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215 Cards in this Set
- Front
- Back
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What change in cardiac pressure leads to marked hypertrophy?
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Higher or increased or more pressure.
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What are the three phases of hypertrophic response of the heart?
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Initial stage (hypertrophy secondary to wall stress) then compensated stage (wall stress normalized by hypertrophy with fibrous tissue laid down) and the exhaustion phase (death of cardiac myocytes/fibrosis/ventricular dilation/reduced output).
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What condition leads to the exhaustion phase of the hypertrophic response?
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The capillary density and perfusion cannot keep up the thickening wall.
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What type of hypertrophy occurs in response to increased pressure?
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Concentric hypertrophy.
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What type of hypertrophy occurs in response to volume overload?
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Eccentric hypertrophy.
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With concentric hypertrophy are the sarcomeres replicated in parallel or in series?
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In parallel.
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With eccentric hypertrophy are the sarcomeres replicated in parallel or in series?
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In series.
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Work performed by the heart related to oxygen demand is determined by wall stress and heart rate and contractility; this is the name of what principle?
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LaPlace’s law.
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What is the most common left to right shunt in the dog?
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PDA.
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From which embryonic arch does the ductus arteriosus develop?
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The left sixth.
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How many days after birth does the ductus arteriosus close?
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7-10 days.
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What is a common cause of a PDA?
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Increased amounts of elastic non-contractile fibers that have grown down from the aortic wall.
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Which ventricle is overloaded with a PDA?
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Left ventricle.
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Increased volume from the PDA causes enlargement of what three structures?
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The ascending aorta/the main pulmonary artery/ the pulmonary vasculature.
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What changes are seen in the heart with PDA?
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Dilated left atrium and eccentric hypertrophy of the left ventricle.
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Which are at greater risk of PDA: male or female?
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Female.
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What is Eisenmenger’s syndrome?
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An open PDA with pulmonary and bidirectional or right-to-left shunt.
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What is Eisenmenger’s complex?
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It’s a VSD with bidirectional or right-to-left shunt.
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What cardiac changes are seen with Eisenmenger’s syndrome?
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Right concentric ventricular hypertrophy and pulmonary hypertension.
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What three radiographic signs are pathognomonic for PDA?
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Dilation of the ascending aorta and MPA and Left atrium.
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Which direction of a septal defect causes enlargement of the pulmonary vasculature?
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Left-to-right.
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Which conditions can result in right-to-left shunt?
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Pulmonary hypertension/pulmonic stenosis/tricuspid insufficiency.
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Which breeds are predisposed to atrial septal defects?
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Boxer/ Doberman/ Samoyed.
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Atrial septal defects are usually a result of abnormal closure of which embryologic structures?
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The ostium primum and segundum.
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Defects at or near the foramen ovale are called what?
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Ostium segundum defects.
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Where do the ostium primum defects occur?
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Lower atrial septum.
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What is the cause of a patent foramen ovale?
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walls of the atria are normally formed but pushed apart by increased right atrial pressure.
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With an atrial septal defect shunting occurs during which phase of the cardiac cycle?
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Diastole.
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With an atrial septal defect what changes are seen in the right heart?
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Right atrial dilation and right ventricular hypertrophy (and pulmonary over circulation).
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With an ASD why is there usually no dilation of the left atrium?
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Even though it receives more blood it immediately shunts across.
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What is indicated if the left atrium is enlarged in the case of a ASD?
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Another defect like an endocardial cushion defect.
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Which breeds are predisposed to a VSD?
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Springer and Bulldog and Westie.
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What is the common location of a VSD?
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Upper septum- just below the aortic valve on the eft.
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During which phase of the cardiac cycle does a VSD shunt blood?
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Systole.
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T/F. Both right and left heart overload may occur with a large VSD resulting in failure on both sides.?
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True (functions like a single chamber when pressures equilibrate).
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With a VSD does the increased right ventricular volume lead to left ventricular hypertrophy?
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Yes bc of increased blood volume eventually making it to the left (according to Ettinger this is not common).
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What are the radiographic findings of a VSD?
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Left atrial dilation and pulmonary hypervascularity (with a large defect the right ventricle enlarges).
