Small Ani. Med 2- Cardio 7

wilsbach's version from 2016-02-04 19:56

Congenital: Patent Ductus Arteriosis, Ventricular Septal Defect

Question Answer
what is this asshole reduviid/kissing bug that carries chagas (looks like DCM)
what happens that results in PDA?Failure of ductus arteriosis to close-- Should occur within hours of birth
in a PDA, which way is the blood moving?L to R shunt bc L has higher pressure, which happens continuously throughout the cardiac cycle
is PDA a pressure or volume overload?Volume overload of pulmonary circulation, LA and LV. Can have pressure overload of RV
if a PDA is super chronic, what can happen?↑ pulmonary artery pressures can cause reversal of shunt (go R to L because RV gets pressure overloaded and gets hypertrophic to compensate)
who is the poster child for PDA? is there a gender bias? what other breeds are prone?FEMALE MALTESE are the MOST prone.. Pom, Shelties, Springers, Keeshonds, Bichon, Poodles, Yorkies, Cockers, GSD, Chihuahua also prone
what is the murmur of a PDA like? (systolic? diastolic? heard best where?)Continuous left basilar murmur
how would you describe the pulse quality in a dog with a PDA? Why is this so?Hyperkinetic/bounding/water-hammer pulses. bounding pulses-- vol down in diastole and pressure too. so then systolic is very high. so then the difference between systolic and diastolic= what you should feel for the pulse
how does PDA appear on rads?Enlarged LV and LA, Overcirculated pulmonary vessels, Ductus Bump (where there is turbulent flow you will see a dilation. )
what will overcirculation (due to PDA) look like on rads?the pulmonary A and V will be dilated but bronchus should be same side..... remember the Artery-bronchus-vein relationship, (ORDER: ABV) where – Veins are “ventral and central” to bronchus
what does it mean if just the veins in the rad are dilated? veins AND arteries?if arteries AND veins, it is PDA. If it is JUST the veins, it is L sided backwards heart failure
wuts dis? this is the "ductus bump" you see with PDAs which is a dilation due to turbulent flow around the ductus
what is prog w/o tx for PDA?Without treatment 50% will die within a year
what are some things you can do to treat a PDA? (2)can put in a Transcatheter (which are things like coils or Amplatz ductal occluder) OR you can surgically ligate
what is the problem with trying to fix a reversed PDA, regardless of if it's a transcatheter or surgical ligation?if put coil in after all those changes- r side is hypertrophic from chronic high pressure, and all blood under all that pressure, go into lungs, blow up vessels in the lungs from sudden severe pulmonary hypertension
she said if you hear "Eisenmenger’s physiology" you should think..PDA (Eisenmenger's syndrome (or ES, Eisenmenger's reaction or tardive cyanosis) is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect (typically by a ventricular septal defect, atrial septal defect, or less commonly, patent ductus arteriosus) causes pulmonary hypertension[)
what are some things you will see if you have a reversed PDA?pulmonary hypertension, Eisenmenger’s physiology, RV enlargement, Hypoxemia, Differential cyanosis
what is Differential cyanosis?aka "blue butt" this is where the head/front of the body is pink and the behind is blue, this happens due to reverse PDAs (instead of L to R the blood is shunting R to L meaning deox blood is going to the body)
WHO GETS Ventricular Septal Defect most often?CATS>dogs
which part of the septum is most often affected by VSD?membranous part
what is the murmur for VSD like? which side? systolic or diastolic? where is it best heard?Systolic HOLOSYSTOLIC plateau murmur loudest on **right side --bc thats where the turbulence is-- hits the R wall so hear it there. . Keep in mind that if TINY hole, can make a BIG noise. if big noise, might have less turbulence
is VSD a pressure or volume overload?Volume overload in RVO (outflow), Pulmonary circulation, LA, LV
what heart problems can occur 2* to VSD?Can create a functional PS with concurrent Left sided murmur
how can you dx VSD?Echocardiography (examine MANY planes to find)
prog of a small VSD?Normal life span, some can close within 2 years of age
to tx VSD you should manage what things?Manage CHF, arrhythmias, and BP (amlodipine which is a peripheral vasodilator which works via Ca++ channel blocking)
what are two possible permanent fixes for a VSD, what are the things you must consider for each?(1) Occlusion devices: if you can get it there and it fits and holds its good, but if in membranous portion, the occluder won't be able to hold onto anything (2) Pulmonary banding: she doesn't think anyone does this anymore. Used to put band around pulm artery-->which inc R sided pressure so then the blood is less likely to try to flow from the L to the R side

