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Year 4 equine > Cardiac Disease > Flashcards

Cardiac Disease Flashcards

1
Q

Differentials for cardiac murmur

A

Physiological
Congenital

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2
Q

When is a horse hypoxic on blood gas

A

PaO2 < 80mmHg

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3
Q

What classes as hypercapnia on blood gas

A

PaCa2 >45mmHg

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4
Q

What does jugular distension suggest

A

Reduced cardiac return
Right sided cardiac disease
Thoracic disease
Pericardial disease

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5
Q

What does peripheral oedema suggest

A

Right sided heart failure - vascular disease
Hypoproteinemia
Chronic endocardial disease

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6
Q

Signs of left sided heart failure

A

Pulmonary oedema
Ruptured chorda tendineae
Bacterial endocarditis
Congenital cardiac disease
Usually bilateral

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7
Q

Signs of left sided heart failure

A

Chronic endocardial disease

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8
Q

Where do you auscultate the mitral valve

A

5th left intercostal space halfway between elbow and shoulder

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9
Q

Where do you auscultate the aortic valve

A

Left side 4th intercostal space

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10
Q

What sound is lub

A

S1 onset of ventricular systole
Closure of AV valves and opening of semilunar valves

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11
Q

What sound is dub

A

Onset of diastole
Closure of semilunar valves and opening of AV
Changes with fever, adrenaline and anaemia

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12
Q

What sound is shhh

A

S4 only audible in 60% thoroughbreds
Onset of atrial systole

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13
Q

What sound is De

A

S3 - only audible in 40% skinny thoroughbreds
Rapid ventricular filling
Loudest over cardiac apex

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14
Q

What presents are a regularly irregular rythmn that goes away with exercise

A

Second degree AV block

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15
Q

How does atrial fibrillation present

A

Irregularly irregular rythmn
Inaudible S4 (active atrial contraction)
Absence of p waves
QRS normal but irregular
Abnormally high HR at exercise

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16
Q

Grades of murmur

A

1 quiet hard to identify murmur
2 murmur quieter than heart sounds
3 murmur as loud as s1/S2
4 murmur louder than s1/S2
5 cardiac murmur with precordial thrill
6 murmur audible with stethoscope off of thoracic wall

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17
Q

When is a holosystolic murmur

A

Between cardiac sounds

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18
Q

When is a pansystolic murmur

A

Across heart sounds

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19
Q

When is a midsystolic murmur

A

Between heart sounds

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20
Q

How does endocarditis present

A

Acute onset congestive heart failure with fever, tachycardia, tachypnea and cardiac murmur
Caused by secondary bacteremia to dental/respiratory/thrombophlebitis disease

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21
Q

What is endocardiosis

A

Progressive valvular degeneration

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22
Q

Treatment/prognosis of endocarditis

A

Broad spectrum antibiotics on sensitivity
Guarded prognosis as permanent damage to valve, right sided can return to performance

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23
Q

Organisms causing endocarditis

A

Pasteurella
Actinobacillus
Streptococci
Rhodococcus equi

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24
Q

Area of endocardial infection

A

Mitral valve more than aortic
Can include aortic route
Right side associated with thrombophlebitis

