Veterinary Cardiology Quiz

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Questions and Answers

What is the most likely cause of a ventricular premature complex (VPC) in a dog?

  • Drug administration
  • Electrolyte derangements
  • Heart disease (correct)
  • Pain

What is the rate of a ventricular tachycardia in a dog?

  • Greater than 250 beats per minute
  • Less than 160 beats per minute
  • Greater than 160 beats per minute (correct)
  • Less than 40 beats per minute

What characteristic of a VPC on an ECG is considered "wide and bizarre"?

  • The QRS complex (correct)
  • The ST segment
  • The P wave
  • The T wave

What is the most dangerous arrhythmia mentioned in the text?

<p>Ventricular fibrillation (C)</p> Signup and view all the answers

What condition is a potential complication of sustained ventricular tachycardia?

<p>Congestive heart failure (B)</p> Signup and view all the answers

What is the most appropriate treatment for a dog with single VPCs without signs of hemodynamic compromise?

<p>Long-term ECG monitoring (B)</p> Signup and view all the answers

R-on-T phenomenon is associated with an increased risk for?

<p>Ventricular fibrillation (B)</p> Signup and view all the answers

What is a common characteristic of a R-on-T phenomenon on an ECG?

<p>A very fast heart rate (B)</p> Signup and view all the answers

What characterizes a ventricular arrhythmia concerning the QRS complex?

<p>Wide and bizarre (B)</p> Signup and view all the answers

In dogs, what heart rate indicates tachycardia?

<blockquote> <p>160 bpm (C)</p> </blockquote> Signup and view all the answers

What can cause a fast heart rate associated with sinus rhythm in dogs?

<p>Fear and excitement (A)</p> Signup and view all the answers

What is a notable characteristic of respiratory sinus arrhythmia in dogs?

<p>Regularly irregular rhythm associated with respiration (D)</p> Signup and view all the answers

What does a wide QRS complex indicate in the context of an ECG?

<p>Ventricular origin of impulses (C)</p> Signup and view all the answers

In which scenario is no treatment typically necessary?

<p>Increased vagal tone in dogs (D)</p> Signup and view all the answers

What is a common cause of ectopic supraventricular tachyarrhythmia?

<p>Severe mitral valve disease (C)</p> Signup and view all the answers

Which of the following would NOT be a likely cause of sinus tachycardia?

<p>Vagal stimulation (A)</p> Signup and view all the answers

What is the expected QRS duration that indicates a wide QRS complex in dogs?

<p>Greater than 0.06 sec (D)</p> Signup and view all the answers

What condition could lead to a transient increase in heart rate in dogs?

<p>Pain or fear (B)</p> Signup and view all the answers

What is the heart rate calculation method when counting QRS complexes in a 3-second period?

<p>Count QRS complexes and multiply by 20 (A)</p> Signup and view all the answers

Which paper speed setting corresponds to each small (mm) box measuring 0.02 seconds?

<p>50 mm/sec (D)</p> Signup and view all the answers

What is the correct method for calculating average heart rate using a standard Bic pen at 25 mm/sec?

<p>Count QRS complexes inside the pen length and multiply by 10 (C)</p> Signup and view all the answers

Which component of the ECG system allows you to determine whether the rhythm is controlled by the sinus node?

<p>Lead II electrocardiogram (B)</p> Signup and view all the answers

In the systematic approach to ECG interpretation, what is the first step?

<p>Note lead and paper speed settings (A)</p> Signup and view all the answers

What does the QRS complex appearance help differentiate between?

<p>Supraventricular and ventricular arrhythmias (C)</p> Signup and view all the answers

How long is a standard Bic pen when it is used for measuring heart rate at 50 mm/sec?

<p>150 mm (A)</p> Signup and view all the answers

What is the normal sinus rhythm characterized by?

<p>Regular intervals and a consistent rate (D)</p> Signup and view all the answers

What defines an underlying sinus rhythm in an electrocardiogram (ECG)?

<p>Presence of P waves for QRS complexes and consistent PR intervals. (A)</p> Signup and view all the answers

What is a common consequence of tachycardia on cardiac output?

<p>Decreased stroke volume due to inadequate filling time. (C)</p> Signup and view all the answers

Which heart rhythm is specifically known to cause loss of atrio-ventricular synchrony?

<p>Atrial fibrillation. (C)</p> Signup and view all the answers

What characterizes a ventricular arrhythmia?

<p>QRS complexes appear wide and bizarre. (D)</p> Signup and view all the answers

Which of the following statements about bradyarrhythmias is correct?

<p>They can lead to cardiac injury due to decreased cardiac output. (A)</p> Signup and view all the answers

What is the primary hemodynamic consequence of atrial fibrillation at high heart rates?

