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Equine Final > Cardio > Flashcards

Cardio Flashcards

1
Q

What is happening during S1?

A

Mitral/tricuspid closure

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2
Q

What is happening during S2?

A

Aortic/pulmonic closure

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3
Q

What is happening during S3?

A

Rapid ventricular filling

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4
Q

What is happening during S4?

A

Atrial contraction

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5
Q

What is a common vagally mediated rhythm?

A

2nd degree AV block

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6
Q

What are the common equine cardiac arrhythmias?

A

2nd degree AV block, sinus arrhythmias, atrial fibrillation, occasional premature depolarizations (usually atrial)

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7
Q

What are some less common equine cardiac arrhythmias?

A

High-grade 2nd degree AV block, idioventricular rhythm, ventricular tachycardia

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8
Q

What is a rare equine cardiac arrhythmia?

A

3rd degree AV block

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9
Q

What is the etiology of 2nd degree AV block?

A

High vagal tone at rest

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10
Q

What is the etiology of rare APCs?

A

Atrial size, exercise

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11
Q

What is the etiology of atrial fibrillation?

A

Large atria, APCs, hypokalemia

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12
Q

How will 2nd degree AV block appear on ECG?

A

A P-wave without a QRS complex

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13
Q

Describe a physiologic (normal) 2nd degree AV block

A

Only one (or occasionally 2) dropped beats at a time, goes away with exercise

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14
Q

How will sinus arrhythmia appear on ECG?

A

Variation in R-R intervals (shorter during inhalation, longer during exhalation)

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15
Q

How do you differentiate atrial from ventricular premature contractions?

A

With an ECG; Atrial more common

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16
Q

What diseases should you consider if there are frequent premature contractions or there is concurrent tachycardia?

A

GI disease, electrolyte abnormalities, CHF

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17
Q

What should you tell an owner about a horse with premature contractions?

A

There is an increased risk of developing a dangerous arrhythmia

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18
Q

What does an atrial premature contraction look like on ECG?

A

A single early beat with an associated P wave

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19
Q

What does atrial fibrillation sound like?

A

Shoes in a dryer

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20
Q

What does atrial fibrillation look like on ECG?

A

No P waves, fibrillation on baseline of ECG

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21
Q

What are likely triggers for atrial fibrillation?

A

APCs induced by exercise, increased atrial size, or hypokalemia

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22
Q

What are the two main populations of horses that get atrial fibrillation?

A

Young active horses without structural heart disease; older horses with structural heart disease (big atria) and secondary atrial fibrillation

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23
Q

What effect does chronic duration of atrial fibrillation have on prognosis?

A

Decreases long term success of conversion

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24
Q

What should you do once you diagnose a horse with atrial fibrillation?

A

Evaluate for other signs of cardiac or systemic disease, get medication history (Thyro-L), determine onset

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25
Q

When is conversion of atrial fibrillation warranted?

A

No/minimal underlying structural disease, AF is interfering with use/activity

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26
Q

When is conversion of atrial fibrillation NOT indicated?

A

When there is significant underlying cardiac disease

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27
Q

What are the two ways to convert atrial fibrillation?

A

Pharmacological- quinidine via NG tube, electroconversion- electrical stimulus under GA

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28
Q

What is the success rate for AF conversion?

A

65-90%

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29
Q

What are the recommendations for horses with ventricular arrhythmias or 3rd degree AV block?

A

Identify underlying cause, recommend NO EXERCISE, recommend referral. After treatment there is still increased risk of recurrence so only ridden by informed adult.

30
Q

What ionophore are horses commonly exposed to when housed near ruminants? What are the clinical signs of ionophore toxicity?

A

Monensin; if short term- enterocolitis, acute myocarditis, sudden death; if long term- progressive myocarditis and fibrosis, exercise intolerance, sudden death

31
Q

What is the treatment for ionophore toxicity in horses?

A

Acute- save feed for testing, lavage stomach, administer mineral oil/activated charcoal, vitamin E, rest for 2 months; Chronic- if horse survives initial period, recommend cardiac evaluation, do not ride

32
Q

What is the prognosis for ionophore toxicity?

A

Poor if showing clinical signs, if they recovery they are likely to be limited by myocarditis

33
Q

What plants have glycosides in them?

A

Oleander, foxglove, rubber vine, lily of the valley, periwinkle, milkweed, bitter root, christmas rose, azalea, star of bethlehem, sabi star

34
Q

What are the clinical signs associated with glycoside toxicity?

A

Colic, diarrhea, ventricular arrhythmias, renal disease, sudden death

35
Q

What is the treatment for glycoside toxicity? What is the prognosis?

A

Activated charcoal via NG tube, supportive care, anti-arrhythmic drugs. Prognosis fair (good if survive short term but 50% mortality)

36
Q

What is the toxic agent in Yew? What are the clinical signs?

A

Alkaloid (taxine). Colic, arrhythmia, sudden death

37
Q

What is the toxic agent in avocado? What are the clinical signs?

