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Degenerative valve disease does NOTÂ occur in _______.
cats
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What are 3 diseases that boxers have a predilection for?
aortic stenosis, arrhythmogenic RV cardiomyopathy, chemodectoma (aortic body tumor)
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What breeds of cat have a genetic predilection for HCM? (5)
persian, ragdoll, norwegian forest cat, maine coon, sphynx
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What are signs of low cardiac output? (3)
exercise intolerance, weakness, syncope
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What are signs of CHF? (4)
signs of low cardiac output plus pulmonary edema or body cavity effusions, +/- respiratory signs
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Describe syncope and its characteristics (how you can differentiate it from seizures).
sudden loss of consciousness and postural tone; syncope is precipitated by activity or excitement and the recovery is VERY quick, may stiffen with head dorsally flexed and urinate
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What are causes syncope? (6)
arrhythmia, reflex-mediated (vasovagal), decreased CO, severe structural heart disease (limits CO), pulmonary hypertension, drugs (diuretics, vasodilators)
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Describe reflex-mediated syncope.
from inappropriate activation of cardiac baroreceptor reflex--> bradycardia + vasodilation; often precipitated by excitement (increases SNS activity)
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Superficial venous engorgement almost always means ___________.
right-sided HF
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3 drug classes that tend to lower BP.
diuretics, vasodiuretics, ACEi
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Arterial BP should be measured in cardiac patients to identify... (3)
hypertension, hypotension, monitor drug effects (diuretics, vasodilators, ACEi)
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By what method can you NOT measure arterial BP?
palpation of arterial pulse
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What is pulse pressure?
systolic pressure minus diastolic pressure (what you feel when you palpate pulse)
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What are methods to directly measure ABP? When are these methods used?
needle or catheter inserted into artery; invasive measures are useful in some anesthesia and critical care situations
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What are methods of indirectly measuring ABP? (2)
oscillometric devices (measures oscillations in artery), Doppler systems (detects blood flow through artery)
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Describe how oscillometric devices work.
small doppler crystals that detect blood flow through and artery using the doppler principal; not very accurate
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Oscillometric devices are better for measuring ___________.
high pressures than lower pressures
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Describe how Doppler flow detector methods of measuring BP work.
place a small doppler crystal over an artery (usually a distal artery)--> listen for flow going through the artery
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What are some technical aspects of using Doppler flow to measure BP?
if you use too small of a cuff, the artery won't be compressed enough and BP will be overestimated; vice versa if you use too large of a cuff
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Where are locations at which you can palpate arterial pulse? (3)
femoral triangle (SA), facial artery (horses), coccygeal artery (cows)
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The HR as calculated by stethoscope os faster than what you palpated. What does that usually mean?
arrhythmia
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What are the ranges for normal arterial BP?
140-110/ 70-90
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What factors determine pulse strength and quality? (5)
rate, rhythm, increased or decreased stroke volume, decreased diastolic BP (vasodilation, PDA, aortic regurgitation), LVOT obstruction
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Systolic BP will increase with... (2)
increased stroke volume, decreased aortic compliance (increase stiffness)
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Diastolic BP decreases with... (3)
decreased HR, decreased vascular resistance (vasodilation), abnormal diastolic runoff (PDA, AR) [same as increased pulse pressure]
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Pulse pressure increases with... (3)
decreased HR, decreased vascular resistance (vasodilation), abnormal diastolic runoff (PDA, AR) [same as decreased diastolic BP]
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Hyperkinetic pulse occurs with __(2)__.
increased SV or increased pulse pressure
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Hypokinetic pulse occurs with __(2)__.
decreased SV or obstruction
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Describe PE findings consistent with PDA. (2)
continuous heart murmur and extremely strong pulses
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So-called "weak pulse" occurs when there is a(n) ____________.
narrower pulse pressure
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Elevated jugular venous pressure is usually indicative of... (2) Less commonly... (4)
right CHF or pericardial disease; large pleural effusion, volume over-infusion (iatrogenic), cranial mediastinal or pulmonary mass (vena caval compression), cranial VC thrombosis
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Increased jugular venous pulses can be caused by... (5)
pulmonic stenosis, tricuspid regurgitation, pulmonary hypertension, an arrhythmia with atrioventricular dissociation (AV block and Vtach), right-sided CHF
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What are causes of pallor? (2)
anemia, systemic vasoconstriction (hypotension)
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What are the types of cyanosis? (3)
central (decreased pO2), peripheral (increased oxygen extraction), differential (reversed PDA)
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Give an example of peripheral cyanosis.
child in cold water with blue lips- vasoconstriction but they are not desaturated
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Describe what differential cyanosis would look like in a dog.
pink MMs in the head but the prepuce/penis is blue
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Describe how differential cyanosis occurs.
pulmonary artery pressure is equal to or higher than in the aorta--> blood goes from the pulmonary artery to the descending aorta; deoxygenated blood goes into circulation to the caudal body (the ascending aorta is not affected to the head is still getting oxygenated blood)
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__(2)__ are common consequences of systemic hypertension in dogs and cats.
Retinal hemorrhage and detachment
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Has dental disease been proven to be important as a cause of heart disease in dogs?
