cardio second packet

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cardio second packet
2013-10-02 21:32:56
cardio second packet

cardio second packet
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  1. valvular disorders
    • acquired AV insufficiency
    • congenital valvular disorders
  2. acquired AV insufficiency
    • endocardiosis-fibrosis
    • endocarditis- infectious
  3. congenital valvular disorders
    • aortic stenosis
    • pulmonic stenosis
  4. acquired valvular disorder etiology and pathophysiology
    • myxomatosis or fibrosis of unknown origin
    • increases in regurgitant volume dilates atria
    • failure from MI less likely prior to 8-10 years
    • makes more than females
    • small and toy breeds more commonly affected
    • necropsy review-62% MI alone, 32% MI & TI, 1% TI alone
  5. clinical signs for acquired valvular disorder
    • dependent on the level of disease present
    • mitral murmur of increasing intensity over time-intensity not estimate of severity of regurge
    • coughing, tachypnea, dyspnea, orthopnea-respiratory noise
    • exercise intolerance, weakness, syncope- evidence of decreased perfusion
    • anorexia, weight loss
    • arrhythmias, pulse deficits
  6. diagnostics for acquired valvular disease
    • radiographs
    • ultrasound
    • ECG
    • BP
    • CBC/GHP baselines
  7. treatment for acquired valvular disease
    • depends on level of disease
    • diuretics-furosemide
    • ACE inhibitors-enalapril
    • Ionotropes-digoxin
    • antiarrhythmics-digoxin, mexilitine, propranolol
    • valve replacement
    • dietary management-low sodium
  8. client education of acquired valvular disease
    • disease progresses, doesn't cure
    • follow up rechecks very important
    • meds need to be given on schedule
    • med doses may be changed or new ones added
    • medication side effects should be discussed
    • exercise altered based on the level of tolerance
    • notify of patients problems
  9. endocarditis etiology and pathophysiology
    • typically bacterial origin
    • secondary to systemic infections or bacteremia
    • tends to be large breed males (GS)
    • bacteria affect the valve and endocardium- platelets and fibrin create vegitations, interference with valve function
    • generally mitral or aortic involvement
  10. clinical signs for endocarditis
    • cardiovascular: +/- murmur per valve involved, water hammer pulses-bonding, additional signs of CHF
    • systemic: sepsis/septic shock, embolism-joint, lungs, kidneys, CNS, eyes
    • others: sudden death
  11. diagnostics for endocarditis
    • radiographs
    • U/S
    • ECG
    • CBC/GHP/UA
    • C/S- blood, urine, teeth, skin, other
  12. treatment for endocarditis
    • appropriate antibiotic support
    • IV fluid support
    • appropriate treatment of CHF
    • appropriate treatment of additional conditions
  13. client education for endocarditis
    • prognosis is poor
    • antibiotics used for min 4-6 weeks
    • +/- resolution of heart disease
  14. cardiac arrhythmias etiology and pathogenesis
    • changes in the heart- stretching of the chambers, scarring/injury of heart tissue
    • changes in other organs-splenic disease/GIV
    • changes in metabolism-hyperkalemia-urinary blockage most in cats
    • classification based on formation-sinus, atrial/supraventricular, ventricular
    • classification based on conduction-blocks and standstill
    • classification based on both formation and conduction- sick sinus syndrome,
    • WPW syndrome
    • escape rhythms - junctional, idioventricular rhythms
  15. clinical signs for cardiac arrhythmias
    vary based on the disease and rhythm
  16. diagnostics for cardiac arrhythmias
    • ECG
    • test appropriate to underlying disease
  17. treatment for cardiac arrhythmias
    • treat the underlying problem
    • treat the rhythm
  18. heart failure etiology and pathogenesis
    • myocardial dysfunction
    • valvular disease
    • pericardial disease
  19. clinical signs for heart failure
    • forward failure-signs of decreased perfusion
