Back to basics: case-based applied physiology

Which neurohumoral system regulates heart rate?

The renin-angiotensin-aldosterone system (RAAS)

Hyppothalamic-pituitary-adrenal axis

Natriuretic peptides

Autonomic nervous system

What is a pulse deficit?

There are more pluses than heartbeats

There are no palpable pulses

You hear a heartbeat but you don’t feel a pulse associated with it

The pulse varies in intensity

What do normal heart sounds represent?

S1 represents closure of the AV valves

S2 represents atrial contraction

S1 represents ventricular filling

S2 represents opening of the semilunar valves

Why does a heart murmur occur?

Increased blood viscosity

Reduced systolic function

Turbulent blood flow

Diastolic dysfunction

Which conditions cause continuous murmurs?

Aortic stenosis

Mitral valve stenosis

Ventricular septal defect with pulmonic stenosis

Left-to-right patent ductus arteriosus

What is it about a PDA that makes the murmur continuous?

The resistance in the pulmonary artery increases during systole

The systolic function of the left ventricle is increased

The resistance in the systemic circulation is always higher than in the pulmonary circulation

The diastolic function of the right ventricle is impaired

What are the radiographic features of left congestive heart failure?

Increased cardiac sternal contact and a bronchial lung pattern

Generalised cardiomegaly and distended caudal vena cava

Pleural and abdominal effusions

Left atrial enlargement, pulmonary lobar congestion, peri-hiliar lung pattern

Why does PDA cause congestive heart failure?

Heart rate is too fast and causes tachycardia-induced cardiomyopathy

Cardiac remodelling causes severe mitral insufficiency

Increased preload causes myocardial fatigue

Pulmonary hypertension leads to pulmonary oedema

Which medication is contra-indicated in a dog with a PDA and borderline congestive heart failure?

Furosemide

Atenolol

Pimobendan

Benazepril/spironolactone combination

How do we know intraoperatively if a PDA is well closed?

Murmur is no longer audible through the oeasophageal stethoscope

Diastolic blood pressure on the monitor increases

Heart rate on the monitor decreases

The patient urinates copiously under the drapes

all of above

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Back to basics: case-based applied physiology