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Module 15 > Congenital Murmurs in Puppies & Kittens > Flashcards

Congenital Murmurs in Puppies & Kittens Flashcards

1
Q

what are pathological cardiac murmurs

A
  1. incompetent or stenotic valves
  2. flow through shunts
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2
Q

what are physiological (functional) murmurs

A

changes in blood viscosity or velocity (anemia), hypoproteinemia, fever

also athletes (big stroke volume)

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3
Q

what are innocent murmurs

A

soft (max G1-2/6)

systolic, short, variable, localized

young animals

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4
Q

what are not innocent murmurs

A

NEVER diastolic or continuous

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5
Q

what are causes of murmurs in kittens and puppies (3)

A
  1. could be innocent flow murmur
  2. systemic disease (anemia)
  3. could be acquired disease but very unusal (early onset cardiomyopathy in cats, myocarditis in puppies)
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6
Q

what are almost all louder systolic mumurs and all continuous murmurs due to

A

congenital anatomical defects

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7
Q

what are the characteristics of innocent murmurs (3)

A
  1. low grade systolic murmur
  2. left heart base
  3. usually gone by 16-20 weeks

if G3+ most likely congenital disease (not innocent)

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8
Q

what are the causes of congenital murmurs in dogs in order of prevelance (8)

A
  1. aortic stenosis
  2. patent ductus arteriosus
  3. pulmonary stenosis
  4. ventricular septal defect
  5. mitral valve dysplasia
  6. tricuspid valve dysplasia
  7. tetralogy of fallot
  8. persistent right aortic arch
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9
Q

what are the causes of congenital murmurs in cats in order of prevelance (6)

A
  1. ventricular septal defect
  2. mitral valve dysplasia
  3. tricuspid valve dysplasia
  4. aortic stenosis
  5. persistent right aortic arch
  6. tetralogy of fallot
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10
Q

what are the causes of congenital murmurs

A

majority is unknown

some may be genetic (known prevalence in pure bred dogs; some screening in some breeds ex boxer)

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11
Q

which breed has a genetic predisposition to aortic stenosis

A

newfoundland

autosomal dominant with modifiers

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12
Q

what breeds have a genetic predisposition to patent ductus arteriosus

A

poodle

polygenic

female:male 2-4:1

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13
Q

what breeds have a predisposition to tetralogy of fallot

A

keeshond

polygenic

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14
Q

what breeds have a predisposition to pulmonary stenosis

A

beagle

polygenic

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15
Q

what breeds have a predisposition to persistent right aortic arch

A

german shepherd

polygenic

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16
Q

how are congenital murmurs diagnosed (7)

A
  1. history
  2. breed/sex/age
  3. physical exam
  4. thoracic radiography
  5. echocardiography
  6. electrocardiography
  7. angiography
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17
Q

what are left base murmurs and when would they be heard (4)

A
  1. patent ductus arteriosus (continuous)
  2. aortic stenosis (systolic)
  3. pulmonary stenosis (systolic)
  4. innocent/functional murmurs (systolic)
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18
Q

what murmurs can be heard at the left apex and when can they be heard

A
  1. mitral valve dysplasia (systolic)
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19
Q

hat are right side murmurs and when can they be heard (3)

A
  1. tricuspid valve dysplasia (systolic)
  2. ventricular septal defect (systolic)
  3. tetralogy of fallot (systolic, also at left base)
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20
Q

what will thoracic radiography show (3)

A
  1. chamber enlargement: left or right sided
  2. pulmonary circulation: vascular congestion or decreased vascularity
  3. great vessel dilation
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21
Q

what will electrocardiography show

A
  1. left sided enalrgement: aortic stenosis, PDA
  2. right sied enlargement: right axis deviation –> pulmonary stenosis, tetralogy of fallot
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22
Q

what will echocardiography show (6)

A
  1. chamber dilation
  2. wall hypertrophy
  3. abnormal valve appearance
  4. valvular incompetence
  5. high velocity flow across valves
  6. shunts
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23
Q

what is the pathology of aortic stenosis

A
  1. sub-aortic stenosis (muscular ridge)
  2. valvular aortic stenosis (valve cusps or annulus)

turbulent flow across aortic region

muscular or fibromuscular ridge or ring beneath the aortic valve

sometimes there is valvular stenosis where the valve cusps are abnormal

can get secondary changes to the valve due to the subaortic stenosis

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24
Q

what is the pathophysiology of aortic stenosis

A
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25
Q

what breeds is aortic stenosis common in

A

Rottweiler

boxer

GSD

newfoundland

golden retriever

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26
Q

is aortic stenosis common in cats

A

rare

may be supra valvular

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27
Q

what is seen on history in animals with aortic stenosis (5)

A
  1. asymptomatic
  2. exercise intolerance
  3. syncope
  4. sudden death (can be first clinical sign)
  5. left sided congestive heart failure (dyspnea, tachypnea, cough)
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28
Q

what is seen on clinical exam with aortic stenosis (3)

