Cardiorespiratory Flashcards
1
Q
small animal common breed issues
A
brachycephalics - BOAS
small dogs - tracheal collapse
large dogs - laryngeal paralysis
ask about familial issues
2
Q
age related common URT issues
A
young - congenital or infectious
old - neoplasia
3
Q
URT exam small animal
A
nares - discharge, stenosis, air flow (unilateral and bilateral)
facial asymmetry, pain - severe infection or neoplasia
ocular - retropulsion (decreased in dental disease and neoplasia), discharge, palpebral swelling (vitamin a deficiency in reptiles)
ears - otitis secondary to dental, polyps
laryngeal and tracheal palpation - foreign body, trauma, kennel cough
auscultation - stridor (laryngeal), stertor (nasal)
oral cavity - dental, choana, soft palate
4
Q
primary nasal and nasopharyngeal signs
A
nasal discharge
sneezing
stertor (snoring)
distortion of facial anatomy
neuro signs (rare)
5
Q
primary laryngeal signs
A
stridor
decreased heat tolerance
voice change (esp birds)
cough
respiratory distress
6
Q
primary tracheal signs
A
cough
respiratory distress - in severe cases
7
Q
specific disease testing - nasopharyngeal
A
PCR swabs
cats - chlamydia felis, calicivirus, herpesvirus, m felis, b bronchiseptica
dogs - adenovirus, parainfluenza, herpes, distemper, b bronchiseptica, mycoplasma spp
small mammals - b bronchiseptica (guineas and rabbits), p multocida and chalmydia (rabbits)
tortoise - herpesvirus, mycoplasma spp, picornavirus (useful to differentiate vial from bacterial)
snakes - adenovirus, reovirus, arenavirus, paramyxovirus, ferlavirus, nidovirus
birds - chlaydia psittaci
8
Q
nasal flush
A
head towards floor - aspiration
sterile saline
cytology and culture
can flush out foreign body - therapeutic
9
Q
nasal swab
A
better sensitivity if deep swab - needs deep sedation or GA
not as useful as flush
10
Q
radiograph - nasal and nasopharynx
A
mostly just useful for dental disease
11
Q
CT - nasal and nasopharynx
A
cross sectional - avoids superimposition of structures
space occupying lesions
surgical planning
if can’t get endoscope through
needs GA
12
Q
rhinoscopy - nasal and nasopharynx
A
preferred
rigid endocscope
deep GA
risk of haemorrhage
masses, fungal plaques, foreign bodie
endocope guided biopsies
samples for culture
targeted treatment or flushes
13
Q
pharygocopy
A
flexible scope - retroflex behind soft palate for caudal nasopharynx
foreign bodies, polyps and stenosis above soft palate
14
Q
emergency management of epistaxis
A
reduce BP to slow bleeding - cage rest, sedation
reduce bleeding - ice packs or packing in nose
treatment for hypovolemic shock (rare)
treat underlying disease
15
Q
common underlying causes - emergency epistaxis
A
coagulopathy
invasive nasal disease
trauma - foreign body, penetrating injury
16
Q
viral causes - nasal and nasopharynx - small animal
A
kennel cough
cat flu
tortoise - herpes
snakes - all viruses - poor prognosis
ferrets - human strains of influenza
17
Q
viral - nasal and nasopharynx - treatments
A
NSAIDs
Nebulisation
systemic mucolytics
fluid therapy
supportive feeding
feline herpes virus - ocular topical antiviral preparations, famciclovir, omega interferon systemic
chelonian herpes - aciclovir (expensive)
18
Q
bacterial causes - nasal and nasopharynx - small animals
A
primary rarer than secondary to immunocompromise or infection
b bronchiseptica
p multocida - rabbits
mycoplasma - birds, chelonia, rats
chlamydia - birds and cats
19
Q
bacterial - nasal and nasopharynx - treatment
A
systemic antibiotics
systemic mucolytics
NSAIDs
supportive care - nebulisation, assisted feeding, fluid
prevention - vaccination and reduced stressors
20
Q
primary conditions - bacterial nasal and nasopharynx
A
viral or fungal infection
dental disease
foreign body
neoplasia - necrosis, inflammation, obstruction
trauma - foreign bodies, penetrating injuries
hypovitaminosis A - damage to epithelium –> immunocompromise
21
Q
fungal disease - small animals - nasal and nasopharynx
A
aspergillosis
dogs - disseminated - immunocompetant
birds - usually immunocompromised
21
Q
foreign body - nasal and nasopharynx
A
cats - grass blade behind soft palate
dog - grass seeds, stones
small mammals and chelonia - hay
removal
treatment of secondary infection
NSAIDs for pain
21
Q
fungal treatment - small animal - nasal and nasopharynx
A
topical - irrigation post debulking, nebulisation with anti fungal agents (amphotericin B, azoles, terbinafine)
systemic -
azoles - don’t use itraconazole in african grey parrots
amphoterin B
terbinafine
supportive care - treat secondary infection, liver support, GI support
monitor - bloods for liver and WBCs
21
Q
trauma - nasal and nasopharyngeal
A
internal - stick injuries
external - bite wounds
remove stick if present
analgesia
treat secondary infections
21
nasopharyngeal polyps - small animal
common in cats
benign - in cats from the lining of the middle ear (hypoplasia)
remove via traction
surgery - incision through midline of soft palate
22
neoplasia - nasal and nasopharyngeal
adenocarcinoma - most common
other epithelial also quite common
radiotherapy
surgery in some cases for reduction
sometimes chemo
10-18 month median survival
23
specific disease testing - layrngeal disease
