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Equine Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What would you find on physical exam that would be indicative of mild cardiovascular disease

A

no clinical signs

reduced exercise tolerance

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2
Q

What clinical signs would you find on physical exam for moderate cardiovascular disease?

A
  • tachycardia
  • tachypnea
  • dyspnea post exercise
  • abnormal arterial pulse
  • jugular distension
  • edema over ventral abdomen- dependent edema in the intradermal space
  • edema in distal limbs
  • pathological arrhythmias.
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3
Q

Physical exam findings indicative of severe cardiac disease

A
  • cool extremities
  • weight loss over time
  • reduced capillary refil time
  • cough (left-sided failure)
  • dyspnea at rest
  • collapse
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4
Q

normal resting heart rate in horses

A

20-40 bpm

All 4 heart sounds are often present

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5
Q

Explain S4 on auscultation

A

Atrial sound (Ba)

  • Low frequency
  • arises from the ventricular vibrations set up when pressure wave caused by atrial contraction reaches the ventricles
  • Occurs immediately prior to S1
  • Arrhythmias
    • Isolated S4 in 2nd degree A-V block
    • Absent in sinoatrial block
  • immediately precedes “lub” (S1)
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6
Q

S1 on Auscultation

A

“Lub”

  • Arises from the ventricle after AV valve closure
  • Split S1 is rarely heard in horses
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7
Q

S2 on auscultation

A

Sound 2- “dub”

  • Sharp and clear
  • Sound is made by the closure of the semi-lunar valvaes and rapid reversal of blood flow
    • A split S2 is uncommon and is often confused with S2-S3 associations
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8
Q

S3 on Auscultation

A
  • Made by early, rapid ventricular filling
  • Heard in about 30-50% of horses
  • Heard chiefly on the left side of horse
  • .14-.17 seconds after onset of S2
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9
Q

What are ascultation sites for cardiac evaluation.

where can you hear S2 and S1 the loudest?

A

Mitral valve 5-6 intercostal space. S1 can be heard the loudest here

Aortic valve 4-5 intercostal space located dorsally in comparison to the others. S2 can be heard the loudest here

Pulmonic valve 3-4 intercostal space located behind the limb.

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10
Q

Origin of the P-wave on Electrocardiography

A

Depolarization with a wave spreading from the S-A node across the right atrium. the interatrial septum and then the left atrium

The P- wave is often bifid at rest

  • first small “hump” represents right atrial depolarization
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11
Q

Origin of the QRS complex on electrocardiography

A
  • Depolarization not as a wavefront across the chambers due to the complexity of the conducting system. Reflects the His-purkinje system
  • Vector analysis of equine QRS is NOT valid. many of the dipoles cancel each other out
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12
Q

T wave Electrocardiography wave origins

A

Repolarization of the ventricles

  • equine T-wave is very labile- may change shape while watching ECG, this occurs with a change in heart rate.

Cannot be used to assess “heart strain”

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13
Q

What part of the cardiac cycle is associated with Systole?

A
  • QRS complex - T wave.
  • Lub- Dub
    • Lub- AV valve closure
    • Dub- Closure of semilunar valves.
  • The time between Lub and Dub should be silent.
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14
Q

If worried about performance horses and cardiovascular abnormalities, what tests should you perform

A
  • Echocardiography used to identify arrhythmias
  • Exercise testing- cardiac evaluation should be performed at or immediately after expected level of exercise.
    • Heart function changes rapidly with cessation of exercise, but assessment of HR and rhythm difficult at intense exercise.
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15
Q

Wandering pacemaker

A

not clinically significant

P-wave shape may change from beat to beat, but the rhythm is regular

Reflects changing sites within the S-A node for impulse generation

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16
Q

Premature sinus beats

A
  • P waves earlier than normal, but of normal conformation
  • normal QRS
  • All 4 heart sounds often present
  • often disappears with exercise
  • Occasional one is not significant
  • if found frequent, myocardial disease is suggested
  • Rest these horses and reevaluate in 4-6 months.
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17
Q

Premature atrial beats

A

Premature sinus beat (Early P waves) with ABNORMALLY shaped P wave.

  • if frequent, suggests myocardial disaese
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18
Q

Describe a Sino-atrial block

A

No P-wave and a twice normal diastolic pause

This pause is silent

More common in ponies

Abolished by Exercise

Vagally mediated

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19
Q

Describe Sinus bradycardia

A

Atrial Arrhythmia

This is very rare- mostly in ponies

  • very slow irregular atrial rhythm

reduced exercise or even lethargy

may resolve with rest.

20
Q

Describe Post exercise sinus arrhythmias

A

Common after light trotting exercise in fit horses

As the heart rate slows, there are sudden pauses, and then a gradual return tothe pre-pause rate

Not usually significant, and can be abolished by more rigorous exercise

-Possibly vegally mediated.

21
Q

Describe Atrial fibrilation

A

- Large horses (rare in ponies and foals)

  • variable signs

On auscultation

- NO atrial sounds (S4)

- Irregularly spaced group of irregular beats

Heart rate 30-40 or up to 80-100

-May have pulse deficits.

