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RUSVM SAM 1 > Congenital Heart Disease > Flashcards

Congenital Heart Disease Flashcards

1
Q

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

A 
Patent ductus arteriosus (PDA)
Subaortic stenosis (SAS)
Pulmonic stenosis (PS)
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2
Q

What are the 3 most common congenital heart disease in cats?

A

Ventricular septal defect (VSD)
Tricuspid valve dysplasia (TVD)
Mitral valve dysplasia (MVD)

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3
Q

What is a patent ductus arteriosus?

A

Ductus arteriosus patent after birth

Blood flows from the aorta to pulmonary artery

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4
Q

Patent ductus arteriosus results in a ___________ overload to the _____ side of the heart

A

Volume; left

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5
Q

What type of hypertrophy would you expect in a patent ductus arteriosus?

A

Eccentric - volume overload

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6
Q

What breeds are predisposed to PDA?

A 
Bichon
Chihuahua 
Poodle 
GSD
Corgi
Shetland sheepdog
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7
Q

T/F: PDA is more commonly see in males rather than females

A

False

Female>male

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8
Q

Continuous heart murmur with PMI at bases
High grade

Heart rate normal to high

Bounding femoral pulse

Asymptomatic

A

PDA

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9
Q

If PDA results in CHF, what clinical signs will you see?

A 
Exercise intolerance 
Tachypnea 
Cough
Dyspnea 
Syncope

Abnormal lung sounds

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10
Q

How can you definitively diagnose PDA?

A

Echocardiography

-turbulent blood flow

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11
Q

What is the treatment of PDA?

A

Curable by surgical ligation/trans catheter occlusion

Both procedures require specialists
Transcatheter occulsion is minimally invasive

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12
Q

What is reversed PDA??

A

Right (deoxygenated) to left (oxygenated blood) shunt

Occurs secondary to severe pulmonary hypertension (PA > aortic pressure)

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13
Q

Reversed PDA can result in??

A

Hypoxemia and polycythemia

Often symptomatic and have differential cyanosis (cranial or caudal depending on if it joins before or after the subclavian arteries

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14
Q

T/F: reversed PDA s correctable by ligation or occlusion similar to a left-right PDA

A

False

Non correctable

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15
Q

How are reversed PDAs managed?

A

Exercise restriction
Phlebotomy
Bone marrow suppression drugs (hydroxyurea)

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16
Q

What disease has subvalvular fibrosis

A 
Subaortic stenosis (SAS) 
-nodule/ridge/ring/tunnel

Not always congenital

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17
Q

How does subaortic stenosis affect bloodflow?

A

Obstructs blood as it flows from the LV to the aorta

-LV must generate higher pressure to maintain cardiac output

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18
Q

SAS results in ________ overload to the _____ side of the heart

A

Pressure; left

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19
Q

What type of hypertrophy would you expect in SAS?

A

Concentric -pressure overload

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20
Q

What is the signalment for SAS?

A

Dog> cat

Large and giant breed
-golden, Newfoundland, Rottweiler, GSD, boxer

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21
Q 
Dog
Left basilar systolic murmur 
Med grade 
Heart rate normal to high
Weak femoral pulse

Asymptomatic

A

SAS

If CHF develops -> abnormal lung sounds, tachypnea, and dyspnea

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22
Q

How can you definatively diagnose SAS?

A

Echocardiography

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23
Q

Severity of a SAS can be determined how?

A

Continuous wave Doppler

Used to measure velocity of blood as it is ejected out of LV

Estimated pressure gradient (PG)=4 x velocity^2

Mild if PG < 40mmHg
Moderate 41-80mmHg
Severe > 80mmHg

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24
Q

Dogs with SAS can develop what potentially fatal arrhythmia?

A

Ventricular arrhythmia

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25
Q

How is SAS treated?? What patients would be indicated?

A

No curative treatment

Atenolol (b blocker) can decrease myocardial O2 demand, improve perfusion, and prevent ventricular arrhythmia
—> moderately/severely affected dogs

Balloon valvulopasty

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26
Q

SAS is a risk factor for ____________

A

Endocarditis

—> patients with SAS should receive antibiotics for any potentially bacteremic episode

High velocity can damage endothelium

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27
Q

What is valvular pulmonic stenosis?

