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Equine Final Year > Cardiac assessment in equid > Flashcards

Cardiac assessment in equid Flashcards

1
Q

Discuss manifestations of cardiac disease?

A

Cardiac murmur

Differential diagnosis

  • Physiological murmur
  • Murmur caused by congenital abnormality

Poor performance

  • Rarely due to cardiac problem:
    • Consider –Lameness, Lower respiratory, upper respiratory, muscular
      • Considerable cardiac ‘reserve’

Collapse / sudden death

  • Rare
    • Concurrent (secondary ventricular dysrrhthmias)
    • Vascular catastrophe

Congestive heart failure

  • Rare in horses
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2
Q

What else affects membrance colour–

A

NITRATE, circulation. SIRS

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3
Q

What types of cardiac disease can you identify?

A

Murmur -endocardial

Arrhythmia –myocardial

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4
Q

Discuss what pulses can tell you?

A

Pulses : Arterial (transverse facial artery cheek artery) and venous

Jugular distension is an indicator of reduced cardiac return. Jugular brings blood back down from head to heart.

  • Right sided Cardiac failure
  • Thoracic disease
  • Pericardial disease
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5
Q

What can peripheral oedema tell us?

A

Periphery : Oedema can be a sign of

  • Right sided heart failure
  • Hypoproteineamia
  • Vascular disease
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6
Q

What can mucous membranes tell us?

A

Perfusion

hypovolaemia

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7
Q

Discuss jugular pulsation?

A

Normally visible in distal third of neck

  • Dependant on head and neck position
  • CVD jugular pulse goes higher up head
  • Or leaning on strap see it higher
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8
Q

Discuss left sided heart failure?

A

Left sided heart failure

  • Causes pulmonary Oedema can be caused by:
    • Ruptured chordae tendonae
    • Bacterial endocarditis
    • Congenital cardiac disease
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9
Q

Discuss right sided heart failure?

A

Right sided heart failure

Peripheral oedema, pitting oedemaon ventrum of horse caused by:

  • Chronic endocardial disease
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10
Q

What are some tips on auscultation?

A

Most problems

  • Listening too far back
  • Listening too low down
  • Not listening on right hand side
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11
Q

Discuss the normal heart sounds?

A

S4 (shh) 1 st sound heard

  • Onset of atrial systole -Audible in 60% of TB

S1 (Lub)

  • Onset of ventricular systole
  • Turbulent blood flow Closure of AV valves opening of Semilunar valves
  • Loudest over LIC 5
  • May be louder if Hypertension, adrenaline, MVD

S2 (Dub)

  • Onset of diastole
  • Closure of semilunar valves, open AV ventricular filling
  • Loudest over LIC 4
  • May be louder if fever, adrenaline, anaemia

S3 (de)

  • Just after opening of AV valves Rapid ventricular filling
  • Loudest over cardiac apex (low LIC5)
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12
Q

What causes murmurs in the normal horse?

A

Heart sounds caused by turbulence

  • Closure of cardiac valves
  • High velocity flow

Murmurs

  • Forward or reverse flow
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13
Q

A 6 Year old TB Gelding -presents with Hx of poor performance the cardiac rhythm is regularly irregular.

What are differential diagnoses?

A

Atrial fibrillation, secondary AV block (main suspicion)

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14
Q

What is the significance of 2ndary AV block?

A

Common in horses not clinically significant with regards poor performance

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15
Q

8 Year old WB gelding. Poor performance and epistaxis . 3 months duration. Thought to be ‘the virus’ but others are now normal the rhythm is Irregularly irregular. Couldn’t hear S4. what would you think it would be?

A

Atrial fibrillation confirmed with ECG

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16
Q

How should you assess cardiac murmurs?

A

Cardiac auscultation

  • Timing and PMI
    • Determine valve affected
    • Determine a TENTATIVE DIAGNOSIS

History and physical examination

  • Determine which horses require further investigation
  • Does horse have any signs of cardiac compromise we can identify

2 main forms of investigation:

Echocardiography: Confirm diagnosis, prognosis & safety (to ride)

Electrocardiography: Concurrent dysrrhythmias–safety (to ride)

17
Q

How are murmurs classified?

A

Grade / Intensity

  • Poor indicator of severity
  • But saying that quite murmurs are less likely to be important

When does it occur/Timing

  • Systole vs Diastole

Where do they Radiate

  • Dorsal or Ventral

Where is point of maximal intensity

  • Cranial -intercostal space 4
  • Caudal -intercostal space 5
18
Q

Discuss murmur grades and what they mean?

A
  1. Quiet murmur often difficult to identify
  2. Murmur quieter than heart sounds
  3. Murmur as loud as S1 and S2
  4. Murmur louder than S1 and S2
  5. Loud cardiac murmur with a precordial thrill (what fly has on right hand side, buzz and vibration can feel against your hand on chest)
  6. Murmur audible with stethoscope off thoracic wall
19
Q

Discuss jugular venous pulses?

A

3 phases to jugular pulses normally:

  1. Atrial contraction
  2. Carotid contraction
  3. Ventricles contract
20
Q

Discuss timings and how to define murmurs with respect to timings?

A
21
Q

What are other assessment of cardiac function?

A

ECG

Blood pressure

  • Direct or indirect methods

Cardiac output

  • Dilution techniques (dye, temperature)
  • Ultrasound
  • VO2 Max.
    • Maximum tissue uptake
    • Requires high speed treadmill, expired gas analysus
22
Q

What causes heart murmurs in horses?

A

Normal blood flow

  • Physiological (ejection type) murmurs
  • Tend to be systolic in aortic valve
  • Fit horse excited cause high velocity of flow
  • Tend to be higher pitched

Valvular regurgitation

Caused by valvular disease:

  • Endocardiosis(congenital)
  • Endocarditis (bacterial)

Cardiac defects

Ventricular septal defects (fly has this)

23
Q

Discuss types of endocardial disease?

A

Endocardiosis

  • Valvular degeneration –progressive
  • Can effect Mitral, aortic, tricuspid valves

Endocardititis

  • Bacterial in origin secondary to bacteraemia
  • Often seen in Cattle: Liver abscess, TRP traumatic reticular peritonitis, mastitis
  • Equine: Dental, respiratory, thrombophlebitis (leeding to seeding)

Other causes

  • Valve dysplasia
  • Valvulitis
  • Valve prolapse
  • Ruptured chordae tendinae
24
Q

Discuss clinical signs of bacterial endocarditis?

A

Clinical signs:

  • Congestive heart failure
  • Fever, cardiac murmur, tachycardia, tachypnoea
  • Associated with acute onset murmu
25
Q

Look at this table of bacterial endocarditis causes in bovine, equine and porcine?

A
26
Q

Dicuss use of echocardiography?

A

Uses of echocardiography

2D / M-mode

  • Assess valve structure / disease
  • Assess chamber enlargement
    • Acute disease so no chamber enlargement

Doppler

  • Assess degree of valvularregurgitation
27
Q

Discuss treatment and prognosis of bacterial endocarditis?

A

Treatment

  • Broad spectrum antibiotics based on sensitivity

Prognosis

Guarded even after bacteriological cure

  • Permanent structural damage to valve
  • Right-sided lesions may have return of performance

Septic emboli may shed to distant sites

  • Lungs (right heart)
  • Kidneys / Joints etc (left heart)
28
Q

Summarise cardiac assessment?

A

A thorough cardiac examination is essential to document causes of cardiac murmurs

  • Not all cardiac murmurs are indicative of cardiac pathology
  • Congestive heart failure is uncommon in horses

Equine Final Year (102 decks)

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