Cardio objectives Word Scramble
|
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Question | Answer |
Heart disease | Something physically abnormal about heart. |
What is heart failure | Cardiac output is inadequate to meet organ demands despite adequate preload. |
What is systolic failure | Poor contraction |
What is diastolic failure | Poor relaxation |
What are normal heart sounds in dogs and cats | S1 and S2 |
What are abnormal heart sounds in dogs and cats | S3 and S4 |
Detection of heart dz/heart failure depends on: | History, physical exam, radiographs |
Diagnostic testing for heart dz | PE, rads, ECG, echocardiogram, lab testing (nutritional deficiencies, drug monitoring, disease) |
key words in patient's history for heart failure | Dogs: coughing, exercise intolerance, respiratory effort, syncope, weakness, abdominal swelling, fatigue. Cats: no coughing. Breathing too fast. |
Pulse deficits | Indicate pathologic arrhythmia |
Auscult AV valves | S1, ICS 3-5, left and right |
Auscult aortic/pulmonic valves | S2, ICS 2-4, left |
Gallop rhythm | Normal S1/S2 AND S3 or S4. STIFF Ventricle |
Murmurs | turbulent blood flow (pathologic OR physiologic |
PMI Left base | pulmonary valve/artery Aorta |
PMI Left apex | mitral valve |
PMI right base | radiation from left basilar murmurs |
PMI right apex | tricuspid valve |
PMI right sternal border | VSD L-to-R shunting |
Systolic heart sound | S1 .i1i. Filling |
Diastolic heart sound | S2 . 1i. Sys/Dias .i1i1i. Sudden end of ventricular filling |
What information ECG gives? | HR, rhythm, conduction pattern, chamber enlargement, myocardial ischemia, inflammation, necrosis, electrolyte abnormalities, effusions, drug toxicity, symp/parasympathetic tone |
When is an ECG indicated? | Evaluate heart dz, drugs/toxicity, arrhythmias/pulse deficits, syncope, weakness, anesthesia, electrolyte screening |
Sequence of electrical activation in the heart? | Atrial depolarization, AV node conduction, ventricular depolarization, repolarization. |
P-wave | Atrial depolarization |
PQ interval | Conduction through AV node |
QRS complex | Depolarization of ventricular myocardium |
ST segment | No electrical charge change, baseline recording |
T wave | ventricular repolarization |
ECG interpretation consists of 5 parts: | Paper speed, lead, calibration, artifact (ex. purring), normal species values |
Sinus rhythm | Upright P waves in lead II at a believable rate (<240) |
MEA | Mean Electrical Axis: usu I and aVF, subtract + from - boxes. |
Right axis deviation on MEA | RV enlargment or BBB (conduction disturbance) Same on L, L for LV |
Right atrial enlargement gives this pattern: | P-pulmonale, P wave taller than .4mV in dog, .2mV in cat. |
Left atrial enlargement gives this pattern: | P-mitrale. P wave wider than .04mV dogs and cats. |
LV enlargement | Widened QRS, enlargement or dilation |
LV hypertrophy? | Subaortic stenosis, hypertrophic cardiomyopathy, hypertension, hyperthyroid |
LV dilation? | Mitral insufficiency, L to R shunt, PDA |
RV enlargement | R axis deviation, from pulmonic stenosis, Tetr of Fallot, HW dz, lung dz with pulm hypertension. |
Ddx for wide QRS | BBB, VPC, vent escape, vent enlargement |
LBBB characteristics | P and PR normal, QRS WIDE and POSITIVE |
RBBB | P and PR normal, QRS WIDE and NEGATIVE |
Depressed ST segment ddx | myocardial ischemia, acute infarction, hyper/hypokalemia, trauma |
Elevated ST segment ddx | myocardial hypoxia, pericarditis, transmural infarction, epicardial contusion |
T wave ddx | myocardial hypoxia, hypothermia, metabolic dz, cardiac drug toxicity |
Long QT segment ddx | hypocalcemia, magnesaemia, kalemia |
Short QT interval | hypercalcemia, kalemia |
Low voltage QRS | <1 mV lead II. Pericardial effusion, pleural eff, hypothyroid, obesity Cats can have whatever size they want. |
6 ddx for arrhythmias | primary cardiac dz, sepsis, drugs/toxins, metabolic/electrolyte/neoplasia, hypoxia, high vagal tone |
Sinus arrhythmia ECG | R to R variation, bradyarrhythmic |
Wandering pacemaker ECG | Stumpy P waves, variable |
Sinus tachycardia ECG | Upright P waves, HR >160 |
Sinus bradycardia ECG | HR <60 |
Sinus arrest | Long blank stretches |
Junctional escape beat ECG | No P waves, i.e. not sinus |
Ventricular escape beat ECG | Lots of P waves, wide and bizarre QRS |
Atrial premature complex ECG | Premature P wave (depolarizing in a different direction) |
VPC ECG | Early exaggerated QRS |
Atrial tach ECG | No P wave associated with it so not BBB, supraventricular, over 240 so not sinus tach |
Atrial fib ECG | No P waves. Random, fast, supraventricular QRS normal but irregular |
Atrial flutter | occasional QRS |
