Surgery

• complications of heart failure include…

  • Ruptured chordae tendinae (acute deterioration)
  • This frequently presents as an acute emergency, severe fulminant of left congestive heart failure
  • They have severe dyspnoea, are stressed and panicky (owner and dog!) and cyanotic
  • This is life threatening
  • Intractable cough (a cough despite standard therapy)
  • Pulmonary Hypertension
  • Pericardial effusion due to left atrial tear
  • Tussive syncope
  • Gross cardiomegaly (which can then act as a space-occupying lesion)
• Left congestive heart failure worsening despite therapy can be due to…

  • General worsening of disease such as a rupture of CT, atrial tear
  • Furosemide resistance
  • Compliance
  • R sided failure and poor GI drug absorption
• what fluids should you give to heart disease patients?

  dextrose saline
• Butorphanol is often enough to sedate for radiography but you can also use a benzodiazepine (0.2-0.3 mg/kg IM once).
• When you get a cat with a murmur tell O to monitor RR. We don’t treat cats until they are in heart failure so there is no point to image them
• Indications for thoracic surgery

  • Pulmonary
  • Primary lung tumour
  • Idiopathic pneumothorax
  • Pulmonary foreign body
  • Lung lobe torsion
  • Vascular ring anomaly (PRAA)
  • Patent ductus arteriosus (PDA)
  • Pericardiectomy for idiopathic pericardial effusion
  • Open heart surgery (mitral valve repair)
  • Miscellaneous e.g., Thymectomy for thymoma, Thoracic duct ligation for idiopathic chylothorax, Oesophagotomy for FB, Tracheal avulsion, Exploratory thoracotomy; e.g. mediastinal abscess, Thoracic wall abnormalities; e.g., pectus excavatum
• Co2 is used as a physiological dissolvable agent in thoracoscopy as the body can handle this gas - nitrogen from the air would be fatal
• for a complete lobectomy, ligate the veins and arteries but also close the lobar bronchus. This can be done with suture but can also be done with staples
• Pacemaker implantation indications...

  • ‘Symptomatic’ bradycardia in both dogs and cats
  • Advanced second-degree atrioventricular block
  • Advanced third-degree atrioventricular block
  • Sick sinus syndrome
  • Persistent atrial standstill
  • Vasovagal syncope
• Most pacemakers are implanted transvenously via the neck using endocardial leads. Rarely, the pacemakers is placed at open surgery using epicardial leads
• 1st degree AV blocks has prolongation of the PR interval, (not an indication for a pacemaker)
• 2nd degree AV block has a normal PQRS but some unrelated p waves - atria firing normally but this is not always going to the ventricle - not always needing a pacemaker
• 3rd degree AV block almost no p waves at all (not related to the QRS). The natural rate is slow
• what abnormality is shown below?

  second degree AV block

  
• What abnormality is shown below?

  third degree AV block

  
• what abnormality is shown below?

  atrial standstill