Which of the following is NOT a determinant of cardiac output?
Preload
Afterload
Contractility
Heart Rate
Stroke Volume
Which of the following terms and definitions is INCORRECTLY paired?
Heart failure- a syndrome of clinical signs and associated neuroendicrine abnormalities that results from impaired emptying or filling of the heart
Heart disease- a structural or functional abnormality of the heart
Left-sided heart failure- characterized by elevations in central venous pressure that result in ascites, pleural effusion, or peripheral edema
All of these are correctly paired
Heart disease can be classified on an anatomical-pathologic basis or on the basis of pathophysiology.
Which of the following is CORRECTLY paired?
Volume overloads- diseases that decrease the diastolic volume of the heart
Pressure overloads- diseases that increase systolic load often because of a decreased resistance to ventricular emptying
Contractile dysfunction- any functional or structural disorder of the sarcomeres can result in contractile dysfunction and the syndrome known as dilated cardiomyopathy
Diastolic dysfunction- diseases that impair atrial filling
In the most general sense, the cardiovascular exam is intended to answer which of the following questions? Check all that apply.
What is the cardiac rate?
What is the cardiac rhythm?
Is the heart enlarged?
Is heart failure present?
What is the disease that has caused heart failure?
A diagnosis of left-sided heart failure is made when there is radiographic pulmonary edema and evidence of cardiac dysfunction which is usually demonstrated by radiographic heart enlargement and/or jugular distension.
What information can we get from thoracic radiographs? Check all that apply. (Hint: it isn't all of them, I promise.)
Cardiac dimensions using the vertebral heart score
Pulmonary vasculature
Concomitant diseases
Distinguishes between cardiomegaly and pericardial effusion
Chambers are easy to distinguish from each other
Which of the following is NOT part of the clinical utility of the ECG?
Arrhythmias (diagnosis and follow-up)
Conduction abnormalities
Monitoring anesthesia
Chamber enlargements
Electrolyte abnormalities
Severity of heart failure
All of the above
An ECHO can confirm the suspected diagnosis, assess cardiac dimensions better than rads, provides non-invasive evaluation of systolic and diastolic function, and evaluation of severity of stenosis or shunts.
Which of the following tests and indications are CORRECTLY paired?
Thoracic radiographs: clinical signs such as cough or dyspnea are present
ECHO: the cause of and enlarged radiographic cardiac silhouette is unclear and/or when a definitive etiologic diagnosis of heart disease is important
ECG/EKG: when the heart rate is inappropriately high, inappropriately low, or inappropriately irregular
ECHO and ECG only
Rads and ECHO only
Congenital malformations are only found in young patients.
Which of the following statements is FALSE?
Relatively mild heart disease can compromise exercise performance/tolerance in athletes. Sedentary animals don't usually have signs of exercise intolerance until cardiac disease is advanced.
Cough that persists for months or years without treatment is most often due to cardiac disease.
Tachypnea/hyperpnea/respiratory distress is a relatively consistent finding in patients with cardiogenic pulmonary edema.
When cardiac disease explains syncope, an arrhythmia often is responsible.
Patients with congenital malformations sometimes develop clinical signs including poor growth (failure to thrive).
What is the normal heart rate for dogs?
60-110
24-50
70-160
160-240
Which of the following is FALSE regarding arterial pulse?
Pulse amplitude is an important characteristic of arterial pulse. The pulse amplitude is determined by pulse pressure (the difference between systolic pressure and diastolic pressure). Pulse pressure depends on stroke volume, aortic distensibility, resistance to flow, end-diastolic volume of arteries, and heart rate.
Weak (hypokinetic) arterial pulse most often reflects a small stroke volume associated with hypovolemia or sometimes (but not usually) heart disease.
Absent arterial pulse may be related to obstruction due to thromboembloism or simply is an "artifact" such as the patient being obese.
Bounding (hyperkinetic) arterial pulse occurs only with PDA. The diastolic run-off throught the PDA contributes to the widening of the the pulse width.
Which of the following is FALSE about central venous pulse?
The jugular veins function as manometers. The degree of distension and the height of jugular pulsation reflects right atrial (and right ventricular diastolic) pressure.
It should be evaluated when the patient is standing.
The height of jugular pulsation needs to be >10 cm to suggest right heart failure, volume overload.
Edema under the chin is common in horses with right heart failure.
Which of the following is INCORRECT about mucous membranes?
CRT is not sensitive to acute decreases in CO
Pallor is due to a decrease in oxyhemoglobin. This may be associated with anemia and/or vasoconstriction.
Peripheral cyanosis may be due to lung disease or (rarely) heart defects such as Tetrology of Fallot.
Which of the following pairings of transient heart sounds and action in the heart are CORRECT? Check all that apply.
S1: AV valve closure
S1: Atrial contraction
S2: AV valve closure
S2: semilunar valve closure
S3: semilunar valve closure
S3: early diastolic filling
S4: early diastolic filling
S4: atrial contraction
Splitting sound occurs when the 2 components of S2 or S1 can be discerned with auscultation.
Which of the following are about transient systolic clicks? Select all that apply.
High frequency sound associated with mitral valve prolapse
Common in older, small breed dogs (a precursor of mitral valve regurgitation)
Audibility of S3 and/or S4
In cats (and many dogs), high heart rates mean that the 2 sounds are "summated"
Heard when atrial pressures are high and ventricle is close to its elastic limit.
A murmur is a prolonged series of vibrations that originates from the cardiovascular system. In general, murumurs arise when laminar blood flow breaks down resulting in disturbed flow.
Which of the following is TRUE of determinants of blood flow character?
Velocity is the most important. Acceleration explains almost all murmurs.
Viscosity is the most important. Anemia may explain murmurs when HCT <~17
Diameter is the most important. As blood vessels are dilated or constricted blood flow changes.
Which of the following is TRUE about murmurs?
Grade 1: a loud murmur with thrill/audible if stethoscope is lifted from chest
Grade 2: loud murmur with an associated thrill
Grade 3: murmur of intermediate intensity
Grade 4: soft murmur
Grade 5: very soft and focal
Which of the following is the timing for systolic murmur?
between S1 and S2
between S2 and S1
A continuous murmur begins during systole and persists after S2. It is also pretty much pathopneumonic for PDA.
What is/are PMI for murmurs?
Left heart base (aortic/pulmonic areas) 4th, 5th ICS
Left apex (mitral) 6th ICS
Most in cats are heard along the sternal borders
Left heart base and left apex
None of the above
Which of the following describe a regurgitant configuration?
Mid-systolic
mid-diastolic
diamond-shaped
associated with outflow tract obstruction
plateau-shaped
associated with AV valves
Innocent murmurs are typically heard in puppies, kittens, and adult horses.
