Small Ani. Med 2- Cardio 5

wilsbach's version from 2016-02-03 17:29

Pericardial dzs

Question Answer
what is a possibly congenital pericardial dz?Peritoneopericardial diaphragmatic hernia (PPDH)
what are some pericardial dzs?Pericardial Effusion, Peritoneopericardial diaphragmatic hernia (PPDH)
you might suspect pericardial dz if you see unexpected...cardiomegaly
if there is pericardial effusion, which part of the heart fails first and why?right sided congestive heart failure, because the right side has a weaker wall so it will be the first to collapse and show problems
what is tamponade?this is a PROCESS where there is impaired filling because of increased pressure (fluid build up) in the pericardial space. the right side is more susceptible to compression because it's wall is weaker than the left.
what is generally the three things to first be compressed by cardiac tamponade?R atria, R ventricle, the vena cava
the rate of accumulation of fluid in the pericardial sac can be acute or chronic. What would you see with an acute case of tamponade? how about chronic?ACUTE: reduced filling and hypotension. CHRONIC: R or biventricular CHF
what are the two things that would cause a big, round heart silhouette on rads?pericardial effusion, DCM
do you think this is an acute or chronic pericardial effusion?gotta be chronic bc if acutely happened the animal would be dead
pericardial effusion has fluid accumulation...what are the possible fluid types? how would you figure this out?GOTTA TAP THE CHEST. Can be transudate, exudate (septic vs sterile), hemorrhagic
which pericardial effusion is most common in dogs?hge
how do you dx pericardial effusion?fluid analysis via pericardiocentesis
(review)appearance, nucleated cell count, protein content, specific gravity of: PURE TRANSUDATEclear, <1500/microliter cells, <2.5g.dL protein, <1.016 SG
(review)appearance, nucleated cell count, protein content, specific gravity of: Modified transudateserosanguinous, amber. <7000/microliter NCC, >2.5g/dl protein, 1.010-1.031 SG
(review)appearance, nucleated cell count, protein content, specific gravity of: septic exudatecloudy/red/green/dark yellow, >7000/microliter NCC, >2.5g/dL protein, 1.020-1.031 SG
(review)appearance, nucleated cell count, protein content, specific gravity of: nonseptic exudateclear/red/dark yellow/ green, >7000/microliter NCC, >2.5g/dL protein, 1.017-1.031 SG
(review)appearance, nucleated cell count, protein content, specific gravity of: hemorrhagicred, variable amount of cells, >3g/dL protein, <1.013 SG
what is pulsus paradoxus?Increase pulse pressure during expiration, decrease during inspiration
if you see ascites, what's up with the heartR sided backwards heart failure
what is that weird ECG thing you only see with pericardial effusions?electrical alternans (more on this in other cards)
what the heck is going on here?This is "electrical alternans", which you ONLY SEE WITH PERICARDIAL EFFUSIONS. Notice how the peak of the QRS complex alternates how high it is, but everything else is normal..this is because the heart is floating in the sac and is swishing back and forth as it beats, which means it's moving closer and farther to the sensor picking up the electrical signal... and the distance is what determined the height of the wave
what are the 5 things you must ask yourself when looking at a ECG?Rate? Rhythem (irreg or reg)? Is there a P for every QRS / Is there a QRS for every P? Is the QRS morphology normal? Measurements?
what'd going on here in this echo?Heart is normal but should NOT have black around it like that-- pericardial effusion
what things can you do with echo if there is a suspected pericardial effusion?eval amt of fluid, location of fluid (best place to tap), if there is cardiac tamponade (look at R side first prolly), eval for masses
what are some neoplasias which might cause pericardial effusion? (read over)Hemangiosarcomas, LSA, thyroid carcinoma, Heart base masses (chemodectomas)
what agent can cause infectious pericarditis and lead to pericardial effusion?FIP
R/O list for pericardial effusions (read over)Neoplasia (Hemangiosarcomas, LSA, thyroid carcinoma, Heart base masses (chemodectomas) ), Infectious pericarditis (FIP), Pericardial abscesses, Effusive pericardial dz, Constrictive pericardial dz, Trauma, Idiopathic pericardial effusion, CVD aka chronic valve dz (said said make is degenerative valve dz) with atrial tear, CHF esp. cats
