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RUSVM LAM I > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the normal heart sounds possible in a normal equine?

A

2-4 sounds

Bah (S4) —lub (S1)————dub(S2)———-ahh(S3)

  • S1= closeure of AV valves; long, loud, low-pitched*
  • S2=Closure of semilunar valves (can be split), shorter, softer, higher-pitched*
  • S3=End of rapid filling phase*
  • S4= Atrial contraction*
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2
Q

How would you descirbe a classic physiological pulse of a horse?

A

No higher than the junction of middle to lower third of the neck with the horses head in a neutral position

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3
Q

How would you desribe a classic physiologic arrythmia in a horse?

A

Mobitz 1 Second Degree AV block (Wrenkebach)

Longer, longer, longer drop. Then you have a Wrenkebach!

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4
Q

What are the possible types of normal ausculations in terms of rhyhtm?

A

2 types of gallop rhythms:

S4-S1-S2 (Bah-lub-dub) - more common

S1-S2-S3

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5
Q

Why are radiographs done in equine cardiac evaluation?

A

To assess the effect of the cardiac function/dysfunction on the lungs

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6
Q

What are the common features of an equine ECG?

A

Notched P (/F) wave

Negative QRS complex

Large T wave

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7
Q

How can you determine whether the arrythmia you are heading is physiologic or not?

A

Exercise or scare the horse

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8
Q

A horse HR can increase from a resting rate of ___-___ bpm to ____-_____bpm in flight/while exercising . This corresponds to an increase in CO from ___ L/min to ___L/min.

A

A horse HR can increase from a resting rate of 26-32 bpm to 220-250 bpm in flight/while exercising . This corresponds to an increase in CO from 25 L/min to 300 L/min.

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9
Q

What is the most common pathologic arrythmia in horses?

A

Atrial fibrillation

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10
Q

Describe the 2 factors affecting the pathophysiology for atrial fibrillation in horses.

A
  1. Cardiac mass
    Horses have a large cardiac mass and thus high vagal tone which causes asynchrony of repolarization of atrial mass (this asynchrony does not affect the horse at rest because their HR is so slow (~30bpm))
  2. Myocardial disruption (accomapnying a disease state)
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11
Q

What are the 2 presentations for a-fib in horses?

A

Paroxysmal: Single episode of poor performance, usually disappears spontaneously within 24-48hrs ; difficullt to diagnose- must use halter monitor

Sustained: can diagnose by ausculation, classical presentation

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12
Q

What are the 3 possible clinical manifestations of a-fib?

A
  1. Most common: Primary arrhythmia without identifyable stuctural heart disease
  2. Secondary arrhythmia in absence of structural heart disease but in presence of systemic abnormality (e.g. e-yle or A/B disturbances) that predipose to the arrhythmia
  3. Secondary arrythmia associated w/cardiac disease affecting the atria
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13
Q

What are the clinical signs seen with a-fib?

How will the ausculation sound and what will the pulse quality be?

A

Exercise intolerance - quitting at the 3/4 post (problem when at maximum intensity), racing poorly (Cardiac output problem- missing atrial kick

Others dependent on underlying cause:

  • EIPH
  • Myopathy
  • Colic
  • Collapse
  • CHF

Auscultation- irregularly irregular (tennis shoe in a dryer)

Pulses- variable strength

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14
Q

In the equine patient what is the most valuable tool to evaluate the heart? What is it used to assess?

A

Echocardiographic evaluation

To assess:

  • Valvular size
  • Chamber size (LA:aoertid width ratio 1.2:1)
  • Cardiac contractility (fractional shortening, ejection fraction)
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15
Q

What is the difference between complicated and uncomplicated a-fib?

A

Presence vs absense of cardiac dysfunction

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16
Q

Your horse patient has a-fib, a normal physical exam, normal echo, but a heart rate < 60 bpm. How do you treat?

A

Quinidine (to convert to normal sinus rhythm)

Oral formulation (Quinidine sulfate) via NG tube preferred to IV

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17
Q

Your horse patient has a-fib, a normal physical exam, normal echo, but a heart rate >60 bpm. How do you treat?

A

Digoxin until HR is normal

and then Quinidine

Must normalize HR because quinidine is tachyarrythmogenic

18
Q

What complications do you need to watch for when treating with digoxin and quinidine?

A

Digoxin toxicity potential is increased by quinidine

(Also must be careful if giving phenylbutazone because it too is highly protein bound and can increase potential for drug toxicity

Quinidine toxicity: GIT sings, neuro (behavioral) signs, widened QRS complex

Idiosynchratic reaction: rapid supreventricular tachycardia (Tx= Digoxin +/- bcarb)

19
Q

If quinidine does not convert your patient from a-fib, what can you try?

