CAEM Pt. 2 > Cardio: Syncope > Flashcards

Cardio: Syncope Flashcards

(57 cards)

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1
Q

Syncope

A

Partial or complete loss of consciousness due to an oxygen shortage to the brain - quick collapse, quick recovery

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2
Q

Weakness

A

Loss of muscular strength - either constant or episodic

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3
Q

What is weakness often associated with in diseased animals?

A

Systemic illness

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4
Q

Is cyanosis common with weakness, and when does it occur?

A

+/- Cyanosis - more prominent after collapse

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5
Q

How do you differentiate between syncope and seizures?

A
  • BOTH = may see urination, defecation, or vocalization

- Seizures = post-ictal for a prolonged period of time

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6
Q

Differentials for syncope (16)

A

1) Decreased CO = poor systolic function, CHF, ouflow obstruction (stenosis)
2) Bradyarrhythmias = sick sinus, atrial standstill, 2nd/3rd AV block
3) Tachyarrhythmias = V-tach, V-fib, supraventricular v-tach
4) Pulmonary hypertension
5) Hypoglycemia
6) Vasovagal event
7) Embolism to the brain - air, bacteria, thrombus
8) Respiratory disease associated with hypoxia
9) Hypotension
10) Anemia

11) Metabolic = lyte abnormalities, Cushing’s, hypothyroidism
12) Neuro disease
13) Musculoskeletal disease
14) Neoplasia
15) Drugs and toxins
16) Infections

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7
Q

Sinus arrest - ECG

A

SA node’s failure to fire = results in a pause that is greater than two R-R intervals

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8
Q

Typical breeds for sick sinus syndrome

A
  • Female miniature Schnauzers
  • Westies
  • Cocker Spaniels
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9
Q

Two things required (and found) to non-definitively diagnose sick sinus syndrome

A
  • Bradyarrythmias
    1) ECG findings = sinus arrest, +/- sinus tachycardia
    2) Clinical signs = pre-syncopal ataxia and weakness + syncope
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10
Q

Helpful “definitive” diagnostic test for sick sinus syndrome

A

> Atropine response test = anticholinergic, removes any vagal tone
- Normal = see unleashed sympathetic tone and tachycardia
> SSS patients = won’t increase their HR by more than 50%

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11
Q

Treatment for sick sinus syndrome

A

Pacemaker placement

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12
Q

Typical breeds for atrial standstill

A

English Springer Spaniels - due to atrial fibrosis

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13
Q

Atrial standstill - ECG

A
  • Bradycardia = 40-60 bpm
  • Regular rhythm w/ ABSENCE OF P waves
  • Supraventricular escape rhythm (coming from near the AV node, just above the Bundle of His) = upright and narrow QRS complexes (went through the His-Purkinje)
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14
Q

Two main causes for atrial standstill

A

1) Primary atrial fibrosis - common in English Spring Spaniels
2) Hyperkalemia (common in blocked cats) = paralyzes the atria

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15
Q

Result of an atrial standstill patient with an atropine response test

A

HR will not increase like normal

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16
Q

Treatment of atrial standstill

A
  • Correct any hyperkalemia

- Pacemaker if there’s persistent atrial standstill

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17
Q

1st degree AV block - ECG

A

> Prolonged PQ interval (w/ or w/o bradycardia)

- “Lazy gatekeeper”

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18
Q

Causes of 1st degree AV block (4)

A

1) Drugs - Ex: B-blockers, Ca+ channel blockers, digoxin
2) Increased vagal tone - GI, respiratory, or neuro disease
3) Primary cardiac disease - degenerative AV changes
4) Tachycardias that shorter the PR/PQ interval

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19
Q

2nd degree AV block - ECG

A
  • Intermittent failure of the AV nodal conduction (“sleepy gatekeeper”)
  • Some P waves are conducted through to His-Purkinje fibers, some are not
    » P waves associated with QRS, and some not
    *May cause a ventricular escape complex if AV block causes significant bradycardia
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20
Q

Difference between Mobitz type I and II 2nd degree AV block on ECG

A
  • Mobitz type I = variation in PR interval w/ some loss of AV node conduction
  • Mobitz type II = fixed PR interval with some loss of AV conduction, +/- ventricular escape rhythms
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21
Q

Cause of Mobitz type I - 2nd degree AV block

A

Secondary to increases in vagal tone - drugs, respiratory or neuro disease

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22
Q

Cause of Mobitz type II - 2nd degree AV block

A

AV nodal pathology - fibrosis

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23
Q

How do we differentiate between Mobitz type I and II 2nd degree AV block?