rare without concurrent signs
kennel cough - usually other signs but can be only laryngeal
24
radiograph - laryngeal disease
masses or obstruction
not that useful
best without ETT
25
CT - laryngeal disease
better sensitivity than radiograph
can access airway lumen
26
MRI - laryngeal disease
soft tissue lesions
airway narrowing
27
laryngoscopy - laryngeal disease
most useful
assessing normal function - arytenoid abduction
thickening
masses
everted laryngeal saccules - BOAS
extraluminal masses - compress airways
laryngeal collapse
28
treatment - laryngitis
inflammation - eg kennel cough, irritation, trauma
NSAID - mild cases
steroids - more severe
treat underlying condition
severe cases - oedema and obstruction - steroids, oxygen, sedation or GA, intubation, tracheostomy
29
treatment - foreign body - laryngeal
less common than nasal or tracheal
remove
treat irritation and secondary infection
tracheostomy if obstructed
30
treatment - trauma - laryngeal
treatment of cartilage fractures - surgery - fibrotic tissue may form in healing, ongoing stenosis
31
emergency treatment - laryngeal
Often present as emergencies
oxygen
sedation
intubation/tracheostomy
antibiotics
steroids - for oedema
surgery - soft tissue repair, remoev foreign bodies, repair cartilage fractures, manage secondary laryngeal paralysis
32
treatment - laryngeal paralysis
common in large dogs - roaring sound
failure of arytenoid and vocal fold movement in inspiration
muscle or nerve damage or generalised neuropathy in cats
cyanosis and collapse in severe cases
anti inflammatories
surgery - laryngoplasty (tie back)
33
treatment - neoplasia - laryngeal
advance imaging to assess
benign - surgery
malignant - surgery, radiotherapy, chemo
34
specific disease testing - tracheal
rarely indicated
kennel cough
35
radiograph and CT - tracheal
tracheal collapse
foreign bodies
stenosis
rule out cardio and pulmonary disease
36
fluroscopy - tracheal
dynamic disease - eg trahceal collapse
can be done conscious
see what happens in breathing or coughing
negative pressure to see if tracheal collapse
assess where to put a stent
37
tracheobroncosopy - trachea
endoscopy
evaulate dynamic disease
masses
foreign bodies
cytology of biopsy samples
pass tube via ETT
38
tracheal wash
saline pushed in then reaspirated
GA
blind or by endoscope
conscious or sedated - LA under skin and catheter pushed through neck into trachea
39
treatment - tracheitis
infection, irritation, trauma
NSAIDs - mild
steroids - severe
treat underlying infection
small foreign body - irritation without obstruction - remove
40
treatment - tracheal obstruction
remove obstruction - may need surgery if big but often complications in tracheal surgery
NSAIDs
treatment of secondary infection
tracheostomy
41
treatment - tracheal trauma
assess any cervical bite for airway damage
can be iatrogenic damage from ETT (cats most common)
penetrating injury - surgical repair, cuff ETT distal to site
minor injury - debridment and primary closure
major injury - resection and anastomosis (stenosis common sequelae)
supportive care - analgesia, antibiotics, airway maintenance until healing (swelling obstruction after surgery)
42
treatment - tracheal stenosis
narrowing of trachea - iatrogenic, traumatic, or neoplasic
oxygen
anxiolytics
dilation - balloon catheter or bougie - can cause fibrosis
stent
low dose rpeds after surgery to prevent stricutre
43
treatment - tracheal collapse
toy breeds predisposed
collapse of cartilage rings
emergency management - cool dark environment (stress), oxygen, sedation, cough suppression, steroids
ongoing -
BCS control
exercise restriction
harness
avoid smoke or heavy perfume
treat concurrent respiratory disease
sedatives in stressful circumstances
conservative management -
steroids
antitussives
antisecretory
bronchodilators
antibiotics
surgical management - extraluminal ring prosthesis, stent
44
BOAS components
all or some of -
stenotic nares and nasal passages
overlong soft palate
laryngeal saccule eversion
tracheal hypoplasia
45
BOAS emergency management
oxygen
sedation
short acting steroids
intubation or tracheostomy
cool dark environment
active cooling if hyperthermic
46
BOAS management
weight management
avoid walking if hot
anti-inflammatories
manage GI signs
47
BOAS surgery
indicated if acute distress or where signs persist with management
correction of stenotic nares
resection of aberant turbinates
soft palate resection
layrngeal sacculectomy
laryngeal tie back
48
BOAS prevention
breed for respiratory function
kennel club respiratory function scheme
49
Cario Physical Exam
heart rate
rhythm
murmur
gallop
femoral pulses
respiratory exam
50
diagnostic tests - cardio - blood pressure
all patients with cardiac disease
can have hyper or hypo tension
hypotension - usually reduced CO - DCM and arrythmia
Hypertension - cats, chronic hypertension can cause hypertrophy, MMVS in dogs,can worsen mitral regurgitation
Doppler
oscillometric
invasive
consider ACE inhibitors
51
diagnostic tests - cardio - hematology and biochem
screening of general health
presence of systemic conditions
52
diagnostic tests - cardio - NT-proBNP
differentiating cardiac from respiratory
