bambang sektiari l. - s1.fkh.unair.ac.ids1.fkh.unair.ac.id/images/ppt/cardiovasc diseases 1.pdf ·...

Bambang Sektiari L.

Four Chambers Great Vessels One-way Valves

Left atrium - Pulmonary veins - Left atrioventricular (“Mitral”)

Left ventricle - Aorta - Aortic semilunar

Right atrium - Vena Cavae - Right atrioventricular (“Tricuspid”)

Right ventricle - Pulmonary artery - Pulmonic semilunar

Receives blood from lungs via the pulmonary

veins and then “pumps” it to left ventricle◦ pulmonary venous blood -- “oxygenated” blood

from the lungs returned to the heart

◦ low pressures

Receives blood from left atria and then

pumps it through aortic semilunar valve to

the body◦ systemic arterial blood -- “oxygenated” blood

distributed to body for use in tissue metabolism

◦ high pressures

Receives blood for body via pre & post cava,

and then “pumps” it through AV valve to right

ventricle◦ systemic venous blood -- “unoxygenated” blood &

CO2 produced by metabolism from body tissues

returned to the heart

◦ low pressures

Receives blood from right atria and then pumps

it to the lungs via the pulmonary arteries ◦ pulmonary arterial blood -- “unoxygenated” blood

to lungs for exchange of CO2 for O2

◦ moderate to lower pressures

EXTRA CARDIAC CONTROLS

CARDIAC CONTROLS

Neural :

◦ Parasympathetic cholinergic (Vagus) to SA and AV

Nodes only -- brake!

◦ Sympathetic adrenergic (Beta 1) to both Nodes and

the Myocardium -- accelerator and strength!

Temperature :

◦ Hyperthermia -- accelerates

◦ Hypothermia -- slows

Drugs :

◦ Positive and negative chronotropes (rate)

◦ Positive and negative inotropes (strength)

Supraventricular

Sinoatrial node (normal pacemaker) in right atrium

Internodal pathways (3) through right atria

Atrioventricular node (conduction delay) in fibrous base of

right atrium

-- “JUNCTION “ --

Ventricular

His Bundle (backup pacemaker) extends from fibrous base

into ventricular septum

Bundle branches (backup pacemaker) --Left bundle

(anterior & posterior fascicles) & Right bundle -- beneath

endocardium of ventricular septum

Purkinje network (backup pacemaker) within myocardium

“Junction”

Normal Cardiac Output

Increased Cardiac Output

Decreased Cardiac Output

Venous return to atria = demands for ventricular

arterial output

Atria contract (systole -- ejection) while ventricles

relax (diastole -- filling)

Ventricles contract (systole -- ejection) while atria

relax (diastole -- filling)

Systemic and pulmonary volumes of blood flow (not

the volumes within) are equal over time

Increased Demand =

Increased RATE !

Increased STROKE VOLUME (filling)!

Increased CONTRACTILITY (strength)

Decreased Demand ( at Rest)=

Decreased HEART RATE !

Decreased STROKE VOLUME (filling) !

Decreased CONTRACTILITY (strength) !

With Disease ! =

Decreased EFFECTIVE STROKE VOLUME !

Decreased CONTRACTILITY !

Possibly Decreased HEART RATE !

Usually Compensatory Increased HEART RATE !

Identify Problems :

A. Signalment

B. History

C. Physical Examination

Propose Differential Diagnoses

Diagnostic Plan :

A. Initial Data Base

B. Specific Procedures

Integrate Findings -- Diagnoses

Appropriate Treatment

Re-evaluate Patient !:

A. Response To Therapy

B. Progression Of Disease

Signalment◦ Age

◦ Breed

◦ Sex

◦ Utilization

Past History

History Present Illness

Physical Examination

Cardiogenic vs Noncardiogenic

Cough

Dyspnea

Syncope

Exercise Intolerance

Weight Loss

Lameness

General Observations :◦ Attitude & Posture

◦ Respiration Rate & Character

◦ Edema & Abdominal Distension

◦ Fever

Cardiac Examination :◦ Inspection

◦ Palpation

◦ Percussion

◦ Auscultation

Systems Review

Head -- mucous membrane color &

capillary refill time

Neck -- jugular distension or pulse

Trachea

Thorax -- point of maximum intensity (PMI) of

cardiac apex beat

Abdomen -- organomegally & ascities

Femoral (brachial, digital, etc) pulse: Rate

Character -- hypokinetic, hyperkinetic, bounding,

collapsing, “water hammer”

Synchrony with heart beat

Canine

Feline

Respiratory FIRST!