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In which condition do the aorta and pulmonary artery communicate directly?
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Aorticopulmonary septal defect (aka window).
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What is the result of an aorticopulmonary septal defect?
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Pulmonary hypertension and Eisenmenger’s Syndrome.
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What causes pulmonic insufficiency?
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Abnormal development of the valve leaflets or dilation of the annulus.
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What change does pulmonic insufficiency cause to the right ventricle?
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Right ventricular eccentric hypertrophy (MPA enlargement to accommodate extra blood).
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What is the radiographic appearance of pulmonic insufficiency?
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Enlarged right heart and pulmonary artery.
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What rare conditions can lead to aortic insufficiency?
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Quadricuspid aortic valve and idiopathic aortic dilation.
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What is the most common result of Mitral and tricuspid valve dysplasia?
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Insufficiency of the respective valve.
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In which species is tricuspid valve dysplasia usually seen?
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Cats (and also in large male dogs).
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Which breed has proven genetic basis for mitral valve dysplasia?
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Labradors (and cats of all breeds).
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What changes to the heart are seen AV valvular dysplasia?
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Corresponding atrial dilation and eccentric ventricular hypertrophy.
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What is a common pulmonary complication to mitral valve dysplasia?
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Pulmonary edema.
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What can be a common clinical sign of Tricuspid dysplasia?
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Jugular pulses.
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What is the third most common congenital heart defect in dogs?
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Pulmonic stenosis.
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Which type of pulmonic stenosis is most common?
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Vavlular.
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Which type of aortic stenosis is most common?
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Subvavlular.
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In which dog breed might there be supravalvular pulmonic stenosis?
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The Giant Schnauzer.
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Subvalvular pulmonic stenosis of Bulldogs and Boxers it actually an anomaly of which anatomic structure?
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An anomaly of the coronary artery as a single large artery wraps around the RVOT.
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What is the primary difference between type A and type B pulmonic stenosis?
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Type is important for prognosis as it describes involvement of the annulus. Type A is changes in the leaflets but no change in the annulus (can be ballooned). Type B is severe thickening of without fusion of leaflets and a hypoplastic annulus.
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With pulmonic stenosis where does dilation of the pulmonary artery occur?
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Post-stenosis.
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What other cardiac conditions are common with pulmonic stenosis?
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ASD or VSD.
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What effect does concentric hypertrophy of the right ventricle from pulmonic stenosis have on the right atrium?
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Dilation (due to increased volume).
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What are the radiographic findings of pulmonic stenosis?
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Prominent right heart and post stenotic dilation of MPA.
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What is the most common congenital heart defect in large breed dogs?
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SAS (Newfies).
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Where does subaortic stenosis occur?
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Just below the LVOT.
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What two primary effects does SAS have on the heart?
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Left ventricular concentric hypertrophy and impaired coronary artery flow (Left atrial hypertrophy secondary reduced left ventricular compliance.
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Jet lesions of the aorta in SAS predisposes the patient to what condition?
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Bacterial endocarditis.
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What is the radiographic appearance of SAS?
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Normal or big left ventricle/ loss of the cardiac waist/ widening of the mediastinum due to dilated aorta.
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What is the term for the condition in which the atrium is separated into two chambers?
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Cor triatriatrium (dexter or sinister depending on which side).
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What two dogs breeds are predisposed to Tetralogy of Fallot?
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Bulldog and Keeshound.
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What are the components of tetralogy of Fallot?
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Overriding aorta/ pulmonic stenosis/ RV hypertrophy/ VSD.
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What are the components of pentalogy of Fallot?
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Overriding aorta/ pulmonic stenosis/ RV hypertrophy/ VSD with an ASD.
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What is the appearance of the left heart in the case of tetralogy of Fallot?
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Underdeveloped due to compromised pulmonary return.
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In tetralogy of Fallot what is the primary cause of morbidity and mortality?
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Polycythemia predisposing to thrombosis and microvascular complications.
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What is the classic appearance of the cardiac silhouette with Tetralogy of Fallot?
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The boot shape (small heart with rounded right ventricular border).
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What cardiac condition can cause cyanosis?