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25
What is echocardiography used to assess
Doppler - valvular regurgitation 2d/m - valve structure/disease Assess chamber size
26
What are the congenital cardiac defects
Atrial septal defect Ventricular septal defect
27
What types of jugular thrombosis can occur
Non-septic - thickening/cording of the vein, reducing patency Septic - hot and painful with discharging tracts
28
What occurs with jugular thrombosis
Venous occlusion Supraorbital, cheek, lips and tongue swelling leading to dysphagia Upper airway t Proximal venous distension
29
Aetiology of jugular thrombosis
Intravenous catheterisation - poor placement, use and care Predisposed by SIRD, MODS, irritant drugs
30
What is thrombophlebitis
Blood clot with vein inflammation
31
Diagnosis of thrombophlebitis
Ultrasonography - assess extent of thrombus, identify sepsis, assess vein, distinguish perivenous swelling from thrombosis, select site for aspiration Culture - catheter tip, ultrasound guided aspirate from thrombus, Swab discharging tracts, blood
32
Treatment of thrombophlebitis
Broad spectrum antibiotics Systemic and topical anti inflammatories - aspirin, nsaids - DMSO and hot packs Heparin (or analogues) Vasodilators (glyceryltrinitrate) Raise head
33
Complications of thrombophlebitis
Embolic disease - bacterial endocarditis, septic pneumonia Long term poor performance - recurrent laryngeal neuropathy - upper airway oedema in exercise
34
Care for IV catheterisation
Insertion - sterile with minimal trauma Catheter material - polyurethane is less thrombogenic Flexible less thrombogenic Use catheter with appropriate time length Use extension set to avoid manipulation
35
What is aorto-illiac thrombosis
Partial or complete occlusion of the terminal aorta and external and internal iliac arteries Exercise induced hindlimb lameness, cold limbs, weak pulses Palpate on rectal exam - visualise ultrasound Treatment - nsaids,aspirin, fenbendazole
36
What is the most common form of sudden death during exercise
Vascular rupture - aorta and pulmonary artery most common sites
37
Aetiology of vascular rupture
Pre existing aneurysm Medial degeneration Congenital Parasitic Uterine vessels - periparturient
38
Management of vascular rupture
Reduce movement Support circulation - transexamic acid Analgesia
39
Aortocardiac fistula
Congenital or acquired hole in aortic wall Sudden death, distress, ventricular tachycardia, loud continuous murmur Intact makes more common Hopeless prognosis
40
Points of description for murmurs
Point of maximum intensity Radiation Shape Character
41
Mitral regurgitation character
All age groups Incidental finding with collapse and sudden death Timing - holosystolic, pansystolic or mid-late systolic Grade 1-6 PMI - left mitral valve Radiation - caudo-dorsally Shape - band/plateau and crescendo
42
Tricuspid regurgitation character
All age groups - racing TB and SB more common Incidental finding with collapse and sudden death Timing - holosystolic and pansystolic Grade 1-6 PMI - right tricuspid Radiation cranio-dordally Shape - band/plateau and crescendo
43
Aortic regurgitation character
Middle age to older horses Incidental, progressive to clinical when older Holodiastolic and pandiastolic timing Grade 1-6 PMI left aortic valve Radiation caudoventrally Decrescendo and musical
44
Which murmurs are well tolerated
Physiological Tricuspid and mitral without structural lesions Slow progressive aortic regurgitation in middle aged
45
Poorly tolerated murmurs
Acute onset - ruptured chordae tendineae, bacterial endocarditis, valvular disease Murmur+ concurrent arrhythmias
46
Clinical signs of pericarditis
Venous distension Ventral oedema Muffled heart sounds Pericardial friction rubs Pleural effusion
47
Aetiology and pathology of pericarditis
Majority idiopathic - eva, flu, strep.pneumoniae, e.coli, actinobacillus Tend to develop fibrinous effusion
48
Diagnosis of pericarditis
Echocardiography - fluid/fibrin in pericardial sac and compression of chambers Electrocardiography - small complexes Pericardiocentesis - cytology
49
Treatment of pericarditis
Pericardial drainage and lavage indicated if RA collapse Indwelling drain and 2x daily lavage with antibiotics Good prognosis with early aggressive treatment
50
What is myocardial disease
Disruption to action potential propagation leading to abnormalities in contraction
51
Manifestations of myocardial disease
No clinical t Poor performance - AF, VPDs (ventricular premature depolarization) Collapse - multiple VPDs, VT rarely death - VT to VF
52
Indications for blood transfusion
Fast loss O2 extraction ratio (vo2/do2) normal is 30% Tachycardia/tachypnoea Decreased pulse quality Cool extremities Pale MM Mentation changes Increased blood lactate Decreased PCV
53
Causes of myocardial dysfunction
Electrolyte abnormalities Increased myocardial muscle mass Increased chamber size - cardiomyopathy Myocarditis
54
How do you evaluate the LA myocardium
Pathology Proteins - cardiac troponin 1 - cell membrane disruption Enzymes - release by cell membrane dysfunction Creatinine kinase - myocardial isoenzyme
55
Causes of myocarditis
Bacterial - staph aureus, strep equi, clostridium chauvoei, mycobacterium spp, secondary to sepsis Viral - FMD, EIA, EVA, EIV, AHS Parasites - large strongyles, toxoplasma, sarcocystis
56
Types of cardiomyopathy in equine
Only DCM reported - subacute/chronic with dilated ventricle Myocarditis Toxic
57
Myocardial evaluation
Echocardiography - long/short axis appearance Fractional shortening - resting equipment cheap and available - telemetric/holter - 24h or exercising ecgs Dobutamine-atropine stress echo Myocardial biopsy
58
How does 2nd degree AV block look on ecg
Considered normal due to high vagal tone Missed beats on auscultation that don't occur at exercise
59
Atrial fibrillation cause
Lack of coordination in electrical activity Can be triggered by electrolyte imbalai
60
Pathophysiology of atrial fibrillation
Larger horses more susceptible - tbs, sbs, draughts High vagal tone, low heart rate
61
Clinical signs of atrial fibrillation
None Exercise intolerance Epistaxis Rare - weakness, myopathy, colic, CHF
62
Types of atrial fibrillation
Paroxysmal - only 24-48h duration, spontaneous conversion, associated with K+ depletion Sustained - longer than 24-48h
63
Diagnosis of atrial fibrillation
Auscultation and PE Resting ECG - no p waves, normal QRS, f waves Further diagnostics prior to treatment - electrolytes and acid base abnormalities - echocardiography for cause/chamber size - exercising ecg
64
Treatment of atrial fibrillation
Quinidine sulphate - use with caution, Negative inotrope, side effects include - fatal dysrhythmias, colitis, laminitis Use with caution - need repeat physical exams/auscultation/continuous ecg monitoring. Monitor toxicity with QRS complexes TVEC - one wire into left pulmonary artery and other into vein and shock
65
Prognosis of atrial fibrillation
Paroxysmal - good to excellent (unless reoccurring) Sustained - no underlying disease - good Sustained - underlying disease - average Sustained, heart failure - poor to grave
66
What dysrhythmias are not compatible with life
Asystole Ventricular fibrillation (unusual)
67
Ventricular dysrhythmia treatment
Lidocaine - first line, CRI 50mg/kg/min prolonged or boluses 0.5mg/kg every 5 mins up to 4mg/kg. SE - nystagmus, muscle twitching, disorientation, excitement, convulsions Magnesium - can be effective for refractory ventricular dysrhythmias - action not understood Procainamide Amiodarone
68
Management of bradyarrhythmias
Causes - drug administration, electrolyte derangements, intestinal disease, primary myocardial disease Treatment - - anticholinergics - glycopyrrolate, atropine, hyoscine - ventricular packing
69
blood types
A,C,D,K,P,Q,U with allelic factors important for transfusion reaction and neonatal isoerythrolysis donors - geldings Aa, Qa and Ca most immunogenic Aa and Qa common donors cross matching essential

Year 4 equine (20 decks)

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