stretching of cardiac chambers
cats -
>100 - increased stretch, further investigation
>270 - respiratory signs secondary to cardiac failure
dogs -
900-1800 - increased stretch
>1500 - increased risk of heart failure in next 12 months
>1800 - likely clinical signs of heart disease
breed differences -
doberman - >735 - increased risk of DCM
labrador - can be normal <2000
SNAP test - good for emergency to differentiate cardiac and respiratory in dyspnoeic patients
53
diagnostic tests - cardiac - troponin
releases in repsonse to cardiac injury - cardiac injury or necrosis indicator
extremely high in myocarditis and sustained ventricular arrhythmia
54
diagnostic tests - cardiac - ECG
establish nature of an arrythmia
NB arrythmias not necessarily cardiac in origin - can be systemic disease
dobermans and boxers - often arrythmia before murmur (non-clinical stage)
55
diagnostic tests - cardiac - thoracic ultrasound
emergency assessment of dyspnoeic patients
differentiate cardiac and respiratory
looking for left atrial enlargement - bascially always cardiac origin
also look for pleural or pericardial effusion
56
diagnostic tests - cardiac - echo
specific diagnosis
assess function
murmur investigation
advised if MMVD murmur 3/6 or higher
screening for at risk breeds
measurements to assess slight dilations, thickenings, valvular prolapse
colour doppler setting to see regurgitation
57
diagnostic tests - cardiac - radiography
best test for congestive heart failure
staging cardiomegaly
use when concurrent disease to see if respiratory failure
stabilise first
sedation - riskier in heart patients but can be done safely - butorphanol and alfax/propofol
size of heart
shape of heart
venous congestion
trahceal collapse
lung patterns
vertebral heart score - long axis and perpendicular axis - serial measurement to monitor progression
vertebal left atrial score - central ventral aspect of carina to caudal aspect of left atrium - differentiate stages of heart disease
measure vertebrae from T4
58
Preclinical management of cardiac disease
delay progression of disease
arrythmias - preclinical in large breeds
antithrombotics - clodidogrel or aspirin - prevent thromboembolism in cats (most significant preclinical risk)
investigate at risk animals
MMVD - investigate form 3/6 murmur
dobermans - screen from 3-4 yo
cats - screen if gallop, murmur or arrhythmia
pimbobendan - improved muscle contraction and vasodilation, improved cardiac output, delayed onset of clinical disease, improved outcoems in MMVD and DCM
59
clinical management of cardiac disease
manage congestion, cardiac output and RAAS
ideally owners can monitor increased resting respiratory rate/effort at home for early warning
pimobendan - control cardiac output
clodidogrel - antithromboembolitic
ACE inhibitors - loop of henles diuretics - fureosemide, torasemide
thiazides - act on DCT - hydrochlorthiazide
spironolactone - aldosterone agonist
ACEI, thiazides and sprionolactone work on different parts of RAAS - can use in combination
benazepril + spironolactone = cardalis - controls 2 arms of RAAS
risk of RAAS suppresion:
decrease blood pressure
decrease GFR
hyperkalemia
kidney injury in azotemic patients
60
deleterious effects of RAAS
electrolyte derangements
myocardial hypertrophy
fibrosis
formation of reactive oxygen species
inflammatory cytokines
61
surgical options for cardiac disease
mitral valve repair - gold standard
transcatheter edge to edge repair - safer alternative to valve repair when contraindications for surgery, cheaper and more available
transeptal puncture - palliative surgery, used to decompress left atrium and reduce pressure - in cases of advanced refractory heart failure
not many places that do them and expensive
but actual fix
should be offered as an option
62
MMVD staging
A - at risk
B1 - degenerative mitral valve changes present, normal left atrium and ventricle measurements
B2 - degenerative mitral valve changes, left atrium and ventricle dilation
C - past or present congestive heart failure
D - CHF refractory to standard therapy
63
DCM staging
B - B2 - differentiate between whether electrical disturbances are present
arrythmias more common early in disease than in MMVD
64
example treatment for different cardiac disease staging
B2 -
pimobendan
may be candidate for repair under bypass or transcatheter edge to edge repair
C-
diuretic, pimobendan, benazepril, spironolactone
may be candidate for valve repair under bypass or trans catheter edge to edge
D -
diuretic, hydrochlorothiazide, pimobendan, benazepril, spironolactone
may be candidate for valve repair under bypass, may benefit from transseptal puncture (temporary palliative)
65
ECG clip positioning
red - right fore
yellow - left fore
green - left hind
66
normal cardiac conduction
impulse starts at SAN
spreads through atria
to AVN
down bundles of His
through purkinje fibres
to ventricles
ventricular contraction
67
PQRS wave
P - atrial contraction
PR - conduction to ventricles
QRS - ventricular contraction
68
supraventricular tachycardia - atrial fibrillation
irregular, chaotic, fast rhythm (>140bpm, large breeds)
variable pulse quality, pulse deficits
