Small Ani. Med 2- Cardio 3

drraythe's version from 2016-04-29 14:56


Question Answer
what are 5 basic general therapeutic goals?(1) Controlling edema and effusions (2) Improving cardiac output (3) Reducing cardiac workload (4) Supporting myocardial function (5) Managing arrhythmias. .....heart pts need FREQUENT REASSESSMENT
you can cause volume redistribution to dec work on heart with venodilators. what are 2 venodilators you can use?Nitroglycerin ointment ((can be absorbed percutaneously), Nitroprusside ICU (IV if youre in ICU)
what are some anxiolytics you can use if the pt is in ER CHF? (3 kinds)Opioids, Diazepam, Acepromazine
what drug can you use to minimize bronchoconstriction in ER CHF?Aminophylline (Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2:1 ratio.)
what are some arterial dilators you can use with ER CHF (and why use) (3)(dec afterload!) Hydralazine (H is a direct-acting smooth muscle relaxant used to treat hypertension by acting as a vasodilator), Enalapril (E is a angiotensin-converting-enzyme (ACE) inhibitor used in the treatment of hypertension), amlodipine (am is her fav bc it is a Ca channel blocker that works in the periphery and not in the heart so it's good for dec afterload)
Congestive Heart Failure Emergency Therapy-- what are some things you can do? (explain reasoning)PROVIDE O2!!! (dec stress on heart to try to provide O2) Do thoracocentesis if necessary (short shallow breathing folks), provide diuresis (dec preload! prolly furosemide), provide Volume redistribution (venodilators), anxiolytics (calm=lower hr), Minimize bronchoconstriction (also help with getting more O2), Dec afterload (arteriodilators to dec afterload), ↑ contractility IF myocardial failure
when do you want to inc contractility in CHF, and what are 3 drugs that will do this?only do this if failure is due to myocardial failure! Can use PIMOBENDAN, DOBUTAMINE, and INAMRINONE
what does dobutamine do?INC CONTRACILITY! sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of β1 receptors of the sympathetic nervous system
what does pimobendan do? It is both a calcium sensitizer and a selective inhibitor of phosphodiesterase III (PDE3) with positive inotropic and vasodilator effects.
what does inamrinone do?inc inotropy-- is a pyridine phosphodiesterase 3 inhibitor. It is a drug that may improve the prognosis in patients with congestive heart failure.[3] Amrinone has been shown to increase the contractions initiated in the heart by high gain calcium induced calcium release (CICR)
what is Nitroglycerin ointment?venodilator (It acts as a drug by releasing nitric oxide)
what is Nitroprusside ICU?venodilator ( It acts as a drug by releasing nitric oxide)
why give diazepam?anxiolytic (agonize GABA)
why give acepromazine?anxiolytic (antagonize A1 and D2)
what is Aminophylline?bronchodilator (compound of the bronchodilator theophylline with ethylenediamine... theo is competitive nonselective phosphodiesterase inhibitor, + nonselective adenosine receptor antagonist,[12] antagonizing A1, A2, and A3 receptors almost equally, which explains many of its cardiac effects)
what is Hydralazine?arteriodilator (direct-acting smooth muscle relaxant)
what is enalapril?Arteriodilator (angiotensin-converting-enzyme (ACE) inhibitor)
what is amlodipine?arteriodilator (Ca channel blocker that works in the periphery and not in the heart so it's good for dec afterload)
if there is ER CHF because it's a cat with HCM, what are the two classes of drugs you want to use in this case?Beta blockers and Ca++ channel blockers
if an animal has chronic CHF, what should you tell owners their activity level should be like?Regular mild to moderate activity. Not strenuous exercise, not bursts
three things you can do with the chronic CHF sufferers diet?SALT RESTRICTION! L-carnitine (amino acid), Taurine (cats without taurine are gonna have heart problems)
3 diuretics you can use to help with chronic CHF?Furosemide, spironolactone, thiazides
what should dose of Furosemide be like for CHRONIC CHF?lowest dose necessary
what is a pro and a con of using Spironolactone as a tx for chronic CHF?PRO: it is an Aldosterone antagonist so it also helps keep Na+ lower which we want. CON: must watch K+ levels!!! it is K sparing (the drug is a aldosterone receptor antagonist. Since aldosterone absorbs Na and gets rid of K, this drug has the opposite effect- monitor for inc levels of K+/ bradycardia/ etc)
what should you keep in mind if you want to use thiazide diuretics to manage chronic CHF? DO NOT USE THIAZIDES WITH RENAL DZ! (work by inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys by blocking the thiazide-sensitive Na+-Cl− symporter)
ACE Inhibitors can be used to manage chronic CHF. What are two drugs in this class, and how do they help with CHF? caution of using these?Enalapril, benazepril--> they are used Mainly for neuroendocrine modulating effects (IE shut down the RAAS) but also work as arteriodilators. Caution in renal failure!
you should never combine vasodilators with...VENOdilators (lol way too much blood pooling in systemic circulation)
what are two vasodilators you can use to tx chronic CHF?Hydralazine (arterial effects), Amlodipine (Ca++ channel blocker)
what are two positive inotropes you can use to treat chronic CHF?(1) pimobendan (2) digoxin
***what kinda drug is pimobendan, how does it work?It's an INODILATOR (inc inotropy and dilates arteries), works by inhibiting phosphodiesterase III
What kinda drug is digoxin, how does it work?works by being a Na+/K+ ATPase inhibitor. This causes Ca++ to inc too. Inc inotropy! Also anti- and pro- arrhythmic (slows AV node conduction- so, dec SUPRAventricular arrhythmia, but might cause vent. bradyarrhythmia)
*what condition must you be cautious of using beta blockers with?Caution with myocardial failure (if big dilated heart that isnt contracing much-- bb isnt choice drug for this situation )
what do beta blockers do?slow down the heart rate (B1 is associated with the heart)
Beta blockers can be used for tx of chronic CHF. which conditions are they good to use in? Bad?Caution with myocardial failure! Can use for HCM, arrhythmias (Atrial fibrillation, arrhythmogenic right vent cardiomyopathy aka boxer cardiomyopathy). It also might be good for remodelling (it might slow remodeling of heart)
amlodipine vs Diltiazemamlodipine is her fav antihypertensive bc it is a peripherally acting Ca++ channel blocker which causes vasodilation. Diltiazem is a centrally (at the heart) acting Ca++ channel blocker (block Ca --> slow HR)

