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Y4 SA - cardiology > Congenital cardiac disease > Flashcards

Congenital cardiac disease Flashcards

1
Q

What is congenital heart disease?

A
  • malformations of the heart and great vessels that are present at birth
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2
Q

Why does congenital heart disease occur?

A
  • altered or arrested embryonic development of the rudimentary heart leading to potentially gross anatomical alterations
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3
Q

When are more defects detectable? How might this change?

A
  • most defects are detectable after birth but the severity of the haemodynamic abnormalities may change significantly during the first 6-12m of age
  • many animals are asymptomatic when 1st examined
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4
Q

Innocent murmurs

A
  • low grade I-II/VI
  • PMI left heart base
  • mid systolic
  • varying intensity with heart rate
  • minimal radiation
  • usually resolve by 6 months (exception some large breed dogs)
  • no structural explanation / no structural cardiac disease
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5
Q

What is a physiological/functional murmur?

A
  • blood becomes turbulent if it’s thin
  • physiological murmurs occur when the blood is thin i.e. the animal is anaemic / hypoproteinaemic
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6
Q

What does a hyperkinetic pulse feel like? Potential causes?

A
  • a tapping pulse as it rises and falls quickly
  • abnormal diastolic run off of aortic blood
  • PDA
  • severe aortic regurgitation
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7
Q

What does a hypokinetic pulse feel like? Potential causes?

A
  • rises and falls slowly
  • left ventricular / outflow tract obstruction
  • aortic stenosis
  • poor left ventricular output
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8
Q

What to do in practice with a murmur in a puppy / kitten?

A
  • if loud (grade 3+) more likely to be a congenital anomaly, but load doesn’t necessarily mean bad (e.g. small VSD)
  • if < grade 2 could be innocent -> reassess at 3 & 6 months
  • return to breeder and get money back
  • can only assess nature & severity of lesion with a full Doppler echocardiogram
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9
Q

What are the common defects?

A
  • ASD (atrial septal defect)
  • VSD (ventricular septal defect)
  • AS (aortic stenosis)
  • PS (pulmonic stenosis)
  • MV (mitral valve) dysplasia
  • TV (tricuspid valve)
  • PDA (patent ductus arterioles)
  • Tetralogy of Fallot
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10
Q

ASD
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe
- extra bits

A

Murmur grade: usually quiet to moderate

Murmur PMI: base L and R

Systolic or diastolic? systolic

Echo changes if severe: R side centric hypertrophy if severe

Extra bits: can be incidental and of no significance

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11
Q

VSD
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe
- extra bits

A

Murmur grade: variable, ‘diagonal’

Murmur PMI: base L, apex R

Systolic or diastolic? systolic

Echo changes if severe: L side volume load - eccentric hypertrophy

Extra bits: small lesion (often loud murmur) tolerated well

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12
Q

AS
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe
- how do you know?
- extra bits

A

Murmur grade: variable, loud if severe

Murmur PMI: base L>R

Systolic or diastolic? systolic

Echo changes if severe: LV concentric hypertrophy

How do you know? If severe, pulses poor, murmur audible in carotid arteries

Extra bits: SAS might get worse until adult - asses at 1y

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13
Q

PS
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe

A

Murmur grade: variable, loud if severe

Murmur PMI: base L?R

Systolic or diastolic? systolic

Echo changes if severe: RV hypertrophy

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14
Q

MV dysplasia
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe

A

Murmur grade: variable

Murmur PMI: apex L

Systolic or diastolic? systolic. may have MS too -> diastolic murmur

Echo changes if severe: L side volume load -> eccentric hypertrophy

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15
Q

TV dysplasia
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe

A

Murmur grade: variable

Murmur PMI: apex R

Systolic or diastolic? systolic

Echo changes if severe: R side volume load - eccentric hypertrophy

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16
Q

PDA
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe
- how do you know?
- extra bits

A

Murmur grade: usually loud

Murmur PMI: base and apex

Systolic or diastolic? continuous

Echo changes if severe: L side volume load -> eccentric hypertrophy

How do you know? continuous murmur

17
Q

Tetralogy of Fallot
- murmur grade
- murmur PMI
- systolic or diastolic?
- echo changes if severe
- how do you know?
- extra bits

A

Murmur grade: variable

Murmur PMI: base usually

Systolic or diastolic? systolic

Echo changes if severe: RV hypertrophy

How do you know? cyanosis

18
Q

What is aortic stenosis?

