you think it is and what should you do?pulmonary edema, load them up with furosemide
*what is the category of drugs that slow down the heart?beta blockers
This is the International Small Animal Cardiac Health Council ISACHC Heart Disease Classification. Explain why we care about it. Read it over a bitHelpful bc articles and things talking about tx refer to what stage the animal is based on this. Also helpful bc within the numbers there are subgroups, so you can move back and forth in classifying with the subgroups
This is the ACVIM Consensus Statement. Is is similar to the International Small Animal Cardiac Health Council ISACHC Heart Disease Classification...why do we like this thing?like to use to know when we should be... Screening programs, Interventions to slow progression, Identifying disease earlier, Symptomatic vs. asymptomatic, Treatment protocols, Hospice care