No
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Hyperthyroidism result in __________ of the heart because __________ is increased, _______ is activated.
hypertrophy; protein synthesis; SNS
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Thyrotoxicosis clinical consequences. (7)
LV hypertrophy, tachycardia, increased pulse, ejection murmur, gallop, HTN, and possibly CHF (if prolonged)
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What are some non-cardiac causes of edema? (4)
inflammation (vasculitis), low serum albumin, venous obstruction, and lymphatic diseases (lymphedema)
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How does bacterial (infective) endocarditis lead to peripheral vascular disease?
thrombus forms on the heart valves and dislodges
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What are causes of peripheral arterial vascular disease? (7)
aortic thrombosis, bacterial endocarditis, increased coagulation, degenerative arterioscleorsis, atherosclerosis, trauma, parasitic arteritis
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What can lead to atherosclerosis in dogs?
severe hypothyroidism and hypercholesterolemia
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If you tap the fluid from a body cavity of an animal with CHF, what will you find?
transudate or modified transudate, (abdomen0 high protein fluid, (thorax) many small lymphocytes
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Why does chyolothorax occur in cats?
impaired drainage of lymph into systemic venous circulation
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What is an example of a disease that sounds normal on auscultation but had marked abnormalities on echo?
heart muscle disease
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What 2 diseases can you almost definitively diagnose by cardiac auscultation?
PDA, mitral regurgitation
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What does diastolic dysfunction sound like on auscultation?
gallop sound
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Most heart sounds are below _________.
audible frequency
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The bell of the stethoscope is used to hear ________.
low pitched, diastolic sounds
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What and where are the valves areas in a dog?
- mitral: at and dorsal to the left apical impulse
- aortic: craniodorsal to MV, second sound is loudest
- pulmonic: one intercostal space cranioventral to aortic valve
- tricuspid: on the right, just cranial to MV
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ID heart murmurs based on their ____________.
point of maximal intensity
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Why is it so important to listen carefully on the right side of cattle?
VSD and tricuspid valve endocarditis are common in cattle
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What animals don't we use valve areas in? What do we do instead?
cats, ferrets, birds; auscult along each side of the sternum, apically, and cranially (palpate apex beat for orientation)
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What are the heart sounds, and what does each represent?
- S1: MV and TV closure
- S2: AV and PV closure
- S3: rapid ventricular filling (normal in LA only)
- S4: atrial contraction (normal in LA only)
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Why can we feel an apex beat?
during isovolumetric contraction as wall tension is developing, the heart actually twists, and as it twists, it hits the chest wall
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The apical impulse occurs during ___________.
early systole
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What does the ventricular gallop sound indicate in small animals?
S3- abnormal ventricular filling; high atrial pressure and a poorly compliant ventricle (CHF)
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What are "clicks"?
sound like gallops but occur in systole; higher pitched
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"Clicks" are abnormal heart sounds that usually result from ___________.
mitral valve prolapse (or tricuspid)
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What are the auscultation findings with atrial fibrillation?
rapid heart rate, irregular rhythm, and with variable intensity heart sounds- "tennis shoes in the dryer"; S4 is absent
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What does the atrial gallop sound indicate in small animals?
S4- abnormal ventricular relaxation and increased atrial contraction pressure (larger kick)
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Relate the following to each other in terms of timing: apical/cardiac impulse, arterial pulse, first heart sound, and second heart sound.
S1- [apex beat]- [pulse]- S2
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The pulse is palpated ___________ (timing, as observed during PE); the precordial impulse is felt at...(timing)
between S1 and S2; the onset of ejection, which is closely after S1
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What are approximate normal pulse rates of horses, cows, dogs, and cats?
- Horses- 30-40
- Cows- 60-80
- Dogs- 60-180
- Cats- 140-240
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Compare S1 and S2 with regard to timing, duration, pitch, and PMI.
- S1: timed with closure of mitral/ tricuspid valves; long sound that extends almost to the opening of the aortic valve; lower pitched than S2; PMI is low at 6th ICS
- S2: timed with close of aortic/ pulmonic valves; shorter in duration; higher pitched; PMI is high in 4th ICS
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What is the definition of cardiac murmurs?
prolonged audible vibrations heard during a normally quiet period of the cardiac cycle
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What are pathophysiologic reasons for heart murmurs?
increased velocity flow, increased SV, decreased viscosity (anemia)--> flow of high pressure to low pressure chamber
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What are the 3 most important factors when evaluating a heart murmur?
timing within the cardiac cycle (systolic, diastolic, continuous, to-and-fro), point of maximal intensity, grade (loudness on 1-6 scale)
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What heart murmurs occur during systole? (3)
aortic/pulmonic stenosis, mitral/tricuspid regurg, ventricular septal defect
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What heart murmurs occur during diastole? (1)
aortic regurgitation
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What heart murmur is continuous throughout the cardiac cycle? (1)
PDA
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What causes a vibration sound during the cardiac cycle?
function systolic murmurs- unrelated to structural heart disease (innocent)
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What is the point of maximal intensity of mitral regurgitation?
apex or mitral area
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What is the point of maximal intensity of aortic/pulmonic stenosis?
aortic/pulmonic valve systolic ejection murmurs
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Aortic regurgitation is most common in ___________ due to ___________.
horses >10 years old; valve degeneration
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What is the point of maximal intensity of PDA?
left base dorsocranial over the pulmonic artery
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What are friction rubs, and what causes them?
muffled or distant heart sounds with pericardial disease
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What is a functional heart murmur?
"Functional" heart murmurs are either physiological or innocent; musical; unrelated to structural heart disease
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Define the term "pathologic" or organic heart murmur.
occurs with structural heart disease, causing increased velocity flow, increased SV, or decreased viscosity (anemia)
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Describe the typical functional cardiac murmur in terms of timing during the cardiac cycle, PMI, and loudness.
functional murmurs usually occur between S1 and S2, closely after S1 [most common is proto-mesosystolic]; functional ejection murmurs are most often loudest over the aortic and pulmonic valves and the great vessels; usually musical or vibratory
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Contrast physiologic and innocent heart murmurs.
- Innocent: unknown cause- common in very young animals, usually gone by 6 months of age
- Physiologic: athletic heart and bradycardia (large SV); anemia, fever, hyperT4 (increased SNS and peripheral vasodilation allows inc SV); high adrenergic tone (stress or drugs)
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