Failing Heart Overview
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Questions and Answers

What is a common early sign of decompensated heart failure in animals?

  • Frequent urination
  • Weight gain
  • Exercise intolerance (correct)
  • Increased appetite

    • Which of the following conditions is most likely associated with weight loss in dogs?

  • Acute kidney injury
  • Chronic left-sided heart failure
  • Hypothyroidism
  • Chronic right-sided heart failure (correct)

    • What does generalized jugular distension suggest in an animal?

  • Pulmonary hypertension
  • Left ventricular hypertrophy
  • Systemic hypertension (correct)
  • Tricuspid regurgitation

    • What is a typical cause of weight loss in animals experiencing cardiac cachexia?

    <p>Malabsorption issues</p> Signup and view all the answers

    During a physical examination, how is venous distension of the jugular vein assessed?

    <p>Animal is standing with head in neutral position</p> Signup and view all the answers

    Which of the following is a primary cause of impaired contractility in myocardial failure?

    <p>Dilated cardiomyopathy</p> Signup and view all the answers

    What commonly results from valvular insufficiency?

    <p>Volume overload</p> Signup and view all the answers

    In which condition does chronic increase in afterload lead to reduced myocardial contractility?

    <p>Pressure overload</p> Signup and view all the answers

    Which of the following can lead to nutritional deficiencies causing myocardial failure?

    <p>Taurine deficiency in specific dog breeds and cats</p> Signup and view all the answers

    What is a common complication associated with prolonged atrial fibrillation?

    <p>Atrial remodelling</p> Signup and view all the answers

    Which of the following conditions is described as leading to excessive pressure overload?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which of the following is NOT a type of cardiomyopathy mentioned?

    <p>Genetic cardiomyopathy</p> Signup and view all the answers

    What condition can be caused by the incompetence of atrio-ventricular valves?

    <p>Volume overload</p> Signup and view all the answers

    What is the primary concern of inadequate preload?

    <p>Inability to fill the heart adequately</p> Signup and view all the answers

    Which condition is NOT associated with diastolic dysfunction?

    <p>Pericardial effusion</p> Signup and view all the answers

    Which symptom is considered the most common complaint in dogs with significant cardiac disease?

    <p>Coughing</p> Signup and view all the answers

    Which type of dyspnoea may present in chronic conditions such as right-sided heart failure?

    <p>Chronic (progressive) dyspnoea</p> Signup and view all the answers

    What physical finding could lead to coughing in cats with cardiac issues?

    <p>Mechanical compression of the trachea</p> Signup and view all the answers

    Which symptom is associated with acute pulmonary issues in dyspnoea?

    <p>Pulmonary embolism</p> Signup and view all the answers

    In which condition would you typically find non-cardiac dyspnoea?

    <p>Pneumonia</p> Signup and view all the answers

    What could indicate cardiac coughing in an animal?

    <p>Pulmonary congestion</p> Signup and view all the answers

    What does dyspnoea that resolves with diuretic therapy suggest?

    <p>Left-sided heart failure</p> Signup and view all the answers

    In which condition is pulmonary oedema primarily seen?

    <p>Left-sided heart failure</p> Signup and view all the answers

    Which indicator is considered sensitive for heart failure diagnosis?

    <p>Respiratory rate</p> Signup and view all the answers

    Which of the following symptoms is a late finding in left-sided heart failure?

    <p>Cyanosis</p> Signup and view all the answers

    Which resolving treatment options indicate respiratory disease when dyspnoea improves?

    <p>Steroids</p> Signup and view all the answers

    Which of the following describes a common consequence of ascites in animals?

    <p>Dyspnoea or tachypnoea</p> Signup and view all the answers

    What is a potential cause of syncope in animals?

    <p>Decrease in cerebral blood flow</p> Signup and view all the answers

    Which symptom might indicate position-related dyspnoea?

    <p>Breathlessness when lying down</p> Signup and view all the answers

    What commonly leads to syncope in animals with heart failure?

    <p>Weakness of heart muscles</p> Signup and view all the answers

    Which abnormal heart sounds can indicate heart failure in animals?

    <p>Soft S2 with presence of S3</p> Signup and view all the answers

    What physiological condition is indicated by paradoxical splitting of S2?

    <p>Left ventricular failure</p> Signup and view all the answers

    In which scenario would S3 be typically heard in dogs?

    <p>Dilated cardiomyopathy</p> Signup and view all the answers

    What is the significance of gallop rhythm in heart sounds?

    <p>Early sign of heart failure</p> Signup and view all the answers

    Cardiac murmurs are caused by what type of blood flow?

    <p>Turbulent blood flow</p> Signup and view all the answers

    Which heart sound changes can indicate valvular issues in heart failure?