you commonly see what 3 conditions concurrently with pericardial effusion?pleural effusion, enlarged vena cava, elevated CVPs (central venous pressures)
3 reasons you might wanna perform pericardiocentesis?Relieve cardiac tamponade, Retrieve samples for analysis, obtain dx (prog)
Why not just treat pericardial effusion with furosemide and an ace inhibitor instead of pericardiocentesis….??because Cardiac tamponade causes Compression on the coronary arteries--> Thus decrease O2 to myocardium--> If you lower the BP decrease blood delivery even more….
reminder: play with three way stop cock, understand itand your own cock if you want but that's none of my business
why would you wanna put your pericardial effusion you just collected into a RED top tube?might wanna see if things clotting...if take blood out of ventricle, its gonna clot (risk of a R side draw, remember). but hemorrhagic effusion/blood in pericardium ALREADY clotted, so get blood that wont clot. so put sample in red top, to know if you did a ventriculocentesis. red top also for culture
what kinda setup would you want (what items) for a pericardiocentesis?
what size cath/what type cath for pericardiocentesis?Angiocath 14-16 G ***AND CUT SOME SIDE HOLES IN IT (not too big tho)
*what kinda monitoring should you DEF be doing if you're doing a pericardiocentesis? ***ECG AT ALL TIMES! Bc the second you touch the heart with anything, watch ECG machine-- will start thowing arrythmias- try not to touch ventricular m if you can
*****WHAT ARE THE TWO PLACES YOU CAN GO TO DO A PERICARDIOCENTESIS? (more on WHY later)(1) 6th intercostal space on LEFT side (2) 4th or 5th intercostal space on the RIGHT
***why do some people like doing the pericardiocentesis on the L side? (and which ICS again?)6th ICS-- on the left side you are Less likely to pierce or lacerate the myocardium (on the R side it's thinner and gives so it's easier to get into it, whereas the L side is thicker so you def feel if you poke it)
**why do some people like doing the pericardiocentesis on the R side? (which which ICS again?)4th or 5th ICS-- on the right side you have less of a chance of hitting the coronary artery (which lives on the L)
if you are doing a pericardiocentesis, where do you want to locally block? which structures?immediately above costochondral junction--> Try and hit pleura, intercostal musculature, and skin
pericardiocentesis--> as you advance the catheter, you should support it with your other hand. describe how you should do this/what you should feel, and what should you monitor for?Can feel it enter the pleural space--> Can feel scraping on the pericardial surface, should see flash when enter the pericardial space--> Advance catheter while removing stylet, attach syringe set up--> Drain effusion monitoring for VPC’s. *Monitor for clotting prior to removing catheter (in case you tapped the ventricle)
once you have drawn up that pericardial effusion with your super pericardiocentesis skillz, what should you submit it for?Submit fluid for analysis, cytology, and culture
4 major risks involved in pericardiocentesis?(1) HGE: Myocardium, coronary arteries, lung. (2) Arrhythmias: VPC’s from myocardial irritation (3) Infection: poor sterile technique, pericarditis, pleuritis (4) Pneumopericardium, pneumothorax
if you poke the myocardium and piss it off, what kinda arrhythmia are you gonna see?ventricular premature contractions (VPC)
if you keep doing pericardiocentesis on an idiopathic pericadial effusion, what is another option other than having to centesis it all the time? or if it's worsening?If worsening, consider subtotal pericardectomy
If what you find with pericardiocentesis is TRANSUDATE, what are the most common ddxs and why do they all cause the transudate?usually happens with Hernia, cysts, CHF, hypoproteinemia, Heart base mass.... this is often because they compress venous return!! (and hypoproteinemia obc just dec oncotic pressure of vessels)
if what you find with pericardiocentesis is EXUDATE what are the most common ddx?Perforation (foreign body), Infection: FIP—cats , nocardia, fungal— dogs
which infectious agents like to cause pericardial exudate effusion in CATS?FP
which infectious agents like to cause pericardial exudate effusion in DOGS?nocardia and fungi
what are the major ddx for a hge effusion?Idiopathic, Cardiac or Heart base tumors, Coagulopathies, trauma, atrial tears
what cardiac/heart base tumors are a likely cause of hge into pericardium?HSA (hemangiosarc), chemodectoma, ectopic thyroid, mesothelioma, lymphoma-- ESP in cats