A
  1. weak pulse
  2. harsh systolic murmur left heart base
  3. +/- left sided CHF
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29
Q

what is seen on radiography with aortic stenosis

A
  1. cardiac silhouette may be elongated
  2. post valvular dilation of aorta may be present
30
Q

what is seen in ECG with aortic stenosis (3)

A
  1. tall R waves (left ventricular hypertrophy)
  2. ventricular premature complexes
  3. ST segment depression (myocardial ischemia)
31
Q

what is seen on echocardiography with aortic stenosis (5)

A
  1. left ventricular concentric hypertrophy
  2. aortic valve dysplasia
  3. sub valvular narrowing of aorta
  4. high velocity flow across aorta
  5. turbulent blood flow across aorta
32
Q

what is the therapy and prognosis of aortic stenosis

A

mild cases: no treatment, good prognosis

severe: beta-blockers (reduce HR, reduce outflow gradient, reduce risk of arrhythmias and sudden death), calcium channel blockers (diltiazem)

guarded prognosis: little/no evidence that beta-blockers, balloon dilation or surgery help, a cutting ballon may be more effective

increased risk of bacterial endocarditis

33
Q

what does aortic stenosis increase the risk of

A

increased risk of bacterial endocarditis

34
Q

what is patent ductus artiosus (PDA) pathophysiology

A

left to right shut causing volume overload of lungs and of the left heart

depending of the size of the ductus may progress quickly (1-3 years) to left sided CHF so early closure is recommended

35
Q

what can also occur in PDA pathophysiology

A

pulmonary hypertension –> right to left shunt –> caudal cyanosis

36
Q

what breeds can be affected by PDA

A

collie

sheltie

CKCS

toy poodle

GSD

spaniel

37
Q

what is seen on history with PDA (2)

A
  1. exercise intolerance
  2. left sided CHF (dyspnea, tachypnea, cough)
38
Q

what is seen on clinical exam with PDA

A
  1. continuous murmur left heart base
  2. water-hammer pulse also called machinery murmur
39
Q

what is seen on thoracic radiography with PDA (3)

A
  1. over perfusion of lungs
  2. +/- pulmonary edema
  3. aortic, pulmonary and left auricular bulge on DV view
40
Q

what is seen on echo with PDA (3)

A
  1. turbulent flow dlow in pulmonary artery
  2. ductus visible joining pulmonary artery
  3. continuous high
41
Q

what is seen on ECG with PDA

A
  1. tall R waves (LV enlargement)
42
Q

what is the treatment of PDA (2)

A
  1. surgical ligation or coil/amplatz plug implantation
  2. treat left sided CHF if present with diuretics and ACE inhibitors
43
Q

what is reversed PDA

A
  1. excessive volume overload of lungs may lead to pulmonary hypertension (PH) usually occurs early in life (large ductus) but may also occur later complication
  2. right to left (sometimes bidirectional) shunting into descending aorta occurs due to pulmonary hypertension
44
Q

what clinical signs occur with reversed PDA

A
  1. hindquarter weakness/caudal cyanosis
  2. may develop polycythemia due to hypoxia
45
Q

what is the treatment of reversed PDA

A

treat polycythemia by phlebotomy +/- hydroxycarbamide

46
Q

what is the prognosis of reversed PDA

A

guarded/poor

but if respond to sildenafil for PH and management of polycythemia may do okay

47
Q

what is the pathology pulmonary stenosis

A
  1. valvular: dusion, thickening, hypoplasia
  2. subvalvular: usually due to secondary hypertrophy
48
Q

what might cause pulmonary stenosis

A

may be associated with aberrant coronary anatomy in bulldogs and other brachycephalics

49
Q

what is the pathophysiology of pulmonary stenosis

A
50
Q

what are the breeds that are affected by pulmonary stenosis

A

west highland terrier

bulldog

boxer

cocker spaniel

beagle

51
Q

is pulmonary stenosis common in cats

A

no

52
Q

what is seen on history with pulmonary stenosis (5)

A
  1. asymptomatic
  2. exercise intolerance
  3. syncope
  4. sudden death
  5. right sided CHF (ascites, dyspnea)
53
Q

what is seen on the clinical exam with pulmonary stenosis

A
  1. weak pulse
  2. harsh systolic left heart base murmur
  3. ascites
54
Q

what is seen on radiography with pulmonary stenosis (3)

A
  1. hypoperfusion
  2. pulmonic bulge
  3. right ventricular hypertrophy
55
Q

what is seen on ECG with pulmonary stenosis

A

deep S waves in leads I, II, III

56
Q

what is seen on echocardiography with pulmonary stenosis

A
  1. thickening/fusoin of pulmonary valve +/- valve hypoplasia
  2. right ventricular hypertrophy
57
Q

how are mild cases of pulmonary stenosis treated

A

no treatment

good prognosis

58
Q

how are severe cases of pulmonary stenosis treated

A
  1. beta blockers
  2. balloon valvuloplasty (works best if fused vavles)
  3. surgical including patch graft

guarded prognosis

59
Q

what is the pathophysiology of ventricular septal defect

A

small perimembranous occurs in the portion of the interventricular septum beneath the aortic valve in the outflow segment of