irregular narrow waves, tachycardia, not consistent P waves preceding QRS complexes
atria not properly contributing to ventricular filling
often precedes CHF
rate or rhythm control to treat - usually rate
69
atrial fibrillation treatment
rate control -
diltiazem - slows conduction through SAN/AVN
digoxin - negative chronotropy
digoxin toxicity - GI and non specific signs, can also cause myocardial toxicity, stop for 24-48 hours then start again at lower dose
frequent monitoring
ideally 24 hour holter ECG
70
supraventricular tachycardia - atrial flutter
manage similar to atrial fibrillation - diltiazen +/- digoxin
no true P wave, around one QRS for 4-5 flutter rates
saw tooth base line pattern
normal QRS
71
ventricular arrythmias - ventricular premature complexes (VPCs)
short R-R interval
no P
wide weird looking QRS
caused by ectopic beat originating somewhere other than AVN
not continuous - just occasional weird complexes
cardiac or secondary to extracardiac cause - abdominal, neoplasia, toxicity, trauma
in cats nearly always from primary cardiac disease
72
ventricular arrythmias - accelerated idioventricular rhythm (AIVR)
4 or more consecutive VPCs
not and emergency usually
common following abdominal surgery
73
ventricular arrythmias - ventricular tachycardias
4 or more VPCs also with fast rate (>160-180bpm)
if sustained and signs of poor cardiac output - emergency
lidocaine bolus
74
bradycardias - sinus node dysfunction (SND)/ sick sinus syndrome (SSS)
Affecting entire cardiac conduction system
fibrofatty replacement of nodal tissue
can have sinus tachycardia, AV block, or tachycardia (brady-tachy syndrome)
middle aged to older small breeds
SND - asymptomatic form
SSS - symptomatic, collapse
not consistent so needs long ECG recording
atropine response test - indicates whether will respond to anticholinergics
management -
anticholinergics
pacemaker
75
bradycardias - AV block
1st degree - long PR - usually not clinically relevant
2nd degree - usually non conductive P waves
- type 1 - wenkebach - phyiological - long PR before block
- type 2 - mobitz - pathological - PR consistent before block
3rd degree - complete interruption of AV conduction - non conducted P waves
76
bradycardias - general signs
non specific - lethargy, anorexia
collapse
heart failure
77
indications - thoracocentesis
accumulated air or fluid in pleural space
--> increased pressure on lungs, dyspnoea
78
causes of pneumothorax
trauma - RTA, penetrating thoracic wound
lung rupture following IPPC
ruptured pulmonary mass
pneumonia
79
causes of pleural effusion
true transudate effusion - hypoproteinemia
modified transudates - right sided CHF, obstruction to lymphatic drainage, lung lobe torsion, neoplasia, diaphragmatic hernia
exudates - active inflammation, sepsis (pyothorax)
chyle (lymphatic fluid) - CHF, neoplasia, trauma, lymphangiectasia, congenital lesions, venous thrombosis
blood - neoplasia, trauma, coagulopathy, lung lobe torsion
80
thoracocentesis - procedure
using needle and threww way tap
needle into intercostal space (Avoid intercostal artery on caudal rib border) - maintain slight suction
stop when pop, fluid flowing, or touch lung
attach tap without allowing air flow into cavity
dorsal needle placement if air being removed, ventral if fluid
81
indications - pericardiocentesis
pericardial effusion
82
causes of pericardial effusion
cardiac or pericardial neoplasms
right sided heart failure
hypoproteinemia
trauma
infection
pericardial effusion --> increased pressure in pericardial sac --> compromised cardiac function
83
signs of pericardial effusion
acute - sudden collapse, dyspnoea, rapid deterioration, death
chronic - insidious onset exercise intolerance, signs of right sided hart failure (Ascites), often mistaken for weight gain
84
indications - chest drain
need for repeated thoracocentesis - higher risk of trauma to lungs to keep doing it over and over
85
pericardiocentesis - procedure
ultrasound to find fluid space around the heart
use ultrasound to guide needle placement
aspirate without going into heart
86
chest drain - procedure
incision at an intercostal space
artery forceps to make a tunnel
push the drain through to space three ribs away from incision
penetrate through intercostal muscle
aspirate to remove air/fluid
finger trap suture
87
calf pneumonia - investigation
post mortem of dead calves
clinical exam of symptomatic and in contact calves
assessment of environmental factors
88
calf pneumonia - environmental factors
vaccination
ventilation
mixed aged groups
new calves brought in
cleanliness
stocking density
ambient temperature
failure of passive transfer
group housing - poorer rate of disease detection
89
calf pneumonia - calf factors
respiratory defenses
failure of passive transfer
stress
90
calf pneumonia - viral causes
BRSV
PI3
adenovirus
coronavirus
rhinovirus
BVD
91
calf pneumonia - bacterial causes
pasteurella multocida
manheima hemolytica
haemophilus somni
secondary to sepsis -
acinomyes pyogenes
salmonella
e coli
also - mycoplasma spp. - mycoplasma bovis most common
92
calf pneumonia - lung lesions
viral - consolidated cranioventral lung field, interstitial pneumonia
bacterial - purulent bronchopneumonia, necrosis
93