<p>Loss of atrial kick leading to decreased exercise tolerance (B)</p> Signup and view all the answers

Which condition is described as the inability of the heart to maintain adequate output during physical exertion?

<p>Sinus bradycardia. (A)</p> Signup and view all the answers

Which characteristic on an ECG is indicative of atrial fibrillation?

<p>Irregular, sawtooth baseline caused by fibrillation (f) waves (B)</p> Signup and view all the answers

In which scenario is 'lone A-fib' most likely to occur?

<p>In giant-breed dogs without underlying heart disease (A)</p> Signup and view all the answers

How is a supraventricular arrhythmia differentiated from a ventricular arrhythmia?

<p>Supraventricular arrhythmias have a normal QRS complex. (C)</p> Signup and view all the answers

What feature is indicative of an abnormal impulse arising from the ventricular region?

<p>QRS complexes longer than 0.06 seconds in dogs. (D)</p> Signup and view all the answers

What does the AV node do in response to rapid atrial activity during atrial fibrillation?

<p>It acts as a filter for the rapid atrial impulses. (B)</p> Signup and view all the answers

Which category includes both sinus bradycardia and atrial fibrillation?

<p>Cardiac arrhythmias. (C)</p> Signup and view all the answers

What is the typical heart rate associated with atrial fibrillation in dogs?

<p>Usually above 180 bpm (A)</p> Signup and view all the answers

Why is it essential to identify the origin of a heart rhythm?

<p>To assess the potential impact on cardiac output. (C)</p> Signup and view all the answers

What is an early sign of 'lone A-fib' in giant-breed dogs?

<p>Severe exercise intolerance or decreased performance (C)</p> Signup and view all the answers

What is the most common approach to manage abnormal ventricular response rates in dogs and cats?

<p>Rate control using oral antiarrhythmics (C)</p> Signup and view all the answers

What is the expected QRS complex appearance in atrial fibrillation?

<p>Narrow and upright complexes (A)</p> Signup and view all the answers

Which treatment is aimed at converting atrial fibrillation to sinus rhythm?

<p>Rhythm control measures (C)</p> Signup and view all the answers

Which characteristic is NOT associated with premature ventricular complexes (PVCs)?

<p>Presence of a related P wave (A)</p> Signup and view all the answers

How can one identify if the premature beats have a ventricular origin?

<p>By the width of the QRS complex (A)</p> Signup and view all the answers

What does the term 'R-on-T' phenomenon refer to in ECG readings?

<p>QRS complex occurs on the T wave of a previous beat (D)</p> Signup and view all the answers

Which of the following is a feature of ventricular premature depolarizations?

<p>Can appear as single, couplets, or triplets (A)</p> Signup and view all the answers

What is indicated by a QRS complex width greater than 0.06 seconds in a dog?

<p>Possible ventricular origin of a beat (B)</p> Signup and view all the answers

Which type of medication is commonly used to control heart rate in dogs with arrhythmias?

<p>Beta-adrenergic blockers (A)</p> Signup and view all the answers

What are the building blocks for more complex ventricular arrhythmias such as ventricular tachycardia?

<p>Ventricular premature complexes (D)</p> Signup and view all the answers

Flashcards

Systematic Approach to ECG Interpretation

The process of analyzing an electrocardiogram (ECG) in a structured and organized manner.

Paper Speed

The rate at which the ECG paper moves, typically 25 mm/sec or 50 mm/sec.

Heart Rate

The number of heartbeats per minute.

Sinus Rhythm

The normal rhythm of the heart, generated by the sinus node.

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Cardiac Arrhythmia

Any deviation from the normal heart rhythm.

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Determining Sinus Node Control

The ability to determine if the sinus node is controlling the heart's rhythm by analyzing the ECG.

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QRS Complex Appearance

The shape of the QRS complex in the ECG, indicating the electrical activity of the ventricles during contraction.

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Bic Pen Measurement

The standard length of a Bic pen cap-on used to measure the duration of ECG events, corresponding to 3 seconds at 50 mm/sec and 6 seconds at 25 mm/sec.

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Atrial fibrillation (A-fib)

An irregular heart rhythm caused by rapid, disorganized electrical activity in the atria.

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What happens during Atrial fibrillation?

The atria, or the upper chambers of the heart, contract in a chaotic and uncoordinated way.

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What is a key ECG feature of A-fib?

The lack of a normal, organized P-wave pattern on an EKG.

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What is the role of the AV node in A-fib?

The ability of the AV node to filter out some of the chaotic atrial signals, preventing every impulse from reaching the ventricles.

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Why is the QRS complex normal in A-fib?

Because the AV node acts as a filter, the ventricles receive more regular signals and the QRS complex (ventricular depolarization) remains normal.

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What is one hemodynamic consequence of A-fib?