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Tetralogy of Fallot (pentalogy)/ VSD or ASD or PDA with Eisenmenger’s/ Pulmonic atresia or Aortic atresia.
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In which congenital condition can you see severe endocardial thickening with white opaque thickening of the luminal surface?
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Endocardial fibroelastosis (Burmese and Siamese and dogs).
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Which acquired heart disease accounts for 75-80% in dogs and 75% cases of heart failure?
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Myoxmatous mitral valve degeneration.
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In which age of the dog is the incidence of myxomatous mitral valve degeneration greater than 75%?
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16 years.
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Is mitral valve endocardiosis more common in small or large breed dogs?
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Small.
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What changes occur to the valve leaflets with mitral valve degeneration?
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Thickened with ballooning/prolapse into towards the atrium.
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What is the cause of a flail valve leaflet?
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Chordae rupture.
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Mitral regurgitation leads to what changes in the left atrium?
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Dilation and increased pressure.
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Pulmonary edema develops when Left atrial pressure exceeds what level?
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20mmHg (it has to exceed pulmonary venous pressure to increase resistance).
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What percentage of the time does tricuspid valve endocardiosis occur with mitral valve disease?
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32% of the time (TVD is rare as a stand alone).
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What clinical sign is seen as a result of Left atrial dilation compressing the left main stem bronchus?
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Coughing.
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Which heart sound is strong indicator of myocardial failure?
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a Third sound (gallop).
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What are the clinical signs of end stage mitral AV degeneration?
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Pulmonary edema/ respiratory distress/ coughing/ eventual right heart failure.
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With mitral valve degeneration the left atrium can rupture causing what condition?
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Pericardial effusion and tamponade.
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What is the radiographic appearance of mitral valve degeneration?
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Left atrial dilation and mild left ventricular enlargement.
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Tricuspid insufficiency occurs most often with what other concurrent disease?
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Myxomatous mitral valve degeneration (to a lesser extent secondary to right ventricular changes and its causes).
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What are the radiographic changes associated with tricuspid insufficiency?
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Left sided enlargement as with Mitral valve disease (since the insufficiency is secondary to that most commonly).
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Which heart valves are most commonly affected by vegetative endocarditis?
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AV valves.
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Vegetative endocarditis is associated with what two other cardiac disease?
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SAS and PDA.
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What are the common organisms that commonly cause vegetative endocarditis?
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Staph/strep/ bartonella.
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What is the number one clinical sign of vegetative endocarditis?
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Lameness (fever and new heart murmur).
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What is the most common cardiomyopathy of cats?
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hypertrophic.
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What other disease is acromegaly in cats associated with?
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Hypertrophic cardiomyopathy.
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In which cat breeds is HCM a heritable condition?
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Maine Coon and Radgdoll (specific mutation).
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What is the current thought as to cause of HCM?
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Functional defect in the sarcomere leading to myocyte hypertrophy.
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Does HCM result in increased or decreased diastolic filling?
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Decreased- resulting in left atrial enlargement.
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On echocardiogram what feature is pathognomonic feature of HCMy in cats?
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Systolic anterior motion of mitral valve leaflet (may be from hypertrophy of papillary muscle).
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HCMy is the most common cause of arterial thromboembolism. What are the three components of Virchow’s triad that can lead to thrombus formation?
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Hypercoagulability. Endothelial disruption of blood flow. Blood stasis.
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What is the radiographic appearance of HCMy in a cat?
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Left atrial dilation creates valentine shaped heart.
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What is the distribution of pulmonary edema in heart failure secondary to HCMy in a cat?
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Diffuse it follows no pattern.
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Echo is diagnostic of HCMy in cats with an LV free wall and IV septal thickness greater than what at end diastole?
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6 mm.
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What are three non-HCMy causes of left ventricular concentric hypertrophy in the cat?
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Hyperthyroidism. Systemic hypertension. Acromegaly.
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Which dog breeds are predisposed to DCMy?
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Doberman Pinscher. Irish Wolfhound. Great Dane.
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DCMy has impaired systolic function and often what change is seen on ECG?
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Atrial fibrillation.
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DCMy in American Cocker Spaniels have what dietary association?
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Taurine deficiency.
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DCMy is typically a disease of which side of the heart?
