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Selected Canine Medicine > Congenital CV Defects (Canine & Feline) > Flashcards

Congenital CV Defects (Canine & Feline) Flashcards

1
Q

Murmurs due to congenital defects usually …

A

Persist or get louder over time (usually louder over time, may not)

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2
Q

What do we know about innocent murmurs (location, age, intensity)?

A

Puppies and kittens.
Systolic, loudest over left heart base.
Often quite soft, go away by 4-6months

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3
Q

How do we do a good job listening to the heart

A

Careful exam
Move the stethoscope around, listen to the loudest area and on both sides of the chest.
Assess pulse quality, feel for a thrill on both sides of the chest, around the heart, dorsal and ventral

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4
Q

What are the seven major congenital CV defects?

A 
PDA
Sub aortic stenosis (SAS)
PS
VSD
ASD
AV (mitral/tricuspid) valvular dysphasia
Tetralogy of fallout
Vascular ring anomalies
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5
Q

List the most unlucky breed for each of the following conditions

A 
PDA - Maltese
SAS - Newfoundland
PS - Bulldog
VSD - English bulldog
ASD - Samoyed
Tricuspid dysphasia - Labrador
Mitral dysplasia - Bull terrier
Tetralogy of fallout - Keeshand
Persistent right aortic arch - GSD
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6
Q

Give an example of a volume overload defect

A

VSD

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7
Q

Give an example of a pressure overload defect

A

Stenosis, pulmonic right, aortic left

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8
Q

Diagnosis of congenital CV defects is often based on what 5 categories?

A 
Signalment/history/physical exam
Chest radiographs
ECG
Echocardiography
PCV/TPP
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9
Q

Outline a PDA (common? Sound? Gender? Breed?)

A 
Commonest congenital CV defect
Machinery murmur
Hyperkinetic pulses
Females get it more
Small breeders
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10
Q

Turbulence in artery leads to what over time?

A

Arterial dilatation (post-stenotic dilatation)

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11
Q

Most congenital CV defects of dogs and cats …

A

Produce an audible murmur
Involve a valve (or valve region) or an abnormal connection between the systemic and pulmonary circulations
Affected valves may be insufficient, stenotic or both

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12
Q

Explain the physiology behind hyperkinetic pulses regarding a PDA

A

Blood is shunted from the left side of the heart to the right side of the heart.

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13
Q

Patent ductus arteriosus diagnoses are based on:

A

Clinical examination
- continuous murmur at the left heart base
- Hyperkinetic pulses (diastolic pressure is low
Radiography
- over-circulation of lung fields (pulmonary hypertension, reversed shunt)
- Dilated main pulmonary artery and descending aorta
- Pulmonary oedema with congestive heart failure

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14
Q

What form of diagnostic imaging can provide a definitive results diagnosis of PDA

A

Echocardiography

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15
Q

How do we treat L - R shunting PDAs

A

Surgery ASAP

Treatment for congestive heart failure if necessary

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16
Q

Outline the use of trans-arterial ducal occlusion with coils (when do we do it? Safe? Follow-up?)

A

Done in PDA cases. Duct occluded with a coil. Very safe, and 95% bed nothing more. It encourages clotting when put into vessel. This will then occlude the PDA

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17
Q

Explain a REVERSED PDA

A

Blood goes from aorta into pulmonary artery as a result of PDA. Pressure equalises, and stops flowing. Pulmonary hypertension may result, causing pressure on the right to be higher. Blood will then start going right to left and flow the wrong way.

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18
Q

Can you think of a situation where the machinery murmur goes away in a PDA? (No treatment)

A

Machinery murmur goes away when pressure matches (becoming REVERSE PDA). Right sided blood goes into the aorta some distance down the aorta.

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19
Q

Wen do we do surgery in R to L shunting PDAs?

A

DONT DO SURGERY - the ductus is now a pressure relief valve

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20
Q

How do we treat R to L shunting PDAs

A

Phlebotomy (blood letting)
+/- hydroxy urea to hit marrow
Enforced rest
Avoidance of stress

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21
Q

In sub aortic stenosis, what are the sites of stenosis in order of most common to least common?

A

Sites of stenosis:

  • Sub-valvular (95%)
  • Valvular (
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22
Q

Which animals tend to get sub aortic stenosis? Why?

A

Certain large breeds of dog

Autosomal dominant with modifier genes influencing phenotype

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23
Q

outline pathophysiological factors of sub aortic stenosis

A

Variable severity
Sub valvular fibrous ring
Develops during first few months of life
LV pressure overload, concentric hypertrophy, inadequate coronary perfusion, worsening outflow tract obstruction

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24
Q

Subaortic stenosis cases tend to have a history of … (4)

A

Exercise intolerance
Syncope
Sudden death
Left sided heart failure

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25
Q

On clinical exam of Subaortic stenosis cases, we tend to see

A

Slow-rising hypo kinetic pulses (pulses par us et tarsus)

Harsh, systolic heart base murmur, radiates widely. +/- low heart base thrill.

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26
Q

What are two methods of diagnosing Subaortic stenosis?

A

Radiography

ECG

27
Q

Explain what you see on ECG and radiography of Subaortic stenosis patients

A

RadX
- Left ventricular enlargement
- Aortic bulge in DV
ECG
- Exercise precipitated ventricular arrhythmia
- Signs of left-sided cardiac enlargement
- +/- ST segment depression

28
Q

On ECG of Subaortic stenosis cases, when do you see ST segment depression

A

Myocardial ischaemia

29
Q

Why do we use echocardiography in known Subaortic stenosis cases?