22
Q

Treatment for Atrial fibrilation

A

Best done early in the disease

-Oral quinidine is the drug of choice, administer via nasogastric tube

Warning- toxicosis can develop if you exceed 90 grams/day in 1000lb horse

23
Q

First degree AV block

A

Common finding

Increase in P-Rinterval at rest

As P-R interval increases, so does the S4-S1 interval

This finding is not clinically significant

24
Q

Describe an Second degree (partial) Atrio-ventricular block

A

verry common in fit, large horses

  • Mobitz I - gradual increases in the P-R interval, then impulse blocked at A-V node
  • Movitz II - may have no apparent increase in P-R interval with spontaneous occasional block at the A-V node
  • Can detect on auscultation: diastolic pause twice the normal length with S4 in the middle of the pause

can be induced by Alpha 2 agonists such as xylazine and detomadine

25
Q

You are ausculting a large, fit horse and notice a diastolic pause twice the normal length with S4 inthe middle of the pause.

What is your diagnosis

A

Second degree AV block.

26
Q

identify the rhythm

A

Second Degree (partial) AV block

27
Q

identify the rhythm

A

Third degree AV block. P waves occur with occational QRS complexes seen. These are asynchronous

28
Q

Explain PVC’s (VPC’s)

A

Occational one in a 5 min period is not uncommon.

Earlier and Louder than a normal beat but NOT preceded by the atrial sound (S4)

Often followed by a compensatory pause - acting as a reset

Can be seen with ingestion of substances such as ionophores

29
Q

Ventricular tachycardia

A

This is very rare in horses.

Treatment of choice is Lidocaine.

You may see this when there is a toxicity with treatment of atrial fibrilation

30
Q

describe a situation when you would see this rhythm

A

Multiform ventricular tachycardia-

Seen with an acute onset of pulmonary edema

Also seen during euthanasia procedures.

31
Q

T/F the loundess of a murmur is indicative of of significance of a lesion

A

False

32
Q

what is the most common pathology associated with equine murmur

A

Most equine murmurs are due to non-infectious acquired lesions: fibrous & degenerative valvular changes of unknown etiology

33
Q

Where do you hear Systolic murmurs the loudest and causes of each location

A
  • Systolic murmurs are audible over the aortic root.
    • Physiologic ejection murmor (common)
    • aortic stenosis (very rare)
  • Audible over the Mitral Valve
    • most due to mild forms of mitral insufficiency
    • Mitral chordae tendinae
    • Can impact peak athletic performance
34
Q

what are clinical symptoms of rupture of the mitral chordae tendinae?

A
  • animal drops dead
  • Sudden onset of pulmonary edema with dyspnea
  • heart failure develops in 24-48 hrs
  • loud widely radiating pansystolic murmur, often with a palpable thril
35
Q

what is the #1 systolic murmur found in Equids? Where in the cardiac auscultation would you ear it?

A

Mitral insufficiency. You would hear this murmur between the lub and dub.

36
Q

What happens to blood flow if there was a rupture of the mitral chordae tendinae?

A

The reversal of flow across the mitral valve.

37
Q

what is the most common cause of diastolic murmurs? how does this murmur sound?

A

Aortic insufficiency - often progressive aortic valvular degeneration

Murmur varies from musical, a pure tone, to a noisy mixed murmur

-pandiastolic. you would hear this murmur between dub to lub. the dub can be masked by this murmur

38
Q

Endocarditis in Equids

A
  • care
  • The most common valve affected is the aortic
  • Clinical signs: fever,anorexia, weight loss

murmur and heart failure generally develops late in the disease

this has a grave prognosis

39
Q

what are the most common congenital lesions associated with Equine cardiovascualr disease

A
  • Ventricular Septal Defect is most common (arabians most common breed)
  • PDA is rareNext
40
Q

Explain PDA, pathology, and treatment

A

PDA’s are rare

-Eicosanoids are required for maintaining patency

Treatment includes NSAIDs, which counteract the Eicosanoids

Generally closes within 4 hours

41
Q

What medication do you use to treat a PDA

A

flunixin meglumine

Acts by counteracting the Eicosanoids which are required for maintaining patency

42
Q

what animal is Aortic Stenosis more common in.

Where in the rhythm do you haer this

A

uncommon in horses but common in New Foundland dog.

Heard between lub and dub, S1 and S2

43
Q

What is the biggest risk factor for development of fibrinous pericarditis

A

Eastern tent caterpillars which is associated with cherry trees.

44
Q

Sound 3 of the cardiac cycle is produced by the sounds associated with

A

Rapid ventricular filling

45
Q

Sound 4 of the cardiac cycle is produced by the sounds associated with:

A

atrial contraction

46
Q

A twice normal diastolic pause is ausculted in a horse. During the pause, a distinct heart sound is detected. These findings are most consistent with

A

2nd degree atrio-ventricular heart block.

Equine Medicine (5 decks)

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