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 &
CO
2produced 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 CO
2for O
2◦ 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. HistoryC. 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 -- S
1and S
2sounds; ventricular mechanical systole (AV closure to semilunar valve closure)
◦ Abnormal :
Splitting of S1 and S2 sounds -- S1with 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-Ventral
Lateral
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
SHOCK
Loss 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 Shock
1. 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