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the Left.
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Radiographic findings of DCMy may be normal or show what changes?
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Left ventricular and left atrial enlargement with variable changes in the right side progressing to venous enlargement and pulmonary edema.
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What is the characteristic findings on echocardiogram in a dogs with DCMy?
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Decreased fraction shortening and ejection fraction combined with increased end-systolic volume.
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In the cat what are some of the differential diagnoses of DCMy?
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Taurine deficiency or volume overload and toxicities (ie Doxorubricin).
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Increased ventricular stiffness and increased diastolic filling pressures result in diastolic dysfunction are signs of what condition in the cat?
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Restrictive CMy.
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What are the radiographic findings of restrictive CMy in the cat?
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Enlarged heart with CHF and pleural effusion is common.
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In a cat significant atrial dilation with normal systolic function and normal left ventricular wall thickness and no AV valve dysfunction is the definition of what condition?
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Unclassified CMy.
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In which breed is arrhythmogenic right ventricular CMy?
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The Boxer.
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What acquired heart condition demonstrates myocardial necrosis and degeneration and inflammation?
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Myocarditis.
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What is the role of taurine in the myocardium?
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Involved in modulation of contractility and metabolic regulation.
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Commonly when is a congenital heart disease diagnosed?
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When a heart murmur is heard on a routine physical.
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What is the definition of heart failure?
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There are two definitions. 1. When abnormal cardiac function leads accumulation and retention of fluid and water. 2. When myocardial failure results in depressed cardiac contractility and loss of pump function.
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What are the causes of diastolic heart failure?
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Pericardial disease restricting filling. Decreased inflow (ie AV valve stenosis). Any myocardial disease with impaired diastolic function (HCMy or Restrictive CMy).
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How does outflow tract obstruction and thromboembolism and pulmonary hypertension cause heart failure?
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Increased resistance to ejection or increased afterload.
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What three conditions can cause heart failure from impaired ejection or volume overload?
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Myocardial disease with systolic dysfunction (DCMy). Misdirected blood flow leading to volume overload (AV valve insufficiency/l-t-r shunt). Any chronic high output state (thyrotoxicosis or chronic anemia).
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T/F. Arrhythmias or conducting disorders are another category of disease that cause heart failure.?
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True. Tachyarrhythmias or chronic bradyarrhythmias.
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What is the effect of heart failure on GFR?
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Reduce GFR and excess hormones leading to Na and water retention.
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When heart failure is gradual which system can increase drainage so there is more tolerance of filling pressures?
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Lymphatics.
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Pulmonary edema decreases oxygen saturation of blood leading to what other pulmonary conditions?
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Pulmonary vasoconstriction and hypertension (possibly right sided heart failure).
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Which species is more sensitive to a decrease in pulmonary oxygen saturation?
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The cat.
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Does pleural effusion occur more commonly with right or left heart failure?
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Most common with failure of both and rarely with isolated right and left.
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By Starling’s law an increased preload secondary to heart failure will cause what to occur?
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Increased stroke volume.
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With decreased stroke volume and decreased Aortic pressures what affect does the arterial baroreflex cause?
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Increased sympathetic activity of the heart and blood vessels and decreased parasympathetic to the blood vessels.
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What happens to the arterial baroreflex response during chronic heart failure?
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It’s reduced.
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What is the sympathetic response of the heart?
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Increases contractility therefore increasing stroke volume. Increases heart rate therefore decreasing systolic duration.
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Norepinephrine augments the RAAS system and stimulates synthesis of ADH having what effect on the kidneys?
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Diminished and redistributed renal blood flow. Reduced Na excretion and increased water retention.
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Renin is released from where in the kidneys due to decreased perfusion?
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The juxtaglomerular apparatus.
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What effect does angiotensin II have on circulation?
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Vasocontriction.
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From which organ is Aldosterone released?
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The adrenal.
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What product of the RAAS system contributes to cardiac hypertrophy?
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Reactive oxygen species (released by RAAS are responsible for the detrimental vascular and ventricular remodeling in chronic heart failure.
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Which hormone works opposite of RAAS causing systemic vasodilation and decreased peripheral resistance?
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Atrial Naturietic peptide.
