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A - Medicine Cardiovascular > Congenital defects > Flashcards

Congenital defects Flashcards

1
Q

What are the 3 most common congenital heart defects in dogs?

A

Patent ductus arteriosus
Subaortic stenosis
Pulmonic stenosis

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2
Q

What are the 2 most common congenital defects in cats?

A

Mitral dysplasia

Ventricular septal defect

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3
Q

What 5 things can you use to commonly help diagnose a congenital heart disorder?

A 
Signalment/history/exam
Chest radiographs
ECG
Echocardiography
PCV/TPP
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4
Q

What 2 things will you find during a clinical exam in a dog with patent ductus arteriosus?

A

Machinery murmur in left heart base
-no silence
Hyperkinetic pulses
-diastolic pressure is low

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5
Q

Over time what will turbulence in an artery lead to?

A

Arterial dilatation

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6
Q

In PDA what direction is the blood usually shunted?

A

Left-to-right
From LV - lungs - LA - LV
-over circulation

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7
Q

What type of dog is PDA most common in?

A

Young small dogs

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8
Q

What things may you see on a radiograph for a dog with PDA?

A

Over-circulation of the lung fields
Dilated main pulmonary artery and descending aorta
Enlarged left atrium
Pulmonary oedema with congestive heart failure
3 ‘knuckles’ on VD - Aortic arch, pulmonic artery and oracle

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9
Q

How do you treat a left-to-right shunting PDA?

A

Surgery as early as possible

Treatment for congestive heart failure if needed

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10
Q

What surgical method is used to fix left-to-right shunting PDA?

A

Trans-arterial ductal occlusion with coils

-Coil with fluff on it promotes clotting, fibrosis and healing of area

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11
Q

What direction does the blood flow in a reversed PDA?

A

Right-to-left
RV-Body-RA-RV
-bypasses the lungs and left side of heart

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12
Q

How do you treat a dog with right-to-left shunting PDA?

A 
Not surgery - has turned into a pressure release valve
Phlebotomy - blood letting
\+/- hyroxyurea to hit marrow 
Enforced rest
Avoidance of stress
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13
Q

What is the most common site for sub-aortic stenosis?

A

Sub-valvular 95%

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14
Q

What is the most common signalment for a dog with subaortic stenosis?

A

Large breed dog

-It is autosomal dominant with other genes influencing phenotype

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15
Q

What is the pathophysiology of subaortic stenosis?

A 
Variable severity
Subvalvular fibrous ring
Develops within first months of life 
LV pressure overload
Concentric hypertrophy
Inadequate coronary perfusion
Worsening outflow tract obstruction
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16
Q

What are 4 history findings for a dog with subaortic stenosis?

A

Exercise intolerance
Syncope
Left-sided heart failure
Sudden death

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17
Q

What are 2 findings you can get from a clinical examination of a dog with subaortic stenosis?

A

Slow-rising hypokinetic pulses
Harsh systolic heart base murmur which radiates widely
+/- low heart base thrill
-can hear murmur all over body and can be very loud

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18
Q

Why is echocardiography important in a dog with subaortic stenosis?

A

To confirm diagnosis

Determine the severity of narrowing

19
Q

How do you treat a dog with subaortic stenosis?

A

Refer for surgery for balloon dilatation or open heart
Beta-1 blocker - Atenolol
Exercise restriction

20
Q

Why should you give a dog with subaortic stenosis beta-1 blockers?

A

To stop the heart working so hard and to prevent worsening

21
Q

Where does pulmonic stensosis usually occur?

A

Valvular

22
Q

What type of animal does pulmonic stenosis most commonly occur in?

A

Small dogs
-Congenital defect
Rare in cats

23
Q

What are some history findings for a dog with pulmonic stenosis?

A

Asymptomatic usually until over 1y.o
Poor exercise tolerance
Syncope
Right-sided heart failure

24
Q

What are some clinical findings for a dog with pulmonic stenosis?