    <p>Soft S1 due to pleural effusion</p> Signup and view all the answers

    What symptom may occur alongside syncope in animals due to impaired blood flow?

    <p>Involuntary urination</p> Signup and view all the answers

    What is the primary function of the right atrium in the heart?

    <p>To receive venous blood from the systemic circulation.</p> Signup and view all the answers

    Which structure separates the left atrium from the left ventricle?

    <p>Mitral valve</p> Signup and view all the answers

    In the context of the heart, what does preload refer to?

    <p>The volume of blood returning to the ventricle.</p> Signup and view all the answers

    What is the role of the papillary muscles in the heart?

    <p>To keep valves from prolapsing during systole.</p> Signup and view all the answers

    Which chamber of the heart is primarily responsible for pumping oxygenated blood to the body?

    <p>Left ventricle</p> Signup and view all the answers

    What initiates the electrical conduction system of the heart?

    <p>SA node</p> Signup and view all the answers

    Which valve is responsible for directing deoxygenated blood into the pulmonary artery?

    <p>Pulmonic valve</p> Signup and view all the answers

    Which component of the heart’s anatomy helps to anchor valve cusps?

    <p>Chordae tendinae</p> Signup and view all the answers

    What percentage of circulating blood is found in the systemic circulation?

    <p>75%</p> Signup and view all the answers

    The left heart operates under which type of pressure environment?

    <p>High pressure</p> Signup and view all the answers

    What separates the right atrium from the right ventricle?

    <p>Tricuspid valve</p> Signup and view all the answers

    What structure carries deoxygenated blood from the heart to the lungs?

    <p>Pulmonary trunk</p> Signup and view all the answers

    How is the left ventricular systole characterized?

    <p>Contraction and ejection of blood into the aorta.</p> Signup and view all the answers

    Study Notes

    Failing Heart 1

    • This presentation covers the failing heart
    • The presenter is Prof Kamalan Jeevaratnam, DAHP, DVM, MMedSc (Mal), PhD (Cambridge), FRCVS (UK) from the School of Veterinary Medicine, University of Surrey.

    Learning Outcomes

    • Review normal anatomy and physiology of the cardiovascular system (CVS).
    • Understand the pathophysiology and causes of heart failure.
    • Describe common clinical signs/presentations associated with failing heart.
    • Describe the pathophysiological process leading to observed clinical signs/presentations in failing hearts.
    • Understand and describe the use of classification schemes for heart failure.

    What are the roles of the cardiovascular system?

    • Delivery of substances: oxygen, glucose, water, amino acids, fatty acids, and other nutrients
    • Removal of substances: carbon dioxide, hydrogen ions, and other waste products
    • Distribution: heat, hormones, cells, and bioactive agents
    • Two fundamental mechanical functions of the heart:
      • Eject enough blood into the aorta and pulmonary arteries to meet tissue perfusion requirements.
      • Receive blood from pulmonary and systemic veins to provide adequate drainage of capillary beds.

    Normal anatomy of the heart

    • 75% of circulating blood is in the systemic circulation, 25% in pulmonary circulation.
    • Encased in pericardium
    • 4 chambers: left atrium, right atrium; left ventricle, right ventricle.
      • Left atrium and right atrium are separated by the interatrial septum.
      • Left ventricle and right ventricle are separated by the interventricular septum.
    • 4 valves: tricuspid, mitral, aortic, and pulmonary. (Tricuspid and mitral are atrioventricular valves).
    • Major vessels: coronary arteries, pulmonary trunk, and aorta.

    Normal conduction system of the heart

    • SA node (sinoatrial node) is the normal pacemaker.
    • Spreads throughout the right and left atria via intermodal pathways to the AV node.
    • AV node then to bundle of His, then left and right bundle branches, and Purkinje fibres to ventricular myocardium.

    The heart as a pump

    • The heart consists of two pumps that work in series
      • Left heart pumps oxygenated blood from lungs to the body (high pressure system)
      • Right heart pumps blood from the veins to the lungs (low pressure system)
    • The pressure in the different heart chambers is shown as numerical examples (120/80, 25/10, 8-10, 0-4, 120/10, 25/4).

    Cardiac Physiology

    • Preload: volume of blood returning to the ventricle (ventricular end-diastolic volume). Affected by venous blood pressure and return rate.
    • Afterload: tension, force, or stress acting on ventricular wall myocytes after shortening, affected by arterial and arteriolar vascular smooth muscle constriction/dilation.
    • Heart Rate: determined by the rate of spontaneous sinoatrial nodal discharge and under autonomic control.
    • Cardiac output = stroke volume x heart rate

    Frank Starling Law

    • Greater amount of blood in ventricles results in greater contractile strength, increasing stroke volume.
    • More cross-bridges cycling, and greater availability of Ca++ to initiate cycling.