    • congestive/backward failure- fluid accumulation- RCHF and LCHF
    • combinations
  20. diagnostics for heart failure
    • radiology/US/ECG
    • CBC/GHP/UA
  21. treatment for heart failure
    • diuretics are the first medication in LCHF
    • ACE inhibitors
    • Ionotropes
    • Diet and exercise
  22. client education for heart failure
    though progressive, potential for good QOL (quality of life)
  23. congential disorders
    • atrial and ventricular septal defects
    • aortic stenosis
    • pulmonic stenosis
    • patent ductus arteriosis
    • persistent right aortic arch
  24. heartworm disease etiology and pathogenesis
    • infection with Dirofilaria immitis
    • myointimal  proliferation
    • lung vessel enlargement and obstruction
    • thromboembolism
  25. clinical signs for heartworm disease
    • variable per damage
    • class system
    • clients to this site
  26. classes of clinical signs for heartworm disease
    • class1- minimal to no clinical history or signs
    • class2- coughing and moderate exercise intolerance
    • class3- cachexia, RCHF, hepatomegaly, hemoptysis, respiratory signs significant
  27. diagnostics for heartworm disease
    • serologic testing (SNAP), Knott's direct- stain for microfilaria
    • radiology-vessels and parenchyma affected-check for change
    • U/S
    • CBC/GHP/UA
  28. treatment for heart disease
    • medical management
    • surgical management
    • prevention
    • stabilizing the heart
    • steroids and asprin use-tetracycline-wohlbachia
    • adulticide-immiticide
    • microfilariacide-ivermectin
  29. surgical treatment for heartworm disease
    • worm removal via jugular venotomy
    • PX extremely poor to grave
  30. prevention for heart worm disease
    • various monthly preventatives
    • some dailies still out there
  31. feline heartworm disease etiology and pathophysiology
    • same organism is the cause-life span shorter in cats-2-3 years
    • fewer worms needed to cause disease
    • worms located further into pulmonary vessels
  32. clinical signs for feline heartworm disease
    • sudden death
    • dyspnea
    • chronic cough
    • chronic vomiting
  33. diagnostics for feline heartworm disease
    • microfilaremia uncommon
    • ELISA for HW Ag most accurate
  34. treatment for feline heartworm disease
    • adulticide mortality rate as high or higher than the natural infection
    • place on preventative to counter new worms
    • wait out the worm life span
  35. client education in feline heartworm disease
    • thromboembolism can occur at any time
    • Px is good in mild to moderate infection
    • complications likely in more severe cases
    • strict post injection rest-activity restriction 4-6 for less severe, cage confinement 3 weeks for class 3
  36. hypertrophic cardiomyopathy etiology and pathophysiology
    • inappropriate concentric hypertrophy of VFW or IVS
    • primary myocardial disease
    • possible genetics- high prevalence in maine coon and persians
    • diastolic dysfunction- causes high filling pressures and increased LA, dynamic aortic outflow obstruction
    • mostly in cats, heart muscles get thick
  37. clinical signs for HCM
    • acute onset, often no past history of murmur or heart disease
    • respiratory signs-NO COUGH, dyspnea-edema or effusion, sudden death
    • heart signs- gallop rhythm, +/- murmur, weak pulses
  38. diagnostics for HCM
    • radiograph-estimate only 20% in cats
    • U/S-main diagnostics tool
    • BP
    • Thyroid levels
  39. treatment for HCM
    • acute phase-furosemide, thoracocentesis, nitroglycerin
    • chronic phase- Ca Channel blockers- diltiazem- all the muscle relax more, beta blockers-propranolol, asprin, coumarin, ACE inhibitors
  40. client education for HCM
    • prognosis is very unpredictable in feline heart disease
    • usually PX measured in months-median for CHF-92 days in one study
    • recurrence of failure
    • complication- meds, ATE for big complications
  41. feline aortic thromboembolism etiology and pathogenesis
    • severe complication of heart disease
    • thrombi lodge distally-usually aortic bifurcation, sometimes forelimbs