A 
High left base systolic ejection murmur
\+/- thrill there
No radiation to carotids
\+/- jugular pulse
\+/- arrhythmias
25
Q

In a dog with pulmonic stenosis, what are 2 findings for both radiographs and ECG?

A

Radiography
-Right ventricular enlargement
-Main pulmonary artery bulge on DV
ECG
-Exercise-precipitated ventricular tachyarrhythmias
-Signs of right-sided cardiac enlargement

26
Q

How do you treat a dog with pulmonic stenosis?

A

Like one with subaortic stenosis

  • ECG to confirm diagnosis and severity
  • Refer for balloon dilatation
  • Exercise restriction
  • +/- beta blocker
  • If needed treat for congestive heart failure
27
Q

What is the blood flow in a ventricular septal defect?

A

LV-RV-Lungs-LA-LV

  • Bypasses systemic circulation
  • Volume overload in RHS
28
Q

What will you hear on auscultation in a dog with a ventricular septal defect?

A

Harsh holosystolic murmur

Loudest on the right side

29
Q

What will you find in radiography of a dog with a ventricular septal defect?

A

Left-sided enlargement
Pulmonary over-circulation
Variable right ventricular enlargement

30
Q

What findings will you see in an ECG and echocardiography of a dog with ventricular septal defect?

A

Echo
-Definitive diagnosis
ECG
-Left-sided enlargement

31
Q

What are 3 possible outcomes from a ventricular septal defect?

A

May tolerate it
May develop early pulmonary hypertension
May develop left-sided congestive heart failure

32
Q

What is the blood flow for an atrial septal defect?

A

LA-RA-RV-Lungs-LA
Over-circulation
Bypasses LV and systemic circulation

33
Q

What will you find on auscultation in a patient with an atrial septal defect?

A

Fixed splitting of S2
-Prolonged RV emptying
+/- systolic murmur over left heart base
+/- diastolic murmur on the right side

34
Q

What will you see on radiographs in a patient with an atrial septal defect?

A

Right-sided cardiac enlargement
Dilatation of the main pulmonary artery
Over-circulation of the pulmonary vessels

35
Q

What 4 things make up a tetralogy of fallot?

A 
Right ventricular outflow tract obstruction
Secondary right ventricular hypertrophy
Ventricular septal defect
Overriding aorta (dextrapositioned)
36
Q

In tetralogy of fallot what 2 changes are primary?

A

Right ventricular outflow tract obstruction

Ventricular septal defect

37
Q

What can occur as a consequence of an overriding aorta in tetralogy of fallot?

A

Blood can go from the RHS to the LHS as it is very hypertrophied and strong
-Cyanotic heart disease

38
Q

Embryologically tetralogy of fallot is a consequnce of what?

A

Conotruncal septal malformation

39
Q

What are some history and clinical findings of an animal with tetralogy of fallot?

A 
Can be tolerated for years
Exercise intolerance
Cyanosis
Usually murmumr from pulmonic stenosis is heart 
Erythrocytosis - elevated PCV
40
Q

Why do you get an elevated PCV in heart conditions associated with cyanosis?

A

Because the chronic low oxygen levels cause an increase in erythropoietin and RBC production

41
Q

What will you find on radiographs of a patient with tetralogy of fallot?

A

Normal sized, or slightly enlarged heart

Pulmonary Undercirculation

42
Q

How do you treat a dog with tetralogy of fallot?

A

Phlebotomy if PCV over 65%
+/- hyroxyurea to lower PCV
Enforce rest
Avoid stress

43
Q

Why do you use hydroxyurea in cyanotic heart disease?

A

Cyanotic heart disease causes increased erythropoietin response and therefore elevated PCV
Hydroxyurea works by limiting new RBC production

44
Q

Why may you use phlebotomy and hydroxyurea together or in combination when treating cyanotic heart disease?

A

Phelbotomy causes an immediate reduction in PCV, but overtime the body will produce new RBC’s to overcome this
Hydroxyurea limits new RBC production and therefore takes 2-3 months to see effects, however these are more long-term medication

A - Medicine Cardiovascular (5 decks)

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