VTach | w+b but so fast it's hard to see |
V fib | Worms |
1st degree AV block ECG | Prolonged AV conduction, "lazy gatekeeper" |
2nd degree AV block ECG Mobitz 1 | Some P waves get through, consistent P-R |
2nd degree AV block ECG Mobitz II | 4:3 P:R ratio (always one more P wave than QRS) |
3rd degree AV block ECG | No P waves, w/b QRS, complete AV block. |
RBBB | w/b QRS, very irregular |
LBBB | w/b QRS, somewhat regular |
Atrial standstill ECG | No P waves, supraventricular (tall and upright) |
Goals of acute CHF treatment | Relieve congestion, oxygenate, improve CO |
L CHF shows what signs | pulmonary edema, respiratory distress, anxious and hypoxic |
R CHF shows what signs | ascites, jugular vein distension, pleural effusion |
diuretics | furosemide |
vasodilators | hydralazine, nitroprusside, nitroglycerin |
sympathomimetics | pimobendan, dobutamine, |
sedation | morphine sulfate, butorphanol, acepromazine |
Treatment for dog with acute CHF | furosemide, oxygen, vasodilators (hydralazine, nitroprusside for more aggressive treatment), sympathomimetic (pimobendan, dobutamine for more severe cases) |
Treatment for cat with acute CHF | furosemide, oxygen, nitroglycerin, thoracocentesis. Dobutamine. |
Mild Chronic CHF, dog | 1. Low dose furosemide 2. ACEi 3. pimobendan |
Moderate chronic CHF, dog | 1. Mid dose furosemide 2. ACEi 3. pimobendan 4. digoxin 5. spironolactone (ALDO antagonist) |
Severe chronic CHF, dog | 1. Max furosemide 2. ACEi, pimobendan, spironolactone, digoxin 3. hydralazine (vasodilation) 4. thoracocentesis |
Refractory CHF, dog | SQ furosemide, nitroprusside, dobutamine, oxygen |
Mild Chronic CHF, cats | Low dose furosemide ACEi (enalapril, benazepril) |
Moderate chronic CHF, cats | Furosemide, ACEi pimobendan spironolactone thoracocentesis |
Severe CHF cats | Max furosemide. ACEi, spironolactone, pimobendan, thoracocentesis. |
Characteristics of supraventricular tachyarrhythmias | Narrow QRS, P waves associated with VPCs, VPC looks like normal sinus complex |
Characteristics of ventricular tachyarrhythmias | Wide QRS, fusion beats present, not associated with P waves. |
Treating supraventricular tach. | Vagal maneuvers: sinus decreases gradually, atrial abruptly. Calcium channel blockers and beta-blockers |
Calcium channel blockers | Diltiazem. To lower HR acutely. Safe with CHF. |
Beta-blockers | Atenolol, sotalol, etc. Not safe with CHF. Antiarrhythmic, negative inotrope, chronotrope, lusitrope. |
Side effects of beta-blockers: | hyperkalemia, lethargy, anorexia, bradycardia |
Chronic supravent therapy | Diltiazem, atenolol, digoxin (takes 5 days) |
Treating acute ventricular arrhythmia | lidocaine, procainamide, esmolol |
When to treat ventricular arrhythmia? | clinical signs, hemodynamic compromise, risk of sudden death |
Chronic maintenance for ventr arrhythmia | Mexiletine, sotalol, atenolol |
Treating bradyarrhythmia: when? | If syncopal, clinical signs, hemodynamic compromise |
How to treat bradyarrhythmia? | Pacemaker! |
Pulmonic stenosis: characteristics? | Left base systolic, right tricuspid (insufficency). RV enlargment, edema, jug disten, weak pulses, hepatomegaly |
aortic stenosis: characteristic murmur? | left base systolic. LV enlargement, arrhythmias, |
Pulmonic stenosis therapy? | CHF, anti arrhythmics, beta blockers. Balloon valvuloplasty, surgery. |
Aortic stenosis therapy? | CHF, anti arrhythmics, beta blockers. Balloon valvuloplasty for aortic (not subaortic) stenosis. Cardiac bypass. |
PDA PMI | Continuous L base murmur |
Mitral Insufficiency PMI | L apex murmur |
Congenital volume overload: | shunts (PDA, VSD, ASD), AV valve dysplasia (mitral in cats, both in dogs), semilunar valves |
VSD PMI | R sternal border murmur |
ASD PMI | Systolic L base murmur |
PDA rads | LA, LV enlarged. General cardiomegaly, pulm overcirculation |
VSD rads | LA, LV enlarged. L CHF. Variable R side enlargement, pulm oc |
ASD rads | RA, RV enlarged. R CHF. pulm oc |
PDA ECG | Tall R, wide P, sinus tach |
VSD ECG | often normal |
ASD ECG | +/- R axis shift. Tall P, sinus tach |
Tetralogy of Fallot | VSD, overriding aorta, pulmonic stenosis, RV hypertrophy. Central cyanosis, polycythemia, lethargy. |
Findings with endocardiosis | Enlarged LA, rounded heart, venous enlargement, mainstem bronchial compression, elevated trachea. Mitral valve most commonly affected. Hypotension, L CHF. Supraventricular arrhythmia. |
Findings with endocarditis | Staph, strep, e. coli. Sepsis, stenoses, CHF, thromboembolism, DIC etc. New Murmur plus FEVER. Ventricular arrhythmia. Heart blocks (irreversible). Culture the URINE. |
Created by:
ceres
Popular Medical sets