Congenital: Atrial Septal Defects, Mitral Dysplasia, Tricuspid Dysplasia, Tetrology of Fallot (TOF)

Question Answer
Atrial Septal Defects usually are defects of what in DOGS?Fossa ovalis/ostium secundum defects
Atrial Septal Defects usually are defects of what in CATS?Ostium primum/endocardial cushion defects
what weird murmur is associated with ASD? how would you describe the sound?hearing a Split S2 is possible. S1 is lub (tricuspid and mitral closing) dub is aortic and pulmonic closing at same time. so if separated out when pulmonic/aortic valve closes just a littleeee late, then you hear "lub-d-dub"
if ASD is severe, what changes to the heart structure might you see?If severe can see signs of RA or RV enlargement
which breeds are prone to mitral dysplasia? WHO IS THE POSTER CHILD? is there a gender predilection?BULL TERRIERS and esp MALE BULL TERRIERS. Also prone are: GSD, Danes, Goldens, Newfies, Mastiff, Rottweilers, cats
in what way is the mitral valve dysplastic, in mitral dysplasia?Shortened or elongate chordae, or cusp attachment
what are CS like for MD?CS similar to DVD except younger (degenerative valve dz) -- Regurgitation and stenosis possible
would you want to do a valve replacement in a MD dog?lol considering we cant get them to live through the procedures, prolly not
who is prone to Tricuspid Dysplasia? poster child? is there a gender discrepancy?Labrador Retriever, GSD, Boxer, Weimaraner, Danes, OESD, Goldens (goldens was the pic on the slide...not sure if that means poster child or not) and MALES are more prone. she seemed to emphasize that this was a PUPPY disease
in Tricuspid Dysplasia, which parts are dysplastic in what ways?Displaced valve/leaflet ("Epstein-like anomaly")
what are the chronic heart changes which result from TD?Right heart enlargement, R CHF
prog for TD?Prognosis is guarded to poor (depends on severity)
WHO are the 2 most prone to Tetrology of Fallot (TOF)?Keeshonds, English Bulldogs
what are the 4 parts of the tetrology of fallot?(1) Ventricular septal defect (2) pulmonary stenosis (valvular or infundibular) (3) Overriding (dextropositioned) aorta (4) RV hypertrophy
common CS of TOF?Exertional weakness, Dyspnea, Syncope, Cyanosis—can occur at rest
what is the murmur you hear in a TOF? is there any variation on that?Holosystolic right sternal murmur (VSD) or.. Systolic ejection murmur at left base (PS)
Why might a TOF pt have polycythemia?Due to the many heart defects, they often are chronically hypoxemic. This leads to an absolute polycythemia (ie poly due to inc number of cells not a loss of fluid or something) and you must consider hyperviscosity syndrome
what will TOF look like on rads?Underperfused lungs/reduced pulmonary vasculature, RV hypertrophy
what will TOF look like on echocardiography?you can directly visualize the defects, and can use doppler to assess flow
gold standard assessment of heart is using...MRI
3 main points of tx for TOF?(1) medical (manage?) CHF (2) Periodic phlebotomy (for the polycythemia) (3) Hydroxyurea (an antineoplastic drug used in myeloproliferative disorders, specifically polycythemia vera and essential thrombocythemia)
whar are the two surgical options for treating TOF?(1) open heart sx (bypass necessary) (2) Anastamoses (Subclavian artery to make a window between aorta and pulmonary artery)