    Heart Failure - Pathophysiology

    • Heart failure is a pathophysiological state where the heart is unable to function to meet the animals' requirements.
    • Progression of heart failure involves neuroendocrine dysfunction and biomechanical dysfunction.
    • Dysfunction can lead to systolic or diastolic dysfunction.

    What are the principle causes of cardiac injury?

    • Myocardial failure: impaired contractility can be primary (dilated cardiomyopathy) or secondary (e.g., nutritional deficiencies, metabolic cardiomyopathies, toxicities, infiltrative cardiomyopathy, atrial fibrillation).

    Volume Overload

    • Valvular insufficiency: incompetence of atrioventricular valves commonly caused by endocardiosis, endocarditis, or congenital issues.
    • Shunts: septal defects or persistent foramen, similar to valvular leaks in pathophysiology.

    Excessive afterload/pressure overload

    • Short increases in afterload help with contractility but chronic afterload will depress contractility.
    • Reduced ejection rate if afterload is always high.
    • Pulmonary or systemic hypertension, obstruction of ventricular outflow tracts, stenosis (narrowing) cause increased afterload.

    Inadequate preload & diastolic dysfunction

    • Reduces ability to adequately fill the chambers and causes diastolic dysfunction.
    • This is related to issues like pericarditis, pericardial effusion, myocardial fibrosis, and restrictive cardiomyopathy; failure of ventricular relaxation.
    • It increases ventricular end-diastolic pressure, exerting stress on the heart and leading to remodeling.

    Algorithm of functional categories and etiologies of congestive heart failure in cats

    • Details the functional categories (Diastolic heart failure, Primary myocardial failure, Ventricular volume overload, Pressure overload) and their etiologies(e.g. Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy, Taurine Deficiency).

    Clinical signs and presentation

    • Coughing: common in dogs with significant cardiac disease, less common in cats. May indicate concurrent respiratory issues. Horses may cough due to pulmonary oedema.
    • Dyspnoea: difficulty breathing, present in various heart conditions (acute pulmonary oedema, chronic disease, exertional, resting etc).
    • Oedema/Ascites: fluid accumulation in the abdomen, commonly in dogs (less so in cats).
    • Cyanosis: bluish discoloration of mucus membranes, usually from reduced oxygenation, commonly a late-stage finding in heart failure.
    • Syncope: loss of consciousness due to reduced cerebral blood flow, typically brief and recurrent. Common in conditions like heart failure. Could be related to cardiac arrhythmia in some cases.
    • Abnormal heart sounds and cardiac murmurs: S1 and S2 are normal heart sounds. S3 and S4 can indicate issues; murmurs indicate turbulent blood flow and may be physiologic or pathologic.

    Weakness, exercise intolerance, and weight loss

    • Weakness and exercise intolerance are nonspecific, often associated with changes in activity level, particularly as early signs of heart failure as the heart can't keep up with demand.
    • Weight loss is more commonly seen in dogs with chronic severe right-sided heart failure (RHF) and is due to conditions like congestion of the pancreas, altered digestion, or protein-losing enteropathy.

    Venous distension

    • Jugular vein distension is examined while the animal is standing to assess venous pressure.
    • Distension, pulse extending above lower third of neck, could indicate right heart failure or tricuspid regurgitation.
    • Generalized jugular distension might indicate systemic hypertension.

    Classification of heart failure

    • Different classes (Class I-IV) classify patients according to severity of clinical signs in the context of heart disease, reflecting how the disease affects activity levels (e.g., Class I = asymptomatic; Class IV = severe clinical signs at rest).

    Stages of Heart Disease

    • Stage A: High-risk animals without present heart disease
    • Stage B: Animals with structural heart disease (e.g., murmur) but no signs of heart failure.
    • Stage C: Individuals experiencing heart failure symptoms related to structural heart disease.
    • Stage D: Animal with advanced heart failure that is refractory to standard treatment.

    Causes of the failing heart

    • Acquired valvular disease, including degenerative mitral valve disease, endocarditis, endocardiosis, and equine valvular regurgitation
    • Pericardial disease (pericarditis, traumatic reticulo-pericarditis)
    • Hypertension (pulmonary and systemic)
    • Cardiomyopathies (e.g., dilated, arrhythmogenic right ventricular, hypertrophic, feline cardiomyopathy)
    • Heartworm disease
    • Cardiac arrhythmias (e.g., atrial fibrillation)

    References

    • List of veterinary textbooks.

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    Failing Heart 1 PDF (2022) - Veterinary Science

    Description

    This quiz delves into the failing heart, exploring its anatomy, physiology, and the pathophysiological processes that lead to heart failure. Learn about the common signs and classifications of heart failure as presented by Prof Kamalan Jeevaratnam. Enhance your understanding of the cardiovascular system's roles in health and disease.

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