Heartworm dz

Question Answer
what body systems is HWD actually a dz of?Pulmonary Vascular disease
what are the 2 main clinical signs of HWD?cough and exercise intolerance
what are the 4 main major complications of HWD?right sided congestive heart failure, cor pulmonale(heart dz bc of lung dz), pulmonary thromboembolism, Chronic inflammatory disease (Glomerulonephritis!)
what is Cor pulmonale?it basically means "heart dz because of lung dz"
does HWD affect preload or afterload of the heart?inc in afterload-- r heart needs to push harder to get past the worms
why the hell would HEARTWORM disease (which affects pulmonary vessels making it a lung dz, lol) have GLOM-NEPHRITIS??HWD is a chronic infectious inflammatory dz--> production of lots of complexes and shit which then block and damage the glomeruli. if you have dog with hw dz, the faster you fix it, less damage to kidneys. push owners to be more aggressive with tx bc of this
she says you gotta know the HW cycle for NAVLE...might as well start getting familiar with it now.
infective stage of HWD?L3 which goes out of the mosquito and into blood stream when mosq takes a blood meal
**what does the heart worm test (snap) test for?tests for female antigen
what should you know if you are going to test a cat for heart worm?cats: only one or two big worms, and if all male infection (more common in cats, super rare in dogs) and females are the ones that make ag, you wont detect it with the snap. So for cat you need to test for ABs!!! in cats, HW looks like asthma (bronchiolar pattern in lungs) but Abs only says exposure. but if exposed and lungs look like shit, prollllly hw
so you dx a dog with HWD...when should you start preventative? or should you not?start right at dx To kill microfilaria and prevent further infection
we should STAGE hwd...why? what do you need to stage?helps you decide treatment options and how aggressive you should be. will need RADS to stage
so you see the cat just has like this one heartworm...should you recc the owners to have it sx removed?oh HELL no. if you ever so much as KNICK the cuticle of that heartworm, that cat will go into anaphylaxis and die.
what did she say the drug of choice was for heartworm?Melarsomine (Immiticide)
what drug that is NOT an anti-parasiticidal should you give to a HW+ pt, and why? Which life cycle is ideal for this drug, and how long do you give it?give them Doxycycline, because the heartworms have a commensal bacteria called "wolbachia" which has a kinda symbiotic relationship with the HW, so if you kill the wolbachia with the doxy, the HW will be easier to tx!. She says the non-infective L3 are more susceptible (to the doxy i think). Give the doxy for 4 weeks
what is the adulticide used to tx HW, and how long do you give it?Melarsomine(Immiticide), Now recommend two month protocol
what is caval syndrome?Caval syndrome is an acute manifestation of heartworm disease that occurs in association with a large number of heartworms in the right heart that entwine around and pass through the tricuspid valve apparatus. They often present with sudden onset of severe lethargy and weakness accompanied by hemoglobinemia and hemglobinuria (worst classification of HWD- Class 4)
if a dog has caval syndrome what is the recc tx for them?sx
when should you re-check for heartworms after tx?Repeat HW Test 6 months post TX
what are the 4 preventatives you can use for HWD(1) Ivermectin—caution in collie types (2) Selamectin (3) Moxidectan (4) Milbemycin
what should you do when you get a HW dog/cat and you need to know how to tx them?YOU ALWAYS GO TO THIS WEBSITE AND CHECK THE PROTOCOL-- it's always changing. (don't mem chart but read over for an idea)