Electrical Abnormalities: intro, general

Question Answer
So arrhythmia consequences can go from no consequences all the way to sudden death. What other heart problem/factor which interplays/ causes arrhythmias causes arrhythmias to be more often associated with death? which situations lead to an arrhythmia which will usually resolve?DEATH: cardiomyopathy. RESOLVE: Thoracic trauma and splenic disease (apparently there is a relationship between splenic dz and vent. arrhythmias)
arrhythmias might compromise what functions of the heart?(1) CO (if they are consistent and debilitating enough, things like dropped beats where the heart wont pump) (2) coronary perfusion (remember coronary vessels perfused during diastole, if the heart is freaking out with arrhythmia, its not being perfused much) (3) Rapid Ventricular tachycardia can lead to myocardial failure
Arrhythmias can be caused by Structural or pathophysiologic remodeling, leading to what 2 kinda problems?Conduction abnormalities, Automaticity errors (ie automatically doign stuff by itself)
5 things which might contribute or cause arrhythmias? (general list)(1) Structural or pathophysiologic remodeling (2) Genetic factors (3) environmental stresses (4) ischemia (5) Modulated by neuroendocrine factors
explain why you have a delayed or off kilter response with a unilateral bundle block, and what affect does this have on the ECG? .. During Left Bundle Branch Block there is a lesion along the left bundle branch which prevents normal conduction down to the left ventricle. As a result, the right ventricle depolarizes normally and then its wave of depolarization spreads to the left ventricle. Therefore, the depolarization of the ventricles during bundle branch block takes longer to occur, resulting in wider QRS complexes. Also you see a notch in the radiograph ("a hitch in the giddyup")
what are predisposing factors for arrhythmias?basically living is a predisposition. To list a few.... Endocardiosis, DCM/HCM/RCM, Neoplasia, Congenital malformation, Accessory conduction pathways, Myocardial fibrosis, ↑ sympathetic tone, Ischemia, Myocarditis/pericarditis, Trauma—24-48 hours, HWD, drugs, concurrent dzs (Thyroid, splenic, GDV, HSA), electrolyte imbalances, hypoxia, shock...
what does hyperkalemia look like on an ECG?loss of P, tented T
(read over) 5 categories of electrical abnormalities in the heart?(1) Sick Sinus Syndrome (2) Arrythmogenic Right Ventricular Cardiomyopathy (3) Atrial arrhythmias (4) Atrio-ventricular blocks (5) Ventricular arrhythmias
3 broad categories of atrial arrhythmias?Premature complexes (APC), Fibrillation, Stand still
2 main kinds of vent. arrhythmias?ventricular premature complexes (VPCs) and tachycardia
what is the main goal of tx of arrhythmias?Maintain/improve hemodynamic stability (do they have enough CO/ good QOL ?)
whats the monitor they use to look for electrical anomalies over a period of time?holter monitor (it's an even monitor if owner pushes button and it only records the event)
arrhythmia interpretation logic: if you have two VPCs but they look kinda different, what does this mean?prolly came from different areas of the heart...
even before you do the "five questions" to try to figure out the arrhythmia, what is the first thing you should do?try to find what is normal for the animal! then try to see how normal they are
what does the P look like in a VPC?there is no P, or at least it has nothing to do with the QRS, bc the rhythm came from the vents
where do all normal QRS's come from?AV NODE
what do you think the first (L) blue box is? second blue box? BOTH are VPCs...start with the second one: dont see a P before it, the QRS looks wide and bizarre. The first one is ALSO a VPC, but you can also see a notch implying it is a fusion beat-- ie, two diff weird beats fused together. In this case, the notch= bundle branch block AND a VPC
what should you remember about Adrenergic Receptors and how the symp or parasymp system uses them?it's not always cut and dry where symp excites and parasym relaxes. for instance, the symp system is fight or flight- you need MORE air, so SYMP will cause RELAXATION through a beta-2 receptor
which beta receptors are in the heart?B1
which beta receptors are in the blood vessels?B2
B1 receptors do what?speed things up/turn things inc contractility of heart (mostly heart stuff, bc otherwise it's alpha receptors which are the stimulatory ones) (remember, symp OR parasymp can use this receptor to stimulate things)
B2 receptors do what?slow things down/turn them off... like vasodilation of vessels, bronchial dilation (remember, symp OR parasymp can use this receptor to relax things)
"beta blockers" for the heart are blocking which type of beta receptor?B1 (bc it causes stimulation, so if you block it, you get relaxation...which is by beta blocker slows down HR)
what are the Adrenergic Receptor Actions of alpha 1, alpha 2, beta 1, beta 2, beta 3 receptors?