calf pneumonia - further tests
bacterial - deep nasopharyngeal swab and culture
viral - BAL and flourescent antibody test (FAT)
auscultation - wheezes and crackles
fecal worm egg count - for lungworm
94
calf pneumonia - treatment
NSAIDs
steroids - in severe dyspnoea
vaccination - can be done when already ill
antibiotics - for secondary bacterial infection
management - ventilation
supportive therapy - fluids
95
calf pneumonia - prevention
quarantine of new calves (shipping fever)
purchase from known vendors
reduced cumulative stressors - not doing everything horrible at same time as weaning, gradual weaning
minimising mixed groups
vaccination of dry cows
colostrum management
management of parturition
post weaning management
96
equine asthma
non-septic lower airway inflammation
mild to moderate - formerly inflammatory airway disease - no signs at rest
severe - formerly recurrent airway obstruction - signs at rest
97
mild equine asthma - IAD
common in young performance horses
no signs at rest
increased tracheal mucous on endoscopy
can be caused by viruses, bacteria, parasites, environmental irritant, allergies
mild increase in BAL neutrophils, eosinophils and/or mast cells without indicators of infection
98
severe equine asthma - RAO
Allergen induced hypersensitivity
usually older than 7
frequent coughing, exercise intolerance, increase respiratory effort at rest
no signs of infection
usually associated with stable allergens and poor ventilation, or environmental pollens
increased tracheal mucous on endoscopy
moderate to severe increase in neutrophils on BAL or TW
diagnosis based on clinical signs of respiratory cytology
99
severe equine asthma - clinical signs
sub-clinical - exercise intolerance
mild - sporadic coughing, serous/mucoid nasal discharge
severe - persistent cough, increased expiratory effort (abdominal heave), mild tachypnoea, wheezing, severe exercise intolerance, weight loss
acute exacerbation - marked tachypnoea, severe expiratory dyspnoea, nostril flaring, paroxysmal coughing
100
equine asthma - pathophysiology
neutrophilic inflammation
mucous hypersecretion
bronchoconstriction/bronchospasm
thickening, inflammation and mucous --> increased expiratory effort --> small airways collapse during expiration
101
equine asthma - treatment
removal of environmental irritants - reduce time at pasture, reduce dust/spore exposure, improve ventilation, turn horse out before mucking out, avoid/soak hay
control airway inflammation
reverse bronchoconstriction
chronic cases can lead to irreversible change
102
equine asthma - medical treatment
rapidexon - dexamethasone
equipred - prednisolone
ventipulmin - mucolytic - open respiratory passages
ipratropium bromide - relaxes airway muscles (inhalant)
brown inhaler - declomateasone dipropionate - steroid inhaler, prevention
orange inhaler - flixotide - prevention of inflammation
aservo equihaler - Ciclesonide - special horse inhaler
ventolin - regular blue inhaler
buscopan - antispasm
atropine - in acute attacks
sputolosin - added to feed, loosens mucous
103
equine bradydyssrhythmias
mostly physiological (normal) - high vagal tone
AV block
sinus arrythmia
sinus bradycardia
sinoatrial block
sinoatrial arrest
abolished with increased sympathetic tone
104
equine tachydysrhythmias
pathological
supraventricular or ventricular
premature depolarisations
tachycardia
fibrillation
causes can be inflammatory, degenerative, metabolic, toxicity
105
equine - second degree AV block
most common physiological dysrhythmia
long pauses and variation in length of diastole - can occur in normal horses
not normal if present during exercise - should be abolished by increased vagal tone
advanced - conduction block at AVN, exercise intolerance or collapse. usually associated with inflammatory or degenerative changes at AVN
106
equine - 3rd degree AV block
complete AV dissociation
severe exercise intolerance and frequent collapse
107
equine - 3rd degree AC block treatment
anti dysrhythmic medication - caution, monitor with ECG holter
anti-inflammatories - dexmethasone
pace maker placement
108
equine - premature depolarisations
Supraventricular - originate in atria - normal QRS
Ventricular - originate in ventricles - abnormal QRS (isolated occurence can be normal)
109
equine - atrial fibrillation
predisposed due to high resting vagal tone and large atrial mass
common in thoroughbreds
110
equine - signs of atrial fibrillation
reduced performance
prolonged recovery after exercise
normal resting HR
low grade cough
irregularly, regular rhythm with absence of S4 on auscultation
sustained - persistent at rest and during exercise
paroxysmal - sudden and transient AF that spontaenously goes back to normal rhythm
111
equine - paroxysmal atrial fibrillation
usually during strenuous exercise
reverts within 24-48 hours post exercise
112
equine - secondary atrial fibrillation
occurs as consequence of underlying structural cardiac disease
eg mitral valve insufficiency (enlarged left atrium) or primary mycocardial disease
signs - more profound exercise intolerance, resting tachycardia, loud cardiac murmurs
113
equine - atrial fibrillation cardioversion
treatment - conversion to normal sinus rhythm