Feline heart dzs: HCM

Question Answer
6 primary types of feline heart dzs*Hypertrophic cardiomyopathy, Restrictive Cardiomyopathy, Dilated Cardiomyopathy (rare), Congenital, Ventricular Septal Defects (VSD), Valve malformations
3 secondary types of feline heart dzsThyrotoxic Cardiomyopathy, Systemic hypertension, Anemia (inc O2 demand)
explain what thyrotoxic cardiomyopathy ishyperthyroid cat--> inc metabolism, inc O2 demand and hypertension add in to make changes to the heart. might look like HCM...they look the same. how to tell them apart? dx with hyperthyroidism, tx that, if it gets better you know it was that
super nice to look at pic showing the diff kinds of heart changes that can happen with dzs
what is going on in restrictive cardiomyopathy?can look like a normal heart form rads and echo...but have a lot of fibrous tissue or changes to myocardium, which makes it very stiff
who tends to get Idiopathic left ventricular hypertrophy (HCM)? why?(usually starts on L hence the L thing) GENETIC link. prone breeds are: maine coon, rag dolls, persians, american short hair
where do you best hear a HCM murmur, and how would you describe it?Systolic murmur that is best heard at the sternum. Also sounds like a "gallop rhythem" which sounds like a 4 beat gallop.
what kinda CHF do cats with HCM get?Left/biventricular CHF
what kinda heart failure (what phase) do HCM cats get?diastolic failure (can't relax enough bc too much mm)
what is "SAM" and how does it relate to HCM?systolic anterior motion of mitral valve leaflet.. basically the valve blows backwards leading to outflow obstruction (mitral valve sucked into outflow, harder for L vent to get blood out, dec CO )
explain why HCM cats get aortic thromboembolisms (ATEs) and where those embolisms usually end upit's common in HCM cats that blood gets out of the aorta, blow though the mitral valve backwards, which leads to L atrium getting volume overloaded, which causes it to get big. Once it's large, blood kinda hangs out in there (blood stasis), and can start to clot. If the clot breaks free, it goes L vent-->aorta-->aortic bifurcation (where it bifurcates into the iliac arteries)-- > saddle thrombus.
which type of fibrillation can happen with HCM?atrial
there is usually idiopathic left vent. hypertrophy with HCM. Explain complications that happen with thisIt leads to higher LA (left atrium) and PV (pulmonary vein) pressures as the ventricle squeezes and blows blood backwards. This leads to Progressive LA (left atrium) dilation, pulmonary congestion and edema. THIS makes thrombus formation possible, as well as SAM (systolic anterior motion of valve, specifically mitral valve) and dynamic outflow obstruction. This stretching and damage can also lead to atrial fibrillation.
what is atenolol, how does it help HCM?It is a ***beta-blocker (she said cats with HCM should def be on a b-blocker) which helps slow HR down (because they are tachy but not enough BP due to limited SV bc thick walls of LV)
so you get a cat that comes in for the first time with HCM. what three drugs would you consider immediately putting them on?A beta blocker (atenolol- control the rate), a Ca++ channel blocker (diltiazem- also help control the rate and help with bp) and an ACE inhibitor (benazepril- help with BP more)
what is Diltiazem, how does it help HCM?Ca++ channel blocker. She said consider if they need it or if they have an arrhythmia (remember a-fib for HCM, might also help with rate control with the beta blocker) (used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. It relaxes the smooth muscles in the walls of arteries, which opens (dilates) the arteries, allows blood to flow more easily, and lowers blood pressure. Additionally, it lowers blood pressure by acting on the heart itself to reduce the rate, strength, and conduction speed of each beat.)