    • pain, paralysis/paresis, dysfunction
    • more than just vascular occlusion
  42. clinical signs for ATE
    • acute paralysis
    • yowling in pain
    • limbs involved are cold and cyanotic
    • pulses absent or weak
    • may or may not be heart abnormalities on auscultation
    • sometimes dyspnea or tachypnea
  43. diagnostics for ATE
    • PE
    • U/S to confirm type of heart disease, also to confirm heart disease, rare metastatic thrombi
  44. treatment for ATE
    • heart disease-handle carefully
    • ATE-surgical, thrombolytic
    • supportive care-pain management, heparin, +/- vasodilators, aspirin, PT
  45. client education for ATE
    • short term prognosis is poor-recovery form clot unpredictable, guideline- necrosis or recovery
    • long term prognosis is poor- recurrence of clot, poor prognosis for heart disease
  46. dilated cardiomyopathy-cats etiology and pathogenesis
    • eccentric hypertrophy or enlarged heart with thin walls
    • thinner walls weaker-low CO
    • taurine deficiency-rarely seen since 1987
    • rare familial from Siamese, Burmese and abussinian
  47. DCM-cats clinical signs
    • murmur, gallop rhythm
    • congestive heart failure- tachypnea and dyspnea
    • forward failure-low temp, cool limbs prolonged CRT, hypokinetic femoral pulses, anorexia, depression
    • occasionally ATE- absent pulses, pain and paralysis
  48. DCM-cats diagnostics
    • CBC/GHP to make sure no other problems
    • radiology-globoid heart
    • U/S- immediately diagnostic
    • pleural fluid analysis- if effusion
    • taurine levels
  49. DCM-cat treatment
    • preload enhancement-diuretics and nitro
    • afterload enhancement- ACE inhibitors- to pull fluids
    • contractility enhancement- digoxin
    • supplementation-taurine
  50. client education for DCM-cats
    • poor prognosis with aggressive care
    • rechecks for med levels, U/S important
  51. DCM-dogs etiology and pathogenesis
    • like the cat-stretched bag-reduced cardiac output, valvular insufficiency 2, arrhythmias
    • suspect genetics or inheritability-dobies, bvosers, cocker spaniels, rotties, labs
    • giant breeds:scottish deerhound, irish wolfhound, GD, st. b, afghan hound
    • carnitine and possibly taurine insufficiency- bosers, goldens, dobies, and cockers
    • male predisposition in most breeds
  52. clinical signs for DCM  in dogs
    • respiratory signs- dyspnea, tachypnea, coughing, lung sounds
    • heart signs- +/- murmurs, often soft if present, atrial fibrillation usually present, dropped pulses
    • general-ascites, abdominal distension, weakness, lethargy, weight loss, syncope
  53. diagnostics for DCM in dogs
    • radiograph
    • U/S-gold standard, Doppler floe
    • ECG
    • CBC/GHP/UA
    • nutritional levels
  54. treatment for DCM in dogs
    • mainly heart failure
    • usually a pharmacopeia of drugs
    • digoxin-ionotrope and antiarrhythmic- more on this disease than in others
    • diuretics
    • vasodilators- ACE inhibitors
    • other antiarrhythmics- maxilitine
    • supplements-carnitine or taurine
  55. client education  for DCM in dogs
    • prognosis generally poor-always fatal, avg 6-24 months post dx, dobies generally less than 6 months post dx
    • sudden death is imminent
    • multiple rechecks-drug level, U/S, rads, ECG
  56. cardiac tamponade
    • acute disease
    • trauma, atrial tears, heart based neoplasia
    • no time for compensation
    • severe ensuring shock
  57. pericardial effusion
    • chronic disease
    • neoplasia and pericarditis
    • slow accumulation allows for compensation
    • large volumes of fluid can cause RCHF
  58. physical exam finding for cardiac tamponade and pericardial effusion
    • ascites and jugular distension
    • tachycardia with weak pulses
    • muffled heart sounds
    • murmurs
    • shock with signs of increased venous pressure are keys
  59. treatment for CT/PCE
    • pericardiocentesis- right 4th to 5th intercostal space at CC junction, over the needle catheter with fenestrations
    • ultrasound guidance- acute life threatening disease is exception