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Cardiology Basics
- 1. CARDIOLOGY BASICS: AT THEHEART OF THE MATTER Jason M . Chin, DVM Oradell Animal Hospital
- 2. Why is theheart so important? It pumps blood to organs to provide: Oxygen Nutrients Removes waste (biproducts of metabolism) Provides means for signaling/communication
- 3. Perfusion Determined byCardiac Output: CO = SV x HR SV = Preload x Contractility Afterload Why are these important to think about?
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- 6. A & P– Electrical Conduction Basic Pathway: SA node to AV node to Bundle of His/Purkinje fibers (ventricles)
- 7. A & P– Electrical Conduction Systole: The ‘active’, contraction phase of the heart cycle Diastole: The ‘relaxed’, filling phase of the heart cycle
- 8. A & P– Electrical Conduction
- 9. The Physical Exam History: As important as any physical parameter Syncope Exercise intolerance Difficulty/Labored breathing Weight loss (cachexia) Observation: What does your patient look like? Dyspnea Coughing Weak Abduction of elbows/Extended head Cheek puffing/Open mouth breathing
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- 12. PE – VitalParameters http://www.cvmbs.colostate.edu/clinsci/wing/fir staid/vital.htm Dog Cat Heart Rate 70-160 bpm 160-240 bpm Respiratory Rate 10-30 bpm 20-30 bpm Temperature 100.0 – 102.5 F 100.0 – 102.5 F
- 13. PE – VitalParameters Pulses Strong and Synchronous Mucus Membranes Pink and Moist CRT < 2s
- 14. PE - Auscultation Cardiac: Murmurs Arrhythmias Pulmonary: Crackles (rales) Wheezes (rhonchi) r/o Upper Airway (referred)
- 15. Murmurs How doyou describe a murmur? Intensity (Grade 1-6) Location (PMI – point of maximal intensity; right/left/sternal, apical/basilar) Timing (Systolic v. Diastolic v. Continuous) Pitch/Frequency (high/med/low, musical/harsh) Shape (plateau v. decrescendo v. crescendo- decrescendo)
- 16. Murmurs Grading System:Freeman and Levine I/VI – Very focal; faint II/VI – Faint, but more easily heard than a grade I III/VI – Moderately loud and easily heard (over larger area on same side) IV/VI – Loud murmur heard over large area including the opposite side (discern between 2 murmurs) V/VI – Palpable thrill over PMI VI/VI – Audible with stethoscope off of body wall
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- 18. Murmurs Some Causes… Valve insufficiency/regurgitation (Chronic Valve Disease) Valve stenosis Septal defects Anemia (physiologic murmur)
- 19. Lung Sounds Location ofsounds is important to note… Normal bronchovesicular sounds Crackles (rales) Wheezes (rhonchi) r/o stridor & stertor (upper airway)
- 20. Arrhythmias Causes ofarrhythmias: Primary conduction disturbance SA Node, AV Node, fibers (blocks) Secondary to heart disease Enlarged heart (dilated, thicker, etc) Secondary to systemic illness Endocarditis, GDV, splenic disease, hyperthyroid, pheochromocytoma, anemia Secondary to electrolyte imbalances Potassium, Calcium, Sodium Secondary to toxin/drug ingestion
- 21. Arrhythmias Sinus rhythm(normal) Respiratory sinus arrhythmia (normal) Faster on inspiration – vagal tone is inhibited Tachyarrhythmia SVT, V-Tach/AIVR, A-Fib Bradyarrhythmia AV Blocks, Sick Sinus Syndrome, SA disease, escape rhythms Premature Beats APC v. VPC Gallop Rhythm
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- 23. Arrhythmias VPC’s, (VentricularPremature Contractions)
- 24. Arrythmias V-Tach (VentricularTachycardia)
- 25. Arrhythmias APC’s (AtrialPremature Contractions)
- 26. Arrhythmias AV Block(1st Degree & High Grade 2nd Degree)
- 27. Arrhythmias A-Fib (AtrialFibrillation)
- 28. Gallop Rhythm Gallop(S3 sound)
- 29. Types of CardiacDisease Congential Defects (ASD/VSD, PDA, Tetrology of Fallot) Endocardiosis/Chronic Valve Disease (insufficiency) Valvular Stenosis (congenital v. acquired) Dilated Cardiomyopathy (dogs) Hypertrophic Cardiomyopathy (cats) Pulmonary Hypertension Systemic Hypertension (primary v. secondary)
- 30. Pathophysiology of Disease Abnormal blood flow (can be d/t arrhythmia, cardiomyopathy, etc) decreased perfusion Stimulates RAAS (Renin-Angiotensin- Aldosterone System) Hormones increase preload, vascular tone, and affect heart myocytes Structural changes ensue: Eccentric hypertrophy Concentric hypertrophy Chamber dilation
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- 32. Congestive Heart Failure(CHF) Left sided Dyspnea Pulmonary Edema Nasal fluid/discharge Right sided Dyspnea Ascites Jugular Pulses
- 33. CHF Chest rads(needed for diagnosis)
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- 35. CHF Treatment: OxygenTherapy Lasix (furosemide) 2mg/kg IM or IV (dog) 1mg/kg IM or IV (cat) Nitroprusside CRI Sedation (Torb – beware Ace and Dexdomitor)
- 36. Atrial Thromboembolism aka“Saddle Thrombus” - Cats!! Gallop rhythm, often underlying heart disease like HCM/RCM/HOCM Due to hypercoagulable blood in chambers (pooling) Hind end paralysis (bilateral > unilateral), usually deep pain negative Cold limbs, cyanotic pads Painful!!
- 37. ATE Negative PrognosticIndicators: Decreased Temperature, HR Bilateral (versus unilateral) In CHF Treatment: Pain management (hydromorphone, fentanyl) Oxygen therapy Lasix (if in CHF – 1mg/kg) +/- Thrombolytic therapy (aspirin, clopidogrel, heparin)
- 38. What does itall mean?? Do we have lung disease or is it something else? Primary v. secondary diseases (asthma/pneumonia v. non-cardiogenic pulm edema/pleural effusion/pericardial effusion v. CHF) Is cardiac disease the underlying cause? What diagnostics and treatments are
- 39. “We’ve got acode 1 trouble breathing…”
- 40. References Braunwald, E. HeartDisease: A Textbook of Cardiovascular Medicine – 5th Ed. Philadelphia: W.B. Saunders Co., 1997 Fox, Sisson, Moise. Textbook of Canine and Feline Cardiology: Principles and Clinical Practice – 2nd Ed. Philadelphia: W.B. Saunders Co., 1999. Drobatz, J.K. Emergency Management of Respiratory Distress. In: Proceedings of the District of Columbia Academy of Veterinary Medicine; 2004.
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