A

Used to confirm diagnosis

Determine severity of the narrowing

30
Q

How do we manage Subaortic stenosis cases

A

Balloon dilatation or open heart Sx
B-1 blocker, e.g. Atenolol
Exercise restriction
NOTE: >50% with severe SAS die within 3 years if left untreated

31
Q

Pulmonic stenosis is a common congenital cardiac defect in what breed and sex?

A

Small dogs, English Bulldogs especially, mostly males

32
Q

Outline the incidence of pulmonic stenosis cases in small animals

A

Rare in cats
Usually valvular
Sometimes sub-valvular
Rarely Supravalvular

33
Q

Outline what you’d expect in the history of a pulmonic stenosis case

A

Annoying client
Often asymptomatic, normal until >1 year old
Syncope
Right-sided heart failure

34
Q

What clinical findings do you expect in pulmonic stenosis cases? Include those that may also be present

A

High left base systolic ejection murmur

  • +/- thrill there too, no radiations to carotid so
  • +/- jugular pulse; +/- arrhythmias
35
Q

What do we see on radiography of pulmonic stenosis cases?

A

Right ventricular enlargement

Main PA bulge on DV

36
Q

WHat do we see on ECG pulmonic stenosis cases?

A

Exercise-precipitated ventricular tachyarrhythmias . Signs of right-sided cardiac enlargement

37
Q

Why do we use echocardiography in known pulmonic stenosis cases?

A

Confirm diagnosis

Confirm severity of lesion

38
Q

How do we manage pulmonic stenosis cases?

A

Refer for balloon dilatation
Exercise restriction, +/- beta blocker
Treatment of congestive heart failure.

39
Q

Outline blood flow in a VSD

A

Blood shunted from Left V to Right V

40
Q

What are the clinical findings on auscultation of a VSD

A

Harsh, holosystolic murmur loudest on right side (cranial R eternal border esp.)

41
Q

What are the radiographically findings of a VSD

A

Pulmonary over-circulation
Right ventricular enlargement (variable)
Left side enlargement

42
Q

What are the clinical findings on ECG and echocardiography of a VSD

A

ECG
- Left sided enlargement
Echocardiography
- Definitive diagnosis

43
Q

The history of VSD patients may differ. What 3 broad possibilities exist in their natural history?

A

May tolerate it
May develop pulmonary hypertension (early)
Left-sided CHF

44
Q

Atrial septal defect - explain flow

A

Shunted from LA to RA.

45
Q

What are the clinical findings on Auscultation of a VSD

A
  • Fixed splitting of S2 (prolonged RV emptying; so pulmonic valve closes after aortic valve; lub-duduP0
    +/- systolic murmur left heart base (relative PS)
    +/- diastolic murmur ( rumble) on right side (tricuspid stenosis)
46
Q

What are you radiographical ASD findings

A

Right sided cardiac enlargement
Dilatation of main PA
Over-circulating of pulmonary vessels

47
Q

ASD ECG reveals

A

Right sided enlargement

48
Q

ASD ultrasonography provides

A

A definitive diagnosis

49
Q

What natural history could you expect (2 possible) in ASD cases

A

Tolerance of lesion OR

Right-sided heart failure

50
Q

List the 4 occurrences in the tetralogy of fallot

A 
Pulmonic stenosis - Right ventricular outflow tract obstruction
Secondary RV hypertrophy
VSD (separate defect)
Overriding aorta (dexter appositional)
51
Q

In the tetralogy of Fallot, blood may shunt from R to L. Why?

A

Muscly right side (overriding aorta) may make blood go R to L, as opposed to normal VSD

52
Q

The tetralogy of fallot is embryologically a consequence of

A

Conotruncal septal malformation

53
Q

What history do you expect in tetralogy of fallot case?

A

May be tolerated for years
Exercise intolerance
Syncope

54
Q

What do you expect to find on clinical exam of Tetralogy of fallot cases?

A

Cyanosis
Usually the murmur of pulmonic stenosis is heard, sometimes the murmur of VSD
Erythrocytosis (elevated PCV)

55
Q

Radiographically, you expect to see what in the tetralogy of fallot?

A

Normal heart size or some cardiomegaly

Pulmonary undercirculation

56
Q

Electrocardiographically, you expect to see what in tetralogy of fallot?

A

Right-sided enlargement

Ventricular arrhythmias

57
Q

How do we treat the tetralogy of fallot cases

A

Phlebotomy (blood letting) if PCV gets high enough to need it
Hydroxy urea to lower PCV
Enforce rest
Avoidance of stress

58
Q

At what point is PCV high enough to warrant a phlebotomy

A

Approx 65%

59
Q

What is atrioventricular valve dysplasia?

A

Mitral or tricuspid dysplasia.

60
Q

What species is mitral dysplasia most common ?

A

Cats, occurs in many large dog breeds too

61
Q

What is tricuspid dysplasia most common in?

A

Male dogs, large breeds

62
Q

WHat are the signs of AV dysplasia related to?

A

Valvular insufficiency.

63
Q

Are AV dysplasia lesions well or poorly tolerated?

A

Can be tolerated for many years

Selected Canine Medicine (6 decks)

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