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Equine Surgery and Medicine > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Physical exam

A

Inspection
Palpation
Auscultation
Percussion

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2
Q

Palpation

A 
Location and intensity of heartbeat
Heart rate
Trauma, deformity
Pain
Precordial thrill, fremitus
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3
Q

Percussion method and use

A

Pleximeter and percussion hammer

To detect pain in the cardiac area

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4
Q

Where is the area of cardiac dullness?

A

Diernhofer triangle- dullness on the left side

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5
Q

Ancillary diagnostic methods

A 
ECG
Echocardiography
Phonocardiography 
Blood pressure measurement 
Pericardiocentesis 
Cardiac catherisation
Lab tests
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6
Q

ECG

A

Resting:
Base apex lead: most commonly used
(einthoven rarely)

Holter and telemetric:
At rest or
While exercising

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7
Q

Lab tests

A

Blood tests

  1. AST
  2. CK in humans MB but in horses MM
  3. LDH and 5 isoenzymes- mainly LDH1 (LDH2)
  4. Cardiac troponin I and T
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8
Q

Location of heart

A

Base: btw 2nd and 6th ICS
Twisted aniclockwise
Right side: cranially
Ledt side: Left and caudally

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9
Q

Location of heart beat

A

Left: 3-5 ICS
Right: 3-5 ICS

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10
Q

Heart sounds: S1

A

Beginning of systole

Initial movement of ventricle
AV valves tense, stopping of blood flow
Early part of ejection

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11
Q

Heart sounds: S2

A

End of systole

Change in direction of blood flow
Closing of semilunar valves

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12
Q

Heart sounds: S3

A

Termination of rapid ventricular filling

Can be heard at or caudal and dorsal to the apex beat

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13
Q

Heart sounds: S4

A

Atrial contraction

Arrest of the distended ventricle

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14
Q

Heart murmurs

A

Prolonged audible vibrations

Develop in a usually quiet part of the cardiac cycle

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15
Q

The normal/ functional murmurs

A

Caused by vibrations after the ejection of blood during systole
OR
Rapid filling of the ventricles during early diastole

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16
Q

Physiological (flow) murmurs

A

Systolic or Diastolic

17
Q

Systolic murmur

A 
Caused by blood flow in aorta and pulmonary artery in early systole
Left side of thorax
PMI over aortic or pulmonary valves 
Grade 1-3/6 
Early-to-midsystolic 
Crescendo-decrescendo or decrescendo
Localised and brief
18
Q

Diastolic murmur

A 
Caused by ventricular filling 
Common in young and thoroughbreds
Left side of thorax
PMI over mitral area
Grade 1-3/6 
Early diastolic (S2-S3) or late diastolic (S4-S1)
Musical/squeaking
19
Q

Classification of endocardial murmurs

A 
Timing 
Duration
Grade
Point of maximum intensity PMI
Quality (shape)
Frequency
Radiation
Effect of changing heart rate
20
Q

Timing

A

Early
mid
late

21
Q

Grade

A

1/6: quiet-requires careful auscultation
2/6: quiet: heard when stethoscope placed over its PMI
3/6: audible over a wider area
4/6: loud and audible. no fremitus
5/6: fremitus and audible with loose contact with the thoracic wall
6/6: loudest even audible when the stethoscope is held apart from the thoracic wall

22
Q

PMI Pulmonary

A

Left 3rd ICS below point of the shoulder

23
Q

PMI Aortic

A

Left 4th ICS below point of the shoulder

24
Q

PMI mitral

A

Left 5th ICS halfway between shoulder and sternum

25
Q

PMI Tricuspid

A

Right 4th ICS

26
Q

Basic interpretation of ECGs

A

Aretfacts can be present, especially in exercise racehorses
Heart rate
Rhythm (R-R intervals):
normal
regularly irregular
irregularly irregular– atrial fibrillation

Relationship between P waves and QRS complexes:
each P wave is followed by a QRS complex
each QRS complex is preceded by a P wave

Duration and morphology of waves, duration of segments and intervals

27
Q

Unique to equine ECG

A

No Q wave

Large negative deflection in the S-wave (not R wave)- but still the R waves are used to describe

28
Q

Sinus rhythm

A

Biphasic P

Positive T-wave that can be biphasic as well

29
Q

Atrial premature complex/ depolarization (APC/APD)

A

3rd cycle: P-wave is earlier than normal– after this normal QRS and P, the P wave is not too early, the ventricular muscle can contract
If P wave more premature- ventricular muscle still in refractory period and the stimulus doesn’t get through AV node- no depolarization, no QRS complex and T-wave
5th cycle: almost no gap between T and P wave

Can cause exercise intolerance

30
Q

Atrial fibrillation

A

Normal QRS complex and T wave
No visible P waves- instead many small f-waves
S-S intervals are very irregular, therefore irregular rhythm
S sound not audible

Exercise intolerance and poor performance
Very common

31
Q

1st and 2nd degree atrioventricular block

A

1st and 2nd degree at the same time
1st cycle: P wave not directly followed by QRS complex, the duration of atrioventricular conduction through AV is longer
Followed by 4 normal cycles
T-wave (late) and P-wave (normal timing) almost together

2nd degree: ventricle muscles in refractory, no contraction, no QRS complex and no T-wave

Block usually repeated after a few normal cycles, most of the 1st and 2nd degree are normal because of the strong vagal tone, this is why you can check if it is physio by walking the horse around- will become excited and the vagal tone won’t be as strong and HR increases, so no more blocks

32
Q

2nd degree atrioventricular blocks

A

P wave not followed by a QRS

NB!! ECG software can misinterpret T-waves for QRS complexes, giving a double HR- this is why auscultation is so important

33
Q

3rd degree (complete) atrioventricular blocks

A

Complete separation of atrial and ventricular depolarization- no conduction through AV node

P wave is normal- indication that SA node is normal

There is automatic pacemaker activity in ventricular muscle, it will contract even though there is no info coming through the AV node
This is why we can see 3 ventricular contractions that are much slower

Extreme level of exercise intolerance

Resolution: pacemaker

34
Q

Ventricular premature complex/ depolarization (VPC/VPD)

A

Originates in ventricle
Different wave forms: 1st (half one) normal and then no visible P-wave
Every 2nd cycle abnormal
CO decreases because the abnormal contraction can’t produce same HMV

Always clinical signs- exercise intolerance and poor performance

35
Q

Ventricular tachycardia VT (uniform)

A

Resting ECG is 140 bpm
QRS and T-wave identifiable, but P-wave is not
Can be temporary with sinus-rhythm
Origin of the premature ventricular rhythm is the same

36
Q

Ventricular tachycardia (multiform)

A

HR very high
Different wave form, variability in QRS complex
Different origins in the ventricular muscles
If sustained– ventricular fibrillation— heart stops

Equine Surgery and Medicine (10 decks)

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