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What is the function of endothelin in heart failure?
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Vasoconstriction and increased myocardial contractility and aldosterone release.
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Chronic endothelin release leads to what changes in the heart?
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Smooth muscle and myocardial hypertrophy.
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What is another name for antidiuretic hormone?
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Arginine vasopressin.
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Where is ADH produced and stored?
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Produced in the hypothalamus and sent to the posterior pituitary.
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Under what conditions is ADH released?
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Released in response to hypovolemia and increased plasma osmolality.
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What is the cause of edema in heart failure?
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Blood backing up behind the failing ventricle increases venous hydrostatic pressure and filtration of across the vessel wall.
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Vasoconstriction to maintain blood pressure in the brain and heart results in what condition of non critical organs?
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Ischemia.
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Heart failure can lead to increased permeability of the GI organs leading to what serious conditions?
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Bacteremia and septic shock.
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Why do 50% of cats have pleural effusion with heart failure?
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The visceral pleura is supplied arteries and veins. The parietal pleura is supplied by the systemic arteries and veins. |
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The visceral layer of the pericardium is also called the what?
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The epicardium.
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What is the most common cause of neoplastic pericardial effusion?
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Haemangiosarcoma.
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What neoplasm is diffuse and originates from the serosal surfaces of the thorax?
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Mesothelioma.
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Which infectious agents in cats can cause pericardial effusion?
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Corona virus (FIP).
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What percentage of pericardial effusions are idiopathic?
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20-25%.
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What are some of the physical exam findings with pericardial effusion?
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Muffled heart sounds. Jugular pulses. Weak femoral pulses. Ascites.
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What is the echo finding of cardiac tamponade?
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Right ventricular free wall collapse during diastole.
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What causes constrictive pericarditis?
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Fusion of the visceral and parietal layers of the pericardium which encases the heart in a fibrous sheet.
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Constrictive pericarditis is commonly a complication of what infection?
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Coccidiodes.
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What are the radiographic findings of restrictive pericarditis?
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Normal with a large cava.
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From which embryonic structures does the diaphragm form?
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The septum transverse
The mesoesophagus Two pleuroperitoneal folds and tissue from the body wall. |
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T/F. In animals, PPDH is never traumatic.?
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True. Because the diaphragm does not form any part of the pericardium in animals.
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What concurrent findings are also seen with PPDH?
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Sternal malformations/congenital heart defect (rare in cats)/ abdominal hernias.
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In cats what other finding indicates PPDH 90% of the time?
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Dorsal mesothelial remnant.
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Which stage of the Dirofilaria immitis live in the pulmonary artery?
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L5 and later.
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Molting of D. immitis larva require the presence of which bacteria?
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Wolbachia pipienpis.
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Which stage of D. immitis infects the host?
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L3.
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What is the length of the life cycle of D. immitis?
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6-7 months.
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What is the length of the life cycle of D. immitis in the cat?
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7-8 months.
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T/F. Cats are infected with the mature L5 heart worms.?
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False. They reject the L5s.
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How may heartworms are cats infected with?
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1-4 but never more than 10.
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What effect can the response to heartworm cause on the kidneys?
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Glomerulonephritis and proteinuria secondary formation of antigen-immunoglobulin complexes.
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Which antigen does the ELISA test detect?
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The female.
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What are the radiographic findings of Heartworm infection?
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Prominent MPA. Large tortuous pulmonary arteries. Right ventricular enlargement.
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Heart worm disease in the dog rarely includes obstruction of the pulmonary arteries. What occurs in the pulmonary arteries?
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Villous myointimal proliferation. Inflammation. Pulmonary hypertension. Disruption of vascular integrity. Fibrosis.
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Why does worm embolization occur in cats?
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Their arteries are smaller and they have less collateral circulation.
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Caudal vena cava enlargement as a sign of right sided heart disease occurs if the CVC: Ao ratio is what?
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Greater than 1.25 it should be considered. It is likely if the ratio is greater than 1.5.
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What is the heart worm associate respiratory disease or HARD?
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Proliferative and inflammatory lesions of the pulmonary bronchioles as well as lesions of the vasculature.
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What is the common cause of thromboembolism from dead worms in Heart worm disease?