A

Persin. Colic, arrhythmia, respiratory distress, neurological signs, edema

38
Q

What are potential etiologies of physiologic murmurs?

A

Anything that increases turbulence (sedation, anemia, stress, excitement)

39
Q

What are differentials for a left sided systolic murmur?

A

Physiologic, mitral regurgitation, VSD (less common location), PDA

40
Q

What are differentials for a left sided diastolic murmur?

A

Aortic regurgitation, physiologic

41
Q

What are differentials for a continuous murmur?

A

Aorto-pulmonary fistula

42
Q

What are differentials for a right sided systolic murmur?

A

Physiologic, tricuspid regurgitation, VSD

43
Q

What are differentials for a right sided diastolic murmur?

A

Aortic regurgitation

44
Q

What kind of left-sided murmur should be referred for cardiac evaluation?

A

Systolic or diastolic, grade 3/6 or louder

45
Q

What kind of continuous/machinery murmur should be referred for cardiac evaluation?

A

Any unless the patient is <1-2 weeks old

46
Q

What are other indications for referring a patient with a murmur for cardiac evaluation?

A

A murmur that has changed in character or grade, signs consistent with CHF, murmur identified on pre-purchase exam

47
Q

If you want to refer a horse but there is no referral option, what course of action should you take?

A

Rule in/out systemic disease, submit cardiac troponin I test, recommend safety guidelines, discuss signs of CHF, recommend regular auscultation

48
Q

Describe how you would perform a basic point of care echo in the field

A

Using the abdominal probe, place on the right side at the 4th intercostal space. Heart should fit on 30cm screen, L heart should be larger than R heart, L ventricle should contract down during systole, mitral and aortic valve leaflets should close fully, no pericardial fluid should be present

49
Q

What things can be detected on a basic point of care echo?

A

Moderate-severe heart enlargement, decreased contractility, obvious valvular lesions or pericardial effusion

50
Q

What are the guidelines for mild regurgitation? Moderate? Severe?

A

Mild- unlikely to cause disease, monitor, no restrictions. Moderate- repeat exam in 6 months to 1 year, make exercise recommendations based on heart structure. Severe- likely to progress, monitor closely and recommend no exercise.

51
Q

What is the most common valve for regurgitation to occur at?

A

Mitral valve

52
Q

What can severe mitral regurgitation lead to?

A

Left ventricular and atrial enlargement and eventually atrial fibrillation and CHF

53
Q

How common is tricuspid regurgitation?

A

Mild- common, severe- rare, leads to a fib and CHF

54
Q

What demographic is predisposed to aortic regurgitation?

A

Older horses

55
Q

What is the most common cause of a diastolic murmur?

A

Aortic regurgitation

56
Q

How can aortic regurgitation progress?

A

Can progress to left ventricular dilation, aortic root enlargement, and secondary mitral regurgitation. May develop ventricular arrhythmias- don’t exercise

57
Q

What does “waterhammer” pulse correlate with?

A

Large difference between systolic and diastolic pulses, left ventricular overload

58
Q

When should PDA close?

A

Within 96 hours of birth

59
Q

What kind of murmur will a PDA cause?

A

Continuous murmur loudest on left side, bounding pulses

60
Q

What is the most common congenital heart defect of horses?

A

Ventricular septal defect

61
Q

What are consequences of a VSD?

A

Left to right shunt (overloads the right heart)

62
Q

Which has a better prognosis, a loud or soft VSD murmur?

A

Loud- means a smaller defect

63
Q

Describe an aortic fistula

A

Aorto-cardiac: rare, older stallions with right sided continuous murmur, causes sudden death or CHF
Aorto-pulmonary: Fresians with left sided systolic and diastolic murmur, often concurrent with aortic rupture. causes sudden death of CHF

64
Q

Where does blood back up in right sided CHF?

A

Systemic circulation (jugular veins, portal veins)

65
Q

Where does blood back up in left sided CHF?

A

Lungs

66
Q

What are common signs of left sided CHF?

A

Pulmonary edema, increased RR and effort, crackles, frothy-pink nasal discharge, tachycardia, poor perfusion, weight loss, exercise intolerance

67
Q

What are common signs of right sided CHF?

A

Jugular vein pulsation, portal hypertension, ventral edema, murmur, tachycardia, poor perfusion, exercise intolerance, weight loss

68
Q

What is the prognosis for horses in fulminant CHF?

A

Poor to guarded unless the disease is reversible (pericarditis)

69
Q

How is CHF treated?

A

Diuretics (furosemide or torsemide), ACE inhibitors (benazepril), digoxin (positive inotrope)

70
Q

Describe bacterial endocarditis

A

Causes fever, depression, anorexia, and weight loss. Diagnose with U/S, CBC, and blood culture. Treat with aggressive antibiotic therapy and supportive care.

71
Q

What is pericarditis most commonly associated with?

A

Respiratory disease (or mare reproductive loss syndrome)

Equine Final (5 decks)

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