success depends on -
duration of AF - prolonged AF leads to structural and electrical remodelling
presence of underlying disease - horses with existing cardiac disease are poor candidates
done with continuous ECG monitoring (hospital setting)
medical - quinidine - prolongs effective refractory period
electrocardioversion - electrodes placed across atria
114
equine - atrial fibrillation - management
regular exercising ECG recordings
moderate exercise levels by maximal HR achievable
severe cases should be retired
115
equine - valvular regurgitation
physiological - some degree normal in fit athletic thoroughbreds
pathological -
congenital - valvular dysplasia
degenerative - endocardiosis
inflammatory/infectious - endocarditis
idiopathic
116
equine - valvular regurgitation - diagnostics
examination - gistory, signs, murmur characteristics
echocardiography - valves, regurgitation jet (dopple, size, direction and velocity), cardiac structure
electrocardiography - concurrent dysrhythmias
117
equine - valvular regurgitation -aortic
most common
middle age
usually degenerative
severity assessed by loudness of murmur, quality or arterial pulse and monitoring progression
good prognosis if no structural change
118
equine - valvular regurgitation - mitral
second most common
higher prevalence in thoroughbreds
most likely form of regurgitation to lead to CHF
pulmonary hypertension
risk factor for AF
119
Equine - ventricular septal defect
most common congenital cardiac defect
common in welsh moutain ponies
hole in membranous portion of srptum
blood flows left to right
loud and course pansystolic murmur on right side (4th intercostal space)
often murmur also audible on left side
prognosis depends on size and position of defect
poor prognosis - large defects as measured on ECG, evidence of right ventricular overload
120
Equine - dysrhythmia and murmur summary
2nd degre AV block common and normal at rest
AF most common dysrhythmia and affects performance
dysrhythmias should be thoroughly assessed in active horses
aortic and mitral regurgitation common
often exist in normal horses and can function. athigh athletic ability
loud or progressive murmurs or those associated with clinical signs should be investigated
121
equine - guttural pouch anatomy
large air filled space - 300-500ml
entrance through ostia
stylohyoid bone through centre
medial compartment - internal carotid artery and occipital condyle
lateral compartment - maxillary artery, external carotid artery and facial nerve
122
equine - guttural pouch empyema
common
strangles - strep equi equi
dullness
pyrexia
bilateral or unilateral nasal discharge
sometimes neuropathy
diagnosed with endoscopy, radiography, culture/PCR to identify bacteria
treatment -
acute - liquid pus - drain by encouraging floor feeding or drain with foley catheter
chronic - chondroids (soild pebbles) - lavage, endoscopic basket or surgical removal
123
equine - guttural pouch mycosis
aspergillus or candida
attaches to neurovascular structures - internal carotid
signs -
epistaxis
death - due to bleeding
dysphagia
facial paralysis
diagnosis - clincial signs and endoscopy
treatment - topical antifungals or surgery (referral - vessel ligation, balloon catheter)
124
equine - guttural pouch tympany
uncommon
foals - fillies and arabs
unilateral or bilateral distension of pouches
otherwise healthy seeming
snoring noise when suckling
secondary to inflammation from infection or persistant coughing
diagnosis - endoscopy, radiography
treatment - foley catheter into pouch for termporary relief, surgery
care for facial nerve
125
equine - temperohyoid osteoarthropathy
uncommon
fusion of temperohyoid joint - due to arthritis or middle ear infection
exacerbated by movement of tongue when swallowing, vocalising, head and neck movements, oral and dental exam
fused joint --> fracture --> nerve damage
signs -
vestibular disease
head tilt
facial paralysis
head shaking
pain on palpation at base of ear
diagnosis - endoscopy, radiography, CT
treatment - NSAIDs, antibiotics, surgery
treatment depending on underlying cause
126
equine - recurrent laryngeal neuropathy (RLN)
common cause of poor performance
degeneration of recurrent laryngeal nerves
large breed horses
paralysis of left intrinsic laryngeal muscles - prevents arytenoid movement
signs -
inspiratory road, exercise intolerance
best to hear noise in canter when all legs of ground (wood sawing sound)
treatment -
prosethtic laryngoplasty - suture to tighten - treatment of choice in performance horses or severe cases
Hobdays - effective at reducing noise
removal of aretynoid cartilage
neuromuscular pedicle graft
tracheostomy - can race with it in
laryngeal pacemaker
post surgical complications - aspiration pneumonia, coughing during feeding, implant failure
127
equine - dorsal displacement of the soft palate (DDSP)
most common nasopharyngeal disorder if both respiratory noise and poor performance
signs -
choking/gurgling/'swallowing tongue" at exercise
respiratory noise
drop in exercise tolerance
can be silent
diagnosis -
resting endoscopy
treatment -
eliinate pre disposing factors and concurrent disease
get the horse fitter
allow time