A

Markedly thickened cusps due to dysplasia +/- commissural fusion or annular hypoplasia

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28
Q

How does pulmonic stenosis affect blood flow?

A

Obstructs blood as it flows from the right ventricle to the main pulmonary artery
—> RV must generate higher pressure to maintain cardiac output

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29
Q

PS results in _________ overload to the _______ side of the heart

A

Pressure; right

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30
Q

What type of hypertrophy do you expect in pulmonic stenosis ?

A

Concentric - pressure overload

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31
Q

What is the signalment commonly seen with PS?

A

Dog> cat

Terrier
Bulldog
Beagle
Samoyed
Chihuahua
Labrador
32
Q

Dog

Left basilar systolic murmur
Any grade

Heart rate normal-high
Femoral pulses are normal

A

Pulmonic stenosis

33
Q

If pulmonic stenosis lead to congestive heart failure, what clinical signs would you see?

A

Jugular venous distention
Abdominal distention
Tachypnea
Dyspnea

Right sided CHF—> systemic congestion

34
Q

Definitive diagnosis requires of pulmonic stenosis requires??

A

Echocardiography

35
Q

Where would you see a bulge on the heart if there was pulmonic stenosis

A

1-2 o’clock

36
Q

What is the treatment of pulmonic stenosis ?

A

Mildly affected+asymptomatic - normal lifespan, no treatment

Balloon valvuloplasty if PS is /moderate/severe (80mmHg)

Atenolol can reduce arrhythmia, dynamic infundibular gradient, syncopal events, and risk of sudden death

37
Q

If you are considering a balloon valvuloplasty surgery in a bulldog/boxer, what would you be concerned about ?

A

Can have anomalous coronary artery (branching from aorta and wrapping under pulmonary artery)

—> valvuloplasty can cause rupture

38
Q

What is a ventricular septal defect (VSD)? How does it impact blood flow?

A

Defect in the inter ventricular septum

LV>RV pressure
Blood from the left goes to the right ventricle

39
Q

Ventricular septal defect (VSD) causes a _____________ overload to the ______ side of the heart

A

Volume; left

40
Q

What type of hypertrophy do you expect in VSD?

A

Eccentric - volume overload

41
Q

What is the most common concurrent congenital defect in dogs with VSD?

A

Pulmonic stenosis

42
Q

T/F: if severe pulmonary hypertension develops or severe PS is present along with VSD, the shunt can reverse (right ->left)

A

True

43
Q

What is the signalment for VSD?

A

cats>dog

English springer spaniel 
West highland white terrier 
Lakeland terrier 
Basset hound 
English bulldog
44
Q

Cat
Systolic murmur with PMI parasternally

Heart rate normal or high
Femoral pulse normal

A

Ventricular septal defect

45
Q

T/F: the smaller the VSD, the launder the murmur

A

True

46
Q

What diagnostics can you use in VSD?

A

Echocardiography
Doppler - ID small defects

Radiographs —> pulmonary over circulation

Moderate/large defects cause more significant chamber dilation (left sided or biventricular) and pulmonary hypertension

47
Q

Treatment for VSD?

A

Small VSDs do not require treatment

Moderate/large—> cardioprotective(ACEi)

Large defects —> PA banding or open-heart surgery (poor prognosis if not closed)

48
Q

What is tricuspid valve dysplasia (TVD)?

A

Thickening/elongated/shortened leaflets

Shortened/absent cordae tendineae

Abnormal papillary mm.

49
Q

How does tricuspid valve dysplasia (TVD) affect blood flow?

A

TV regurgitation is the most common result, but stenosis can also occur

50
Q

TVD results in _______ overload to the __________ side of the heart

A

Volume; right

51
Q

What type of hypertrophy do you expect in TVD?

A

Eccentric - volume overload

52
Q

What other cardiac abnormality can you see in TVD due to high right atrial pressure?

A

Patent foramen ovale

53
Q

What is the signalment of TVD?