Cardiac :◦ Heart rate & rhythm

◦ Normal -- S1 and S2 sounds; ventricular mechanical

systole (AV closure to semilunar valve closure)

◦ Abnormal : Splitting of S1 and S2 sounds -- S1 with conduction delay,

S2 with increased arterial pressure

S3 and S4 sounds are abnormal -- ventricular diastole

(filling) = “gallop rhythm”

Murmurs = turbulence :

Physiologic -- anemic

Innocent -- positional or neonates (development)

Pathologic -- cardiovascular disease

“PMI” “Mitral” Pulmonic

Aortic PDA Carotids “Tricuspid”

DESCRIPTION Location of PMI -- usually valve area where heard loudest !

Timing in cardiac cycle -- systolic or diastolic (hard to tell with

rapid rates)

Duration -- early, late, holo (during), pan (throughout) & continuous

Intensity (Grade):◦ 1 = nearly imperceptible -- must listen in a quite room & be right over PMI!

◦ 2 = soft, but definite -- heard right over one area of chest (PMI)

◦ 3 = low to moderate -- heard for some distance from PMI

◦ 4 = loud -- heard throughout chest, but no palpable “thrill” on chest

◦ 5 = very loud -- heard throughout chest with a palpable “thrill” on chest wall!

◦ 6 = very loud -- “thrill” & heard with stethoscope just off chest wall

Quality :◦ Regurgitant = “plateau”

◦ Ejection = “diamond shape” or crescendo-decrescendo

◦ Machinery = varying but continuous (systole-diastole)

Congenital Causes of Cardiac Diseases

Acquired Causes of Cardiac Diseases◦ Dysrhythmia's

◦ Heartworm disease

◦ Valvular & Endocardial

◦ Myocardial diseases

◦ Pericardial diseases

Causes of Hypertension

(Cardiovascular Disease)

Initial data base

Specific procedures

(Risk/Cost vs Benefit) :

◦Noninvasive

◦ Invasive

Signalment, History & Physical

Clinical Pathology :◦ Hemogram (CBC)

◦ Serum Chemistries

◦ Urinalysis

◦ Heartworm

◦ Pleural or Peritoneal Fluid Analysis

◦ Serology & Endocrine Tests

CARDIOVASCULAR DISEASE

Cost or Risk versus Benefit

Based on Your Clinical Findings (Signs) :

Radiography

Electrocardiogram (ECG)

Ultrasound -- Echocardiography

Indirect blood pressures

Central venous pressure

Blood gases -- Arterial & Venous

Two views -- lateral and DV

Cardiac Silhouette

Lungs & Vascular structures

Pleura and Mediastinal space

Chest Wall and Diaphragm

Uses Heart & Chamber enlargements

Compensation vs decompensation

Masses & Pericardial effusions

Limitations Fluid obscures soft tissue

Good equipment -- Short exposure times

Dorsal-VentralLateral

ECG Interpretation Rate

Rhythm

Mean Electrical Axis (?)

Evaluate complexes (Lead II):◦ Amplitude of deflections or “waves” = height in

millivolts

◦ Duration of “complexes” or “intervals” = length in

milliseconds

Summarize all leads

Normal (at rest) :Small dogs 80-160 bpm

Giant breeds 60-140 bpm

Cats 80-180 bpm

Tachycardia :Dogs > 160-180 bpm

Cats > 200 bpm

Bradycardia < 60-80 bpm

HEART FAILURE

Circulation failure manifestations, The Heart can pump blood cause of decrease of myocard contraction.

