Cardio - Congenital Diseases Flashcards
How is a grade I murmur described?
Soft murmur heard in only 1 valve location, only in very quiet room, may only be intermittent
How is a grade II murmur described?
Soft murmur heard consistently, but only in 1 valve area
How is a grade III murmur described?
Moderate murmur heard in multiple valve locations on one side of the chest
How is a grade IV murmur described?
Loud murmur heard on both sides of the chest
How is a grade V murmur described?
Loud murmur heard at all valve locations associated with precordial thrill
How is a grade VI murmur described?
Loud murmur heard at all valve locations, even with stethoscope held 1 cm from chest wall
What are the locations for describing murmurs?
L apical, L basilar, R apical, parasternal
What are the timing categories for murmurs?
Systolic, diastolic, continous, to-and-fro
What are ways to describe the quality of a murmur?
Regurgitant (plateau), ejection (crescendo-decrescendo), machinery, decrescendo
What are “innocent” puppy/kitten murmurs?
physiologic murmurs without structural heart disease
Why are physiologic murmurs common in puppies and kittens?
They have larger SV than adults –> turbulence in Ao/PA
Thinner chest walls
Higher SNS tone
Anemia (lower blood viscosity)
What are characteristics of innocent murmurs?
Soft (grade I-III), L-sided, early or mid-systolic, disappear by 4-6 months
What are the most common congenital heart diseases in puppies?
PDA, PS, SAS
What is a PDA?
patent ductus arteriosus;
Failure of closure of ductus arteriosus (descending Ao –> MPA)
What are the consequences of a PDA?
L-R shunt –> LV volume overload –> L-CHF
What is the signalment for PDA?
Poodle, Sheltie, Pomeranian, Cocker, Maltese, Yorkie, GSD
Female > male
What kind of murmur is heard with PDA?
Continuous “washing machine” murmur at L heart base
What is the prognosis of PDA with and without treatment?
With = normal life
Without = POOR
What are the 2 types of treatment for PDA?
Interventional catheterization (ACDO)
Surgical ligation (thoracotomy)
What is PS?
Pulmonic Stenosis:
Congenital narrowing/thickening of the pulmonic valve
What are the consequences of PS?
RV pressure overload –> R-CHF, syncope, arrhythmias
What is the signalment for PS?
Smaller breeds (3 Bs: Boxer, Beagle, Bulldog), Chihuahua, Schnauzer
Male = female
What murmur type is heard with PS?
Systolic ejection murmur at the L heart base
What is the prognosis of PS?
Depends on severity;
Mild = normal lifespan
Severe = guarded with no treatment, good with balloon valvuloplasty
What are the treatment options for PS?
Mild/moderate = atenolol
Severe = balloon valvuloplasty
When should you refer a systolic L-sided murmur to a cardiologist?
If it is LOUD (grade IV or higher);
If it is soft, recheck and refer if still present >6 months
What is SAS?
Subaortic Stenosis
Congenital ridge/narrowing below aortic valve
What is unique about SAS?
The lesion continues to pregress throughout growth
What are the consequences of SAS?
LV pressure overload –> LVH –> syncope, arrhythmias, sudden death, L-CHF, endocarditis
What is the signalment for SAS?
Large breeds (Newife, Boxer, GSD, Gonden, Rottie)
Male = female
What type of murmur is heard with SAS?
Systolic ejection murmur at L heart base
What is the prognosis for SAS?
Depends on severity:
Mild = normal lifespan without tx
Severe = ~5 years (bimodal)
What is the treatment for SAS?
Atenolol if mod/severe;
No good procedure - balloon valvuloplasty NOT effective
This is not a valve that you can just pop open like in PS
How long do echoes need to be rechecked in SAS?
Continue rechecking as an adult as the disease progresses until dog is fully grown
What are other congenital heart diseases in dogs?
VSD - R sided murmur
Tricuspid valve dysplasia - Labs, R-sided murmur
Cyanotic heart defects (R to L shunting) - tetralogy of Fallot, reversed VSD/PDA
When should you refer a puppy with a murmur?
Any continous, diastolic, or R-sided murmur
L-sided murmur if you can hear it on both sides
Any murmur still heard after 6 months
What are the most common congenital heart diseases in kittens?
VSD, AV valve dysplasia
_____ murmurs are more common in cats than dogs, even as adults.
physiologic
Why are there fewer surgical/interventional options for congenital diseases in cats?
They are small
_____ heart disease is still a reasonable differential for cats <1 yr
acquired
What is a VSD?
Ventricular Septal Defect:
Abnormal communication between LV and RV
What are consequences of VSDs?
L-R shunting –> LV volume overload –> L-CHF
What type of murmur is seen with VSDs?
Systolic plateau or decrescendo murmur @ R side
What is the prognosis for a small/restrictive VSD?
Normal lifespan with no treatment (LOUD murmur!)
What is the prognosis for a large/nonrestrictive murmur?
L-CHF (softer murmur)
What size VSD is more common?
small/restrictive
What is the treatment for a small VSD?
none
What is the treatment for a large VSD?
Treat CHF when it occurs;
No corrective procedure in cats (can attempt surgery or device closure in dogs)
What is mitral and tricuspid valve dysplasia?
Abnormal development and leakage/stenosis of mitral and/or tricuspid valves
What are the consequences of MV/TV dysplasia?
LV or RV volume overload –> R- or L-CHF
What murmur is heard with MV/TV dysplasia?
Systolic plateau/regurg murmur @ L or R apex
What is the prognosis of MV/TV dysplasia?
Depends on degree of dysplasia/regurg/stenosis
What is the treatment for valve dysplasia?
Treat CHF when it occurs, no corrective procedure available
When should you refer a kitten with a murmur?
Same rules as dogs, but there are fewer surgical/interventional options for cats
What age has innocent murmurs?
<4 months
What is the intensity of an innocent murmur?
I-II, maybe III
What is the timing of an innocent murmur?
systolic
What is the location of an innocent murmur?
L side
