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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
Q

What is echocardiography used to assess

A

Doppler - valvular regurgitation
2d/m - valve structure/disease
Assess chamber size

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26
Q

What are the congenital cardiac defects

A

Atrial septal defect
Ventricular septal defect

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27
Q

What types of jugular thrombosis can occur

A

Non-septic - thickening/cording of the vein, reducing patency
Septic - hot and painful with discharging tracts

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28
Q

What occurs with jugular thrombosis

A

Venous occlusion
Supraorbital, cheek, lips and tongue swelling leading to dysphagia
Upper airway t
Proximal venous distension

29
Q

Aetiology of jugular thrombosis

A

Intravenous catheterisation - poor placement, use and care
Predisposed by SIRD, MODS, irritant drugs

30
Q

What is thrombophlebitis

A

Blood clot with vein inflammation

31
Q

Diagnosis of thrombophlebitis

A

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
Q

Treatment of thrombophlebitis

A

Broad spectrum antibiotics
Systemic and topical anti inflammatories
- aspirin, nsaids
- DMSO and hot packs
Heparin (or analogues)
Vasodilators (glyceryltrinitrate)
Raise head

33
Q

Complications of thrombophlebitis

A

Embolic disease
- bacterial endocarditis, septic pneumonia
Long term poor performance
- recurrent laryngeal neuropathy
- upper airway oedema in exercise

34
Q

Care for IV catheterisation

A

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
Q

What is aorto-illiac thrombosis

A

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
Q

What is the most common form of sudden death during exercise

A

Vascular rupture - aorta and pulmonary artery most common sites

37
Q

Aetiology of vascular rupture

A

Pre existing aneurysm
Medial degeneration
Congenital
Parasitic
Uterine vessels - periparturient

38
Q

Management of vascular rupture

A

Reduce movement
Support circulation - transexamic acid
Analgesia

39
Q

Aortocardiac fistula

A

Congenital or acquired hole in aortic wall
Sudden death, distress, ventricular tachycardia, loud continuous murmur
Intact makes more common
Hopeless prognosis

40
Q

Points of description for murmurs

A

Point of maximum intensity
Radiation
Shape
Character

41
Q

Mitral regurgitation character

A

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
Q

Tricuspid regurgitation character

A

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
Q

Aortic regurgitation character

A

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
Q

Which murmurs are well tolerated

A

Physiological
Tricuspid and mitral without structural lesions
Slow progressive aortic regurgitation in middle aged

45
Q

Poorly tolerated murmurs

A

Acute onset - ruptured chordae tendineae, bacterial endocarditis, valvular disease
Murmur+ concurrent arrhythmias

46
Q

Clinical signs of pericarditis

A

Venous distension
Ventral oedema
Muffled heart sounds
Pericardial friction rubs
Pleural effusion

47
Q

Aetiology and pathology of pericarditis

A

Majority idiopathic - eva, flu, strep.pneumoniae, e.coli, actinobacillus
Tend to develop fibrinous effusion

48
Q

Diagnosis of pericarditis

A

Echocardiography - fluid/fibrin in pericardial sac and compression of chambers
Electrocardiography - small complexes
Pericardiocentesis - cytology

49
Q

Treatment of pericarditis

A

Pericardial drainage and lavage indicated if RA collapse
Indwelling drain and 2x daily lavage with antibiotics
Good prognosis with early aggressive treatment

50
Q

What is myocardial disease

A

Disruption to action potential propagation leading to abnormalities in contraction

51
Q

Manifestations of myocardial disease

A

No clinical t
Poor performance - AF, VPDs (ventricular premature depolarization)
Collapse - multiple VPDs, VT
rarely death - VT to VF

52
Q

Indications for blood transfusion

A

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
Q

Causes of myocardial dysfunction

A

Electrolyte abnormalities
Increased myocardial muscle mass
Increased chamber size - cardiomyopathy
Myocarditis

54
Q

How do you evaluate the LA myocardium

A

Pathology
Proteins - cardiac troponin 1 - cell membrane disruption
Enzymes - release by cell membrane dysfunction
Creatinine kinase - myocardial isoenzyme

55
Q

Causes of myocarditis

A

Bacterial - staph aureus, strep equi, clostridium chauvoei, mycobacterium spp, secondary to sepsis
Viral - FMD, EIA, EVA, EIV, AHS
Parasites - large strongyles, toxoplasma, sarcocystis

56
Q

Types of cardiomyopathy in equine

A

Only DCM reported - subacute/chronic with dilated ventricle
Myocarditis
Toxic

57
Q

Myocardial evaluation

A

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
Q

How does 2nd degree AV block look on ecg

A

Considered normal due to high vagal tone
Missed beats on auscultation that don’t occur at exercise

59
Q

Atrial fibrillation cause

A

Lack of coordination in electrical activity
Can be triggered by electrolyte imbalai

60
Q

Pathophysiology of atrial fibrillation

A

Larger horses more susceptible - tbs, sbs, draughts
High vagal tone, low heart rate

61
Q

Clinical signs of atrial fibrillation

A

None
Exercise intolerance
Epistaxis
Rare - weakness, myopathy, colic, CHF

62
Q

Types of atrial fibrillation

A

Paroxysmal - only 24-48h duration, spontaneous conversion, associated with K+ depletion
Sustained - longer than 24-48h

63
Q

Diagnosis of atrial fibrillation

A

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
Q

Treatment of atrial fibrillation

A

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
Q

Prognosis of atrial fibrillation

A

Paroxysmal - good to excellent (unless reoccurring)
Sustained - no underlying disease - good
Sustained - underlying disease - average
Sustained, heart failure - poor to grave

66
Q

What dysrhythmias are not compatible with life

A

Asystole
Ventricular fibrillation (unusual)

67
Q

Ventricular dysrhythmia treatment

A

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
Q

Management of bradyarrhythmias

A

Causes - drug administration, electrolyte derangements, intestinal disease, primary myocardial disease
Treatment -
- anticholinergics - glycopyrrolate, atropine, hyoscine
- ventricular packing

69
Q

blood types

A

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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