A

Cats> dog

Lab
Boxer
Irish setter
GSD

54
Q

Cat

Right apical systolic murmur
Heart rate normal or high
Femoral pulses are normal

A

Tricuspid valve dysplasia

55
Q

What signs would you observe is there was CHF due to TVD?

A

Jugular venous distention
Pulsation/abdominal distention
Tachypnea/dyspnea

56
Q

How can you definitively diagnose TVD?

A

Echocardiography

  • when tricuspid regurgitation is severe, the left ventricle is usually small (volume underload)
  • when stenosis is present, RA is dilated and RV is small
57
Q

What is the treatment for TVD?

A

Mild- no treatment required

Moderate/severe- cardioprotective drug(ACEi)

In severe cases can develop CHF

  • > surgical valve replace the
  • > interventional therapy with balloon valvuloplasty
58
Q

What is mitral valve dysplasia

(MVD)?

A

Any part of the valve can be affected

Short/thick leaflets with an occasional cleft
Short/thick/long/thin cordae tendineae
Annular enlargement, malposition of papillary mm.

59
Q

T/F: mitral regurgitation is most common, but stenosis can also occur

A

True

60
Q

Mitral valve dysplasia results in _____________ overload to the ______ side of the heart

A

Volume; left

61
Q

What type of hypertrophy do you expect in mitral valve dysplasia?

A

Eccentric - volume overload

62
Q

What is the signalment of MVD?

A

Cat>dog

Great Dane 
GSD 
Bull terrier 
Golden retriever 
Newfoundland
63
Q

How can animals with MVD present ?

A

Asymptomatic or L-sided CHF

Left apical systolic murmur
If there is a stenosis, may hear a diastolic murmur

64
Q

CAT

Left apical systolic murmur
Heart rate may be normal or high
Femoral pulse normal

A

Mitral valve dysplasia

65
Q

What is the definitive diagnosis for MVD?

A

Echocardiography

If stenosis is present - LA dilated and LV small

Thoracic radiographs are useful for determining LA/LV enlargement and CHF

66
Q

How do you treat MVD?

A

Mild -does not require treatment

Moderate/severe -cardioprotective drug

Beta blocker in patients with LV outflow obstruction

Many with severe MVD develop CHF—> surgical repair/replacement of valve/balloon valvuloplasty

67
Q

Atrioventricular septal defects are most common in what species?

A

Cats&raquo_space; dogs

68
Q

What congenital heart disease has its PMI at left/right parasternal,diastolic, or systolic ?

A

Atrioventricular septal defects

—> no surgical/interventional therapy
—>can develop CHF and sudden death

69
Q

What is tetralogy of fallot (ToF)?

A

Pulmonic stenosis

Secondary concentric hypertrophy of the right ventricle

Overriding aorta

Ventricular septal defect

70
Q

How is the blood flow affected during tetralogy of fallot?

A

High pressure in the RV (secondary to PS) —> deoxygenated blood from the RV shunts into the LV
—> hypoxemia and polycythemia

71
Q

What is the most common cause of cyanotic heart disease in cats and dogs?

A

Tetralogy of Fallot

72
Q

What is the treatment of ToF?

A

Non-selective beta blocker (propranolol)
Exercise restriction
Phlebotomy
+/- hydroxyurea

Partial balloon valvuloplasty
Surgical

Open-heart repair of VSD and PS

73
Q

What defect allows blood to flow from the left atrium and right atrium?

A

Atrial septal defect

->murmur is common and often low grade

74
Q

What is persistent right aortic arch?

A

Vascular ring anomaly (VRA) characterized by persistence of the right fourth aortic arch during fetal development

—> esophageal signs- regurgitation

75
Q

What type of murmur is only ever systolic and low grade, usually heard in the base of the heart

A

Innocent heart murmur

76
Q

Where is the PMI of a innocent heart murmur?

A

Aortic/pulmonary valve (left heart base)

77
Q

What causes a innocent heart murmurs and what animals do you see it in?

A

Murmur caused by high velocity flow through an immature CVS

NOT a structural heart disease

Puppies and kittens - usually disappear by 6months of age

RUSVM SAM 1 (26 decks)

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