A
  • narrowing of the aorta
19
Q

What are the 3 types of aortic stenosis?

A
  • Sub-aortic stenosis (common)
  • Valvular aortic stenosis (uncommon)
  • Supra-valvular (rare)
20
Q

Sub-aortic stenosis - cause

A
  • sub valvular narrowing caused by a fibrous or fibromuscular ring - spectrum of severity
  • ± mitral dysplasia as well
21
Q

Sub-aortic stenosis - age of maximum severity

A
  • can increase in severity as dog matures reaching maximum severity at 1-2y/o
22
Q

Sub-aortic stenosis - what can increase the intensity of the murmur

A
  • exercise/excitement can cause an increase in the intensity of the murmur
23
Q

Sub-aortic stenosis - breed predispositions

A
  • Boxers, Newfoundlands, Golden Retrievers
24
Q

Most common findings with aortic stenosis

A
  • lethargy
  • exertional weakness
  • syncope
  • sudden death occurs in approx 1/3 of dogs with SAS
25
Murmur associated with aortic stenosis
- harsh systolic ejection murmur, PMI aortic valve - precordial thrill at the left heart base - radiates to right heart base - ± diastolic murmur depending on presence and severity of AI (aortic insufficiency)
26
Types of pulmonic stenosis
- infundibular - sub-valvular pulmonic stenosis (uncommon) - valvular pulmonic stenosis (common) this can be the leaflets themselves or the annulus of the valve - supra-valvular (rare) - anomalous coronary artery
27
Which dogs tend to be affected by pulmonic stenosis
- smaller breed dogs - terriers, bulldogs
28
CS of pulmonic stenosis
- many cases are asymptomatic on presentation, CS depend on severity of lesion - right sided heart failure, syncope, exercise intolerance - sudden death does occur in some severe cases - prominent right apical beat - PMI murmur left heart base - radiation cranially ventrally - prominent jugular pulses
29
PDA - what is it?
- blood shunting from aorta into pulmonary artery - functional closure of the ductus usually occurs within hours after birth - permanent closure occurs days to weeks post birth - with fully patent ductus arterioles blood shunts constantly from the descending aorta to the pulmonary artery during both systole and diastole - volume overload of the pulmonary circulation and LA and LV
30
Where is a PDA best heard?
- left heart base but very cranial and dorsal (in axilla)
31
PDA - CE
- continuous machinery murmur PMI left heart base - hyperkinetic pulses - volume overload leads to a large haemodynamic burden on the left ventricle which fails - after 12m many dogs will progress into left sided congestive heart failure and show typically CS
32
PDA tx
- surgical - occluder (catheter into femoral artery, run into the aorta and drop the occluder into the ductus arteriosus)
33
Where are VSDs usually located in dogs?
- high in the membraneous part of the septum just below the aortic valve and under the tricuspid leaflet (perimembraneous)
34
What does VSD lead to?
- volume overload of the pulmonary trunk, pulmonary circulation, LA, LV - small defects are usually clinically unimportant (restrictive) - moderate to large VSD lead to volume overload and potentially LCHF
35
VSD - CS
- most dogs are asymptomatic but CS depend on the size of the defect - exercise intolerance, LCHF - systolic murmur PMI cranial right sternal border - ± murmur of functional PS
36
Atrial septal defect
- little shunting of blood across them as pressure is low - so not necessarily a big deal
37
Tricuspid dysplasia
- particularly young labs - go into right sided failure
38
Concentric vs eccentric hypertrophy of the heart
Concentric - occurs when the heart wall thickens, often due to pressure overload, without a significant increase in chamber size Eccentric - involves an increase in chamber size (dilation) and proportionate increase in wall thickness, typically in response to volume overload

Y4 SA - cardiology (15 decks)

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