change tack - nose bands or tongue ties to stop caudal movement of tongues
tracheostomy
128
equine - epiglottic entrapment
loose epiglottic mucosal tissue traped over dorsal surface of epiglottis
signs -
respiratory noise
exercise intolerance
some incidental asymptomatic cases found at endoscopy
diagnosis -
resting endoscopy
exercising endoscopy (may only entrap under exercise)
treatment -
surgery
129
equine - sub-epiglottic cysts
uncommon
inflammatory, traumatic or congenital
signs -
foals - nasal discharge of milk, repsiratory noise (congenital)
poor performance
coughing
dysphagia
nasal discharge
diagnosis -
endoscopy - oral, may be missed on nasal endoscopy
treatment -
excision via lryngotomy
laser excision
formalin injection
130
equine - arytenoid chondropathy
inflammatory/infectious/dystrophic change
one or both arytenoids
young thoroughbreds
signs -
acute - respiratory distress, inspiratory noise
chronic - poor performance, inspiratory noise
diagnosis -
endoscopy
treatment -
NSAIDs
antibiotics
steroids
tracheostomy
arytenoidectomy
debridement
131
equine - 4th-brancial arch defects
congenital
signs -
right sided laryngeal dysfunction
rostral displacement of palatopharyngeal arch
abnormalities of cartilages and associated msucles
aerophagia --> bloating
poor performance
dysphagia
aspiration pneumonia
burping
respiratory obstruction
diagnosis -
endoscopy
radiography
treatment - none, maybe tracheostomy
poor prognosis for performance
132
equine - characteristics of infectious URT disease
nasal discharge
pyrexia
cough
depression
anorexia
lymphadenopathy
limb oedema
ocular discharge
abortion/acute onset neurological disease (EHV 1)
133
equine influenza
young horses, big groups
subclinical shedding
primary aerosol and direct contact spread
virus attaches to mucosal cells and penetrates URT cells
signs -
coughing - dry, harsh, frequent - main thing
pyrexia
nasal discharge
dullness
inappetance
muscle soreness
complications - secondary bacterial infection
treatment (symptomatic) -
NSAIDs
good air hygiene
rest
antibiotics for secondary infection
antivirals - not often used
134
Equine Herpesvirus 1 and 4
latency - in t lymphocytes and trigeminal nerve ganglion
1 - respiratory, abortion, and neuro
4 - respiratory only
1 -
likes endothelial cells - vasculitis and thromboischemia
effects nervous system - ischemic nerve cell death - ataxia, bladdder ditension, urinary incontinence, penile protrusion, flaccid tail and anus
placental disease - abortion, still birth, weak foals
signs (both) -
usually mild in adults
rhinopneumonia
biphasic pyrexia
nasal discharge
swelling lmph nodes
oedema and hyperemia of mm
coughing - less harsh than influenza
complications - secondary bacterial infection
treatment -
symptomatic
antibiotics for secondary infection
135
equine - other URT viruses
picornavirus - rhinitis
gammaherpesviruses - multimodal pulmonary fibrosis
adenovirus - usually only if immunodeficient
hendra virus and african horse sickness - systemic but can manifest as respiratory disease
136
strangles
strep equi equi (bacterial)
chronic carrier
abscesses - pathognomonic
inhaled or ingested, attaches to tonsil crypts
signs -
local rhinitis
pharyngitis
translocation to local lymph nodes
abscess formation - can drain into guttural pouch causing guttural pouch empyema
pain
mucopurulent nasal discharge
pyrexia
inappetance
swelling - respiratory distress, cough, dysphagia
complications - dyspnoea, carrier state, metastatic strangles (abscesses at other sites), pupura haemorrhagica (hypersensitivity reaction - need steroids, antibiotics, analgesia and nursing)
treatment -
NSAIDs
hot pack abscesses
lance abscesses
tracheostomy - if respiratory distress
antibiotics - only if very sick and compromised - can lengthen disease and prevent development of immunity
137
equine - respiratory biosecurity
isolation and barrier nursing of clinical cases
separate equipment and feed and water buckets
PPE
foot baths
clean and siinfect between handling horses
identify in contact animals and keep in separate groups
avoid crowding
138
equine - respirtory - confirmation of freedom from disease
EIV - signs resolved, repeat negative PCR on nasopharyngeal swab
EHV - signs resolved (endemic in UK, never confirmed free)
strep equi - signs resolved, 3 negative swabs, negative bilateral guttural pouch samples
139
farm animal pneumonia
respiratory disease complex
viruses followed by bacteria
husbandry and environmental
welfare and economic impact
young animals
stress
main cause of mortality in young cattle
usually LRT
140
weaning - causes of stress
leave mother
change in diet
market/transport
change of housing
141
bovine respiratory disease complex - signs
dullness
lethargy
pyrexia
inappetance
tachypnoea
dyspnoea
coughing - not in shipping fever
nasal and ocular discharge
142
bovine respiratory disease complex - mycoplasma bovis
increasing diagnoses as cause
mastitis
eye infection
joint infection
repro infection
meningitis
associated with manheimia hemolytica
biofilm
no cell wall - limited treatment options
143
bovine respiratory disease complex - manheimia hemolytica
normal respiratory tract flora
severe inflammation
bronchopenumonia
concurrent infections