CONGESTIVE HEART FAILURE Myocardial could not be keeping the cardiac out put Clinical Syndrome characterized by light output, pulmonic and vein

system congestion

Causes of CHF

Acquired Heart Diseases (valves disorder) congenital heart disease Heart worm diseases

Symptom

Left-side HF: - Cough - Dyspneu- Orthopneu - edema Pulmonum- Paroxysmal Cough

RIGHT-side HF :- venous congestion - hepatomegaly- splenomegaly - Cardiac cachexia- ascites - sub cutaneous edema - Hydrothorax – Hydropericard

Therapy

1. digitalis (digoxin, digitoxin etc.)

2. Diuretics (furosemide, spironolactone etc.)

3. Low sodium diet

4. Bronchodilators

5. Supportif drug therapy:

Antibiotics

narcotics (morphine)

phlebotomy

Abdominocentesis

Thoracocentesis

O2 therapy

Rest

SHOCKLoss of effective circulating blood volume, causing low tissue

perfusion and therefore inadequate oxygen delivery to meet the demand s of tissue metabolism.

Symptom:

- Anemia - reduced temperature

- weakness - decrease of sensoric function

- Tachycardia - Tacypnea

- CRT > 2 seconds - Oligo/anuria

Types of Shock1. Haemorrhagic shock

2. Hypovolemic shock

3. Septic shock

4. Traumatic shock

5. Neurogenic

6. Anaphylactic shock

7. Cardiogenic Shock

Therapy O2 Therapy

Fluid Therapy

Hemostat

Steroid

Antibiotics

Vasoactive Drugs

Anticoagulants

Diuretics

Warmed

PATENT DUCTUS ARTERIOSUS

failure of the ductus arteriosus to close shortly after birth and thereby allowing continued flow of blood

between the aorta and pulmonary artery.

Common breeds:

: POODLE, COLLIE DAN POMERANIAN.

DUC.ARTERIOSUS TERBUK

most cases of PDA involve blood flow from the higher pressure region (aorta) to the lower pressure region (pulmonary artery and right ventricle)

LEFT TO THE RIGHT SHUNT (SISTOLE/DIASTOLE)

Symptoms :

Usually presented at 6 - 12 weeks of age

ANAMNESIS :- Exercise intolerance - Abdominal distension- Dyspnea - Syncope- Paralise - Seizure- Cyanosis

Clinical Examination:- Water hammer pulse (JERKY Pulse)- Continuous Murmur- pulmonary hypertension

Prognosis : IN FAUSTA

Therapy : Operative

An abnormal narrowing of the pulmonary artery usually at the valvular level

Common breed : ENGLISH BULLDOG, FOX TERRIER and CHIHUAHUA.

Symptoms:◦ No symptoms◦ Dyspnea◦ Exercise intolerance◦ Right-side heart failure◦ Systolic murmur◦ Diastolic duplication◦ Abdominal distension

Therapy : Operative (Restricted activity, diet)

Narrowing of the left ventricular outflow tract of the heart

Common breed : AGJ, Boxer, New foundland and Cats.

Symptoms:

◦ Asymptomatic - Cough

◦ Panting - Congestion

◦ Syncope - Edema Pulmonum

◦ Systolic murmur

◦ Sudden death cause ventricular filbrillation

Cardiac congenital anomaly allowing communication between the

atria through a defect in the interatrial septum

Symptoms :

- None (defect is small)

- Dyspnea post exercise

- ecxercise intolerance

- weakness

- Right-side HF

- Cyanosis (RIGTH TO THE LEFT SHUNT )

- Systolic murmur / diastolic reduplication

An anomalous communication between the two ventricles

Most common in cats

Symptoms :

- Asymptomatic (most patients)

- A left-side HF

- pulmonic hypertension

- Cyanosis

- Systolic murmur

- Prechordial Thrill

- Jerky pulse

Common in dogs and cats

Consist of :◦ Ventricular septal defect◦ Overrriding, dextropositioned aorta◦ Pulmonic stenosis◦ Right Ventricular hypertrophy

Symptoms:

- < 1 year old - Polycythemia,

- Systolic murmur - Cyanosis- Dyspnea- Exercise intolerance- Syncope- Growth disorders