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The adulticide treatment.
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Caval syndrome is associated with a large number of heartworms located where?
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They are in the right heart and entwined around the tricuspid apparatus.
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What are the outstanding features of caval syndrome?
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Tricuspid regurgitation. Poor cardiac output. Intravascular hemolysis (hemoglobinemia and hemoglobinuria).
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What is an ophthalmic sign of PSS in cats?
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Copper colored irises.
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What type of PSS are usually seen in small breed dogs?
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Extrahepatic and single.
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What is a common PSS in cats?
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Extrahepatic left gastric to caval.
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In which type of dogs breeds does intrahepatic shunts occur?
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Large breed.
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What are the three types of intrahepatic PSS?
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A left divisional and right divisional and central (Window).
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Acquired extrahepatic shunts are secondary to what condition?
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Portal hypertension.
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What is the normal portal vein to Ao ratio in systole?
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0.7- 1.25.
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Is portal velocity at the porta hepatis increased with intrahepatic shunts or extra hepatic shunts?
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Intrahepatic shunts (more resistance).
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What is the accuracy of ultrasound for PSS?
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94%.
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What is the most common location for hepatic AVMs?
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The hepatic artery and the portal vein.
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Most AV fistulas occur where in the body?
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Extremities.
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What is an infarct?
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Localized ischemic necrosis produced by the occlusion of arterial supply or impairment of venous drainage.
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What is the physiologic cause of ischemic event?
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Vasoactive substances that are released by the clot result in vasoconstriction and reduces collateral circulation.
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T/F. Arterial occlusion in the CNS is usually diagnosed.?
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False. It is rarely diagnosed because several arteries would need to be occluded to produce clinical signs.
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Endocarditis can produce what kind of emboli that can deleterious effects on the kidney and GI?
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A systemic shower of emboli.
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Splenic infarcts may be observed in patients with what conditions?
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A hypercoagulable state (liver disease). Kidney disease. Hyperadrenocorticism.
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Bone infarcts are occasionally seen in patients with what two neoplasias?
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Osteosarcoma and fibrosarcoma.
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What is an arterial thrombus?
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A clot in an artery.
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An infarction of an arterial bed by embolic material derived from a distant location is called what?
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Thromboembolism.
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What is a thrombosis?
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It’s where there abnormal endothelium and a clot forms in the vessel. This is very rare in animals.
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What is a common site of a thrombus in the heart?
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In the heart, it is seen in a dilated left atrium or auricle.
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What is the most common site of thrombus?
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The aortic trifurcation.
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What is the second most common site of thrombus?
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The right subclavian artery.
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What is a sign on an echocardiogram to use prophylactic anti-thrombotics?
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Spontaneous contrast (smoke) in the enlarged left atrium.
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What is a red thrombus?
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A venous thrombus of fibrin and erythrocytes formed under low flow.
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What are two common causes of venous thrombi?
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Phlebitis and trauma.
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What is lymph?
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It is interstitial fluid that is comprised of plasma that exits the capillaries and enters the tissues.
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Which body parts are excluded from the lymph system?
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Bone. Cartilage. Epithelium and CNS.
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What is the composition of chyle?
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Lymph and chylomicrons.
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Where is chyle absorbed?
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The lacteals in the small intestine.
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What is the most common cause of chylothorax?
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Idiopathic.
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What are some other categories of etiologies of chylothorax?
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Trauma. Increased or decreased lymphatic flow. Increased venous pressure.
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Which dog and cat breeds are predisposed to chylothorax?
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Shiba Inu and Afghans. Oriental cats.
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What lab values are used for a definitive diagnosis of chylothorax?
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Fluid Triglyceride is greater than serum triglyceride.
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How is chylothorax treated surgically?
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Thoracic duct ligation +/- pericardectomy.
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What is lymph edema?
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Fluid accumulation in the interstitial space from abnormal drainage.
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What is the difference between primary and secondary lymph edema?
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Primary is an abnormality of lymph vessels or nodes. Secondary is caused by a disease process- usually neoplasia causing an obstruction.
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What are two types of tumors of lymphatic capillaries?
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Lymphangioma. Lymphangiosarcoma.
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