shipping fever
signs similar to histophilus somni
144
bovine respiratory disease complex - IBR
herpes - latency
old as well as young
lots of nasal discharge
high morbidity
sudden spread
erosions on nasal septum
pyrexia
depression
halitosis
ddx - manhemia hemolytica, malignant cattharal fever, bluetongue
can vaccinate while sick
145
cattle lungworm
coughing
vaccination available
picked up off pasture
146
fog fever
atypical interstitial pneumonia
intoxication from lush grass after winter
147
ovine respiratory complex - bacteria
manheimia hemolytica
pasteurella multocida
bibersteinia trehalosi
mycoplasma ovipneumoniae
148
ovine respiratory complex - viruses
PI3
ovine pulmonary adenocarcinoma (jaagsietke)
maedi-visna
149
ovine lungworm
milder then cattle
chronic cough
150
ovine respiratory complex - manheimia hemolytica
most important sheep respiratory pathogen
2 forms - septicemic and systemic
septicemic - sudden death in young lambs
systemic - acute onset depression, lethargy, inappetance
vaccines - combined with clostridial diseases
151
ovine respiratory complex - biberstenia trehalosi
recently weaned lambs
sudden death
treatment - oxytetracycline
vaccines - combined with clostridial diseases
152
ovine respiratory complex - PI3
young and growing lambs
usually mild or non-clinical
153
ovine respiratory complex - mycoplasma
enzootic pneumonia
mild to severe
coughing
reduced weight gain
isn't usually fatal, but bad for production
154
ovine respiratory complex - Jaagsietke
contagious tumour - lungs
respiratory transmission
retrovirus
iceberg disease
lungs produce lots of fluid and are heavy
secondary bacterial infections
weight loss
fluid out of nose when wheelbarrowed
laboured breathing
nasal discharge
155
ovine respiratory complex - maedi visna
interstitial pneumonia
transmission. incolostrum, or air borne
very contagious
no vaccine
no cure
causes caprine arthritis encephalitis (CAE)
156
porcine respiratory disease complex
mycoplasma hyopneumonia - enzootic pneumonia
streptococcus suis
barking cough
gradual spread - aerosol
vaccination available
ELISA
lung scoring at slaughter
157
farm animal pneumonia - prevention
colostrum management
nutrition
vaccination
ventilation and air quality
minimise stress
early identification and isolation
quarantine of new animals
158
equine - infectious pleuropneumonia
viral - equine influenza
bacterial - rodococcus equi equi
contamination of LRT with URT bacteria
inhibition of normal clearance mechanisms
159
equine - transit fever
pleuropneumonia
stress during travel
head held up for long
aspiration
160
aims in anaesthesia - patients with cardiac disease
maintain CO levels
avoid hypo-hypertension
avoid excessive tachy/bradycardia
avoid increases in myocardial workload
avoid myocardial depression and arythmogenesis
maintain oxygenation (NB IPPV can be detrimental - can impair output through lungs)
maintain good fluid balance and avoid overinfusion
161
mitral regurgitation - anaesthesia
common in older patients
can lead to pulmonar congestion or oedema
pre oxygemate
keep HR steady
avoid ionotropic drugs
aim for small decrease in afterload - avoid ketamine and alpha-2 (increase afterload)
avoid arrythmias - can use and anti-arryhthmic drug
maintain preload
IPPV for pulmonary congestion/oedema - may help push fluid back into circulation
162
cardiomyopathy - anaesthesia
CO is HR dependent
common in dobermans
occurs in DCM, and HCM
avoid big HR changes
dobutamine infusion - maintains BP
avoid ketamine. inhyperthyroid cats - want to ensure adequate preload and avoid sympathetic stimulation
163
ventricular dysrhythmias/cardiac contusions - anaesthesia
anaesthetise sooner rather than later - golden 12 hours before contusions appear
ensure other parameters within good limits
ensure good analgesia - opioids
avoid sympathetic stimulation
if arryhtmia is significant and not responding to treatment - recover
164
pacemakers - anaesthesia
mostly in patients with 3rd degree AV block
pre treat - atropine, glycopyrrolate, isoproterenol
pre-oxygenate
don't use anything that lowers HR - pethidine preffered
place external pacing leads prior to induction (riskiest part so good to have them in place)
165
patent ductus arteriosus - anaesthesia
if reverses to R-L then poor candidates for anaesthesia - global hypoxia
systemic hypertension and increased pulomary circulation pressure can cause shunt reversal - IPPV and inhaled anaesthetic agents
prevent hypothermia. -often young patients
avoid worsening of shunt - hypoxia, high CO2 pain
maintain HR - pethidine as opioid of choice
pre oxygenate
analgesia
166
branham reflex
sudden bradycardia may occur reflexively after patent ductus arteriosus ligated
167
effect of anaesthesia on gas exchange
hypoventilation - detrimental as many resp conditions already have underlying hypoventilation
avoid drugs causing bronchospasm
dead space
IPPV - can compress pulmonary capillaries
ventilation/perfusion mismatch exacerbated
shunts --> hypoxemia
increased shunt fraction
168
airway challenges - anaesthesia
jaw fractures
TMJ pathology
jaw pathology
eosinophilic myositis
IPPV where necessary
careful with airwat pressures
ET tube
pulse ox in recovery