when you are using echo to measure a HCM cat, what measurements do you want to take?Left atrial to aortic ratio lets us assess if we are at risk for throwing a thrombus and what we should do about it. So measure diameter of aorta, and diameter of left atrium--> they Should be 1:1 or 1:1.5. The pic here shows that the left atrium is WAY too big (remember you can tell that the aorta is the aorta bc its the only perfectly round thing) (also the "smokey" looking part that swirls like smoke in real time is turbulent blood flow) (also Can look at Left ventricular internal diameter in diastole, Left ventricular internal diameter in systole and then compare to what should be normal for the size of the animal youre assessing.)
what is benazepril, how does it help HCM?ACE inhibitor. helps with hypertension and CHF
if they are not hypertensive but are tachycardic...put them on what?atenolol (beta blocker)
if you have a cat with HCM that is in CHF, you tx for CHF. How would you do this?Furosemide (diuretic), if ER, provide O2. And this is a CAT, so with CHF the fluid can be in BOTH places: (1) pulmonary edema from L sided backwards heart failure (2) plural effusion (bc cats). <---so might consider thoracocentesis with this and cats
HCM cats have blood stasis in L atrium due to backwards blood flow and L atrium enlargement. What drugs can you give to help prevent thrombus formation?Can try aspirin (super cheap) try the lowest dose you can. (remember that aspirin inhibits platelets till platelet is dead). Or clopidogrel(Plavix©) ((which helps with platelets but doesnt mess with the COX pathways)
what are the major 5 goals of tx of HCM?enhance ventricular filling, relieve congestion, control arrhythmias, minimize ischemia, prevent TBE

Feline heart dzs: Restrictive Cardiomyopathy (RCM) + Peritoneopericardial Diaphragmatic Hernia

Question Answer
why does RCM happen?idiopathic
what is happening in RCM?Left ventricular endomyocardial fibrosis
WHO tends to get RCM?Middle aged to older cats
what does the murmur sound like with RCM?there will be a Systolic murmur heard best at the sternum. they can also have a gallop rhythem. -- this is the same as HCM
how can you tell a HCM murmur from a RCM murmur?both are systolic murmurs best heard at sternum with a possible gallop rhythm. So you will need to do an ECHO to differentiate-- RCM will NOT have a large heart like HCM, but it will be moving abnormally
what kinda CHF can RCM cats get?left or biventricular CHF
what is ATE? how is it relevant to RCM?aortic thromboembolism. improper movement of ventricles--> turbulence--> inc chances of thrombi which would follow path to aorta since they are in L heart
what kinda arrhythmias do RCM cat get?Ventricular arrhythmias (HCM gets atrial fibrillation)
Peritoneopericardial Diaphragmatic Hernia are from a defect in what?septum transversum (IT IS CONGENITAL!) (The septum transversum is a thick mass of cranial mesenchyme, formed in the embryo, that gives rise to parts of the thoracic diaphragm and the ventral mesentery of the foregut )
which cats are prone to PPDH? when do you usually see it?Can present late in life or be an incidental finding. DLH, Persians, Himalayans prone.
which dogs are prone to PPDH?Weimeraners

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