Study These Flashcards
A

Atropine response test - AV block is usually reconciled with type I (gets rid of the vagal tone), but persists with type II

24
Q

Treatment for Mobitz Type I - 2nd degree AV block

Study These Flashcards
A

Treat the underlying cause of vagal tone - treat GI, respiratory or neural disease, stop administering drugs

25
Treatment of Mobitz Type II - 2nd degree AV block
Pacemaker if bradycardic
26
3rd degree AV block - ECG
> COMPLETE AV block - NO P waves are conducted through the AV node to the ventricles +/- Ventricular escape rhythms may be present
27
Causes of 3rd degree AV block (2)
1) AV node pathology - fibrosis, infiltrative disease, VSD's | 2) Severe drug intoxication - beta or Ca++ channel blockers, digoxin
28
Response of patients with 3rd degree AV block to the atropine response test
Increased P wave rate (SA node fires more), but no increase in the ventricular escape rate
29
Treatment for 3rd degree AV block
Pacemaker
30
Three types of tachyarrhythmias that can cause syncope
1) V-tach 2) V-fib 3) Supraventricular tachycardia
31
Treatment for v-tach
Lidocaine
32
Treatment for v-fib
Defibrillation
33
Why does pulmonary hypertension cause syncope?
Right side of the heart cannot propel enough blood to the brain, against the high pulmonary pressure = hypoxia to the brain
34
What is a vasovagal event?
Low HR and low BP secondary to a reflex (defecating, etc)
35
Diagnostic tests for a patient with suspected syncope (8)
- PE and history - ECG - Thoracic rads - Echocardiogram - Blood pressure - Blood work - CBC, chem - Heart monitor = "Reveal" - Atropine test
36
Diagnostic tests for a patient with collapsing weakness
- Metabolic work-up - Neuro exam - Myasthenia gravis titers - ECG +/- Echo - Blood pressure +/- Heart monitor
37
Diagnostic tests for a patient with suspected seizures
Neuro work up
38
Definition of heart disease
Physical or functional abnormality of a component of the cardiovascular system (mainly the heart)
39
Definition of heart failure
Physical state in which the CO is inadequate to meet the needs of organ systems for metabolism, despite adequate preload (not due to hypovolemia or dehydration) --> SHOWING clinical signs
40
What four variables play a role in determining stroke volume?
1) Systolic function = heart contractility 2) Pre-load = atrial pressure, end of diastole 3) After-load = resistance to blood leaving the heart (SVR) 4) Diastolic function = how fast and completely the heart relaxes
41
Difference between systolic and diastolic dysfunction
- Systolic = inadequate pumping, poor contractility, Ex: DCM | - Diastolic = inadequate relaxation, Ex: HCM
42
True or false - atrial pressures rise with both systolic and diastolic dysfunction
TRUE
43
Three main diagnostic techniques to differentiate heart disease from failures (and some others...)
1) History w/ more questions (Cough? Sleeping?) 2) PE 3) Thoracic radiographs 4) Echo 5) ECG 6) CBC, chem
44
Key words you may hear with heart failure (7)
- Weakness - Exercise intolerance - do they have energy to exercise - Cough - Difficulty breathing - Lethargy - Collapse, syncope - Abdominal swelling = ascites
45
Things to focus on in a PE, with a suspect cardio patient
- History, signalment - Job or purpose - Thoracic auscultation - Peripheral pulses FINISH THE WHOLE PE
46
What makes the heart sounds we auscult?
Blood stopping suddenly
47
What makes the S1 heart sound?
Blood stopping as it hits the AV valve - SYSTOLE
48
What makes the S2 heart sound?
Blood stopping as it hits the closed aortic and pulmonic valves - DIASTOLE
49
What makes the S3 heart sound?
Sudden end of rapid ventricular filling, pulling blood in from the atria - DIASTOLE
50
What makes the S4 heart sound?
Blood stopping as the atria contract, forcing it into the ventricles - DIASTOLE
51
What does a gallop rhythm indicate?
Stiff ventricles
52
What heart sounds do we normally hear in dogs?
S1 and S2
53
What heart sounds do we normally hear in cats?
S1 and S2, but it may summate into a single sound
54
What three things do we use to characterize heart murmurs?
1) Point of maximal intensity - where? 2) Loudness or grade 3) Timing - diastole, systole
55
What type of murmur is occurring if you hear the murmur while you feel a peripheral pulse?
Systolic murmur
56
What type of murmur is occurring if you hear the murmur in between heart beats?
Diastolic murmur
57
Four types of timing with heart murmurs
1) Diastolic 2) Systolic 3) Systolic-diastolic 4) Continuous
CAEM Pt. 2
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