A

Electocardioversion

Usually transvenous (TVEC) under general anesthesia

Amioderone (limited success, class III AA)

Flecanide (not a good choice)

20
Q

What are possible etiologies for VPCs in horses? What are the therapies indicated to manage VPCs?

A

Edx: E-lyte abnormalities, endotoxemia, myocardial inflammation, hypoxia (E.g. Surgical colic cases)

Tx: Lidocaine (treat underlying disease first)

21
Q

How would you describe the typical physiologic/functional murmur of a horse?

A

Less than Grade 3-4/6

Low intensity

Soft decrescendo or cresendo-decresendo

Left Heart base (over pulmonic and aoertic valve areas)

Systolic

Ejection murmur

Absence of precordial thrill

22
Q

How can you confirm that a murmur is physiologic?

A

Echocardiographic assessment

23
Q

What are the most common pathologic murmurs in horses?

A

VSD (most common)

ASD

PDA

24
Q

T/F: Horses rarely develop stenosis.

A

True

25
Q

Which valvular insufficiencies are most common and most significant in the horse? Which one is most likely to lead to cardiac failure?

A

Mitral- most likely to lead to heart failure

Aortic

26
Q

What clinical signs are associated with a severe mitral insufficiency? Mild?

A

Severe: Sudden death, Chordae tendinae rupture, acute decompensation in failure

Mild: Exercise intolerance

CS impacted by horse’s ‘job’

27
Q

In horses, which progresses more quickly, a degenerative or an inflammatory valvular lesion?

A

Inflammatory

28
Q

What are the important structures/funcitons ot evaluate in the ultrasonographic exam of a horse with mitral insufficiency?

A

Chamber size (LA & LV)

Regurgitation fraction

Pulmonary artery size

29
Q

What clinical sign develops when the chordae tendinae rupture?

A

Loud honking murmur

30
Q

In a horse with a mitral insufficiency, the size of __________ is an important prognostic factor, while in a horse with an aortic insufficiency the size of _________ is important.

A

Pulmonary artery

Aortic root

31
Q

How would you describe a murmur caused by aortic insufficiency?

A

Diastolic

Noisy/musical

Mostly on left but can radiate to right

Grade 2-4/6

Decresendo

PMI at 4th ICS

32
Q

T/F: Aortic insufficiency is most often found incidentally during an annual exam on an older horse.

A

True

33
Q

What valve is most commonly affected by vegetative endocarditis in a horse? What about in a cow?

A

Horse: Mitral valve (due to PULMONARY abscesses)

Cow: Tricuspid valve (due to LIVER abscesses)

34
Q

What 3 factors contribute to the development of vegetative endocarditis?

A
  1. Endothelial damage
  2. Bacterial able to adhere
  3. Local clotting activated
35
Q

What clincial signs are associated with vegetative endocarditis?

A

Fever of unknown origin (FUO)

Tachycardia, murmur

ADR with intermittent fever

36
Q

What therapies are indicated for vegetative endocarditis? What is the follow-up protocol?

A

Tx: Broad spectrum Antimicrobials q4-6 weeks (minimum), Anti-inflammatories (Flunixin, Aspirin)

Penicillin for strep

Gentamycin for actinobacillus (switch to TMS after initial IV tx)

Metronidazole for B. fragilis

Follow-up: Recheck ECG, blood culture 60 days post end AB’s

37
Q

What is the purpose of giving aspirin for vegetative endocarditis?

A

It decreases PTL aggregation thus preventing further expansion of the lesion

38
Q

What are the 2 types of pericarditis? How are they treated?

A
  1. Effusive
    * *Tx= Drainage**
  2. Constrictive/fibrinous
    * *Tx= Pericardectomy** (C/O’d in effusive to prevent contaminating thorax)
39
Q

What clinical signs are associated wiht acute pericarditis?

A

Ventral edema

Distended jugular veins

Poor pulses

Weakness

Listlessness

Colic

Syncope

Fever

40
Q

T/F: Similarly to small animals, heart failure treatment is lifelong.

A

False, usually short-term

41
Q

What are the frist 2 drugs typically used to treat heart failure in horses?

A

Enalapril (ACEi)

Furosemide (Loop diuretic)

42
Q

What drug is used to improve cardiac output in a horse in heart failure? What vasodilator has been used with some success?

A

Digoxin (inotrope)

Hydralazine

RUSVM LAM I (19 decks)

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