Reduced efficiency of the heart's pumping action due to the loss of the atrial kick.

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Why is sustained A-fib a concern?

The rapid, irregular heart rhythm associated with A-fib can lead to weakening of the heart muscle (cardiomyopathy).

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How is A-fib treated?

Medical antiarrhythmic medications are used to restore a normal heart rhythm in certain cases of A-fib, such as in horses and giant breed dogs.

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Arrhythmia

A heart rhythm originating outside the sinoatrial (SA) node, occurring at an abnormally high or low rate, or creating beats at irregular intervals.

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Sinus Bradycardia

A slower than normal heart rate originating in the SA node.

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Sinus Tachycardia

A faster than normal heart rate originating in the SA node.

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Atrioventricular (AV) Block

A condition where the electrical impulses are delayed or blocked as they pass through the atrioventricular (AV) node, causing slow or irregular heartbeats.

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Atrial Standstill

A blockage of electrical signals from the SA node to the ventricles, resulting in a complete lack of ventricular activation.

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Sick Sinus Syndrome

A condition where the SA node fails to generate a regular heartbeat, leading to irregular and sometimes slow heart rate.

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Atrial Premature Complexes

Abnormal heartbeats occurring prematurely in the atria, often causing a noticeable skipped beat.

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Supraventricular Tachycardia (SVT)

A rapid heart rhythm originating in the atria or AV junction, often causing palpitations.

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Atrial Flutter

A rapid, irregular heartbeat occurring in the atria, causing palpitations.

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Ventricular Premature Depolarizations (VPD)

A type of arrhythmia where abnormal electrical impulses originate from ventricular tissue, leading to premature, wide, and bizarre QRS complexes.

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Premature Ventricular Complexes (PVCs)

A type of arrhythmia where abnormal electrical impulses originate from ventricular tissue, leading to premature, wide, and bizarre QRS complexes.

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Ventricular Premature Complexes (VPC)

A type of arrhythmia where abnormal electrical impulses originate from ventricular tissue, leading to premature, wide, and bizarre QRS complexes.

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Ventricular Bradycardia

A heart rate that is slower than normal and the electrical impulses that trigger the heartbeats originate from the ventricles.

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Wide QRS Complex in VPC

The QRS complex in a VPC is typically wide, greater than 0.06 seconds in dogs and 0.04 seconds in cats.

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Ventricular Couplet

Two consecutive PVCs.

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Ventricular Triplet

Three consecutive PVCs.

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R-on-T Phenomenon

A situation where the QRS complex of a PVC occurs so early that it coincides with the T wave of the preceding beat.

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Ventricular Arrhythmia

An arrhythmia originating in the ventricles (lower chambers of the heart), characterized by a wide and bizarre QRS complex (longer than 0.06 seconds in dogs and 0.04 in cats) and no preceding P-wave.

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Sinus Arrhythmia

An irregular heartbeat pattern characterized by a cyclical slowing and speeding of the heart rate, often associated with respiration (speeding on inhale, slowing on exhale).

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Sinus Rhythm with Cyclic Slowing and Speeding

A normal ECG finding in dogs and fit horses, signifying high vagal (parasympathetic) tone.

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Sinus Tachycardia as a Physiologic Response

A fast heart rate, characteristic of sinus tachycardia, that can be a normal response to high sympathetic tone (stress, fear, excitement, exercise, etc), or certain drugs and conditions.

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Regularly Irregular Rhythm

A heart rhythm characterized by a heart rate that is consistently regular, often seen in patients with high vagal tone.

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Regular Rhythm

A heart rhythm that is characterized by a consistent rate, without any fluctuations.

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ECG (Electrocardiogram) Characteristics

The electrical impulses associated with a heartbeat.

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QRS Complex

The portion of the ECG that represents the electrical activity of the ventricles during depolarization (contraction).

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Ventricular fibrillation

A type of heart rhythm where the ventricles beat rapidly and irregularly, increasing the risk of sudden death.

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Ventricular tachycardia

A life-threatening cardiac rhythm originating from the ventricles, characterized by 4 or more rapid consecutive ventricular premature contractions (VPCs) exceeding 160 beats per minute in dogs.

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R-on-T

A type of ventricular tachycardia where a premature ventricular contraction (PVC) occurs during the vulnerable period of the T wave, increasing the risk of ventricular fibrillation.

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Ventricular Premature Contractions (VPCs)

A heart rhythm abnormality that could be a sign of a more serious heart condition.

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Congestive heart failure (CHF)

A condition where the heart's ability to pump blood effectively is weakened, often caused by damaged heart muscle.

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Single VPC

A single premature ventricular contraction (PVC) that is not followed by additional PVCs or tachycardia, and therefore not considered clinically significant.

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Holter monitoring

A diagnostic test where an ECG is recorded over a 24-hour period to monitor heart rhythm and detect abnormalities.

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Primary myocardial diseases

A group of heart conditions that affect the myocardium (heart muscle) leading to impaired contraction.

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Study Notes

ECG Interpretation

  • A systematic approach to ECG interpretation involves several steps
  • First, note the lead and paper speed settings, typically 25 mm/sec or 50 mm/sec.
  • Determine the heart rate by counting QRS complexes in a 3-second period and multiplying by 20.
  • Establish if there is an underlying sinus rhythm.
  • Describe any rhythm abnormalities if absent.

Learning Objectives

  • Students will list and discuss the steps in ECG interpretation.
  • Students will identify the presence of a sinus rhythm.
  • Students will define cardiac arrhythmias and normal sinus rhythm.
  • Students will list the criteria of a normal sinus rhythm using ECG leads.
  • Students will identify rhythms controlled by the sinus node in ECG leads.
  • Students will differentiate between supraventricular and ventricular rhythms (ECG criteria)

Bic Pen Trick

  • A standard Bic pen can be used to quickly estimate heart rate.
  • Count the QRS complexes contained within the length of the pen.
  • Multiply the result by 10 if the paper speed is 25 mm/sec or by 20 if the paper speed is 50mm/sec.

Paper Speed Settings

  • 25 mm/sec: Each small box = 0.04 seconds, each big box = 0.2 seconds, 25 small boxes = 1 second
  • 50 mm/sec: Each small box = 0.02 seconds, each big box = 0.1 seconds, 50 small boxes = 1 second

Sinus Rhythm

  • Depolarisation begins at the sinus node, the pacemaker of the heart.
  • In lead II, P waves should be positive, reflecting atrial depolarisation from the sinus node.
  • There should be a P wave for every QRS complex and consistent PR intervals.

Arrhythmia Definition

  • An arrhythmia is any alteration in heart rate, regularity, or normal activation sequence of the electrical heart activity
  • This includes abnormal origins for the electrical activation of the heart, irregular rate, and irregular beat intervals.

Arrhythmia Significance

  • Arrhythmias can result in cardiac injury from decreased cardiac output,
  • Especially when rhythms are too fast (tachycardia) or too slow (bradycardia),
  • Some specific arrhythmias (e.g., atrial fibrillation) affect atrio-ventricular synchrony potentially leading to sudden death.

Arrhythmia Classification

  • A clinically relevant scheme exists for classifying heart rhythm abnormalities, including both bradyarrhythmias (slow heart rates) and tachyarrhythmias (fast heart rates).
  • Bradyarrhythmias include sinus bradycardia, atrioventricular block, atrial standstill, and sick sinus syndrome.
  • Tachyarrhythmias include sinus tachycardia, atrial premature complexes, supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular premature complexes, accelerated idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation.

Supraventricular vs. Ventricular Arrhythmias

  • Supraventricular arrhythmias originate from tissue above the ventricles (atria or AV junction).
  • Ventricular arrhythmias originate in the ventricles.
  • Ventricular arrhythmias are generally more dangerous due to potential consequences on cardiac output and function.
  • ECG characteristics distinguishing the origins include QRS complex shape and width, and the presence/absence of a preceding P wave.

Sinus Arrhythmia

  • Characterized by cyclic slowing and speeding of heart rate linked to respiration.
  • Considered a normal finding in many physiological states, but can be exaggerated by certain diseases or conditions.

Sinus Tachycardia

  • A sinus rhythm with a fast heart rate.
  • Rate cutoffs for diagnosis are species-specific: e.g., dogs >160 bpm; cats >200 bpm; horses >44 bpm; cattle >80 bpm.

Atrial Fibrillation (A-fib)

  • A disorganized atrial activity often associated with advanced heart disease in dogs and cats, or as a “lone” form in some cases.
  • Distinguished by an irregular or “sawtooth” baseline, absence of P waves, and often having a rapid heart rate.

Ventricular Premature Complexes (VPCs)

  • Abnormal impulses arising from the ventricles.
  • Often appear as “wide and bizarre” complexes with a missing preceding P wave.
  • Early development of VPCs, especially “R-on-T” phenomenon, increases risk for dangerous ventricular fibrillation.

Ventricular Tachycardia

  • A rapid heart rhythm arising from the ventricles characterized by four or more successive VPCs.
  • May be uniform (identical) or multiform (different in shape).
  • A dangerous rhythm often associated with dilated cardiomyopathy.

When to Treat Ventricular Arrhythmias

  • Single VPCs usually do not warrant treatment unless there are other concerns.
  • Evaluate for occult complex processes in patients with recurring, frequent, or unusually shaped VPCs.
  • Treat underlying causes (e.g., heart disease, electrolyte imbalances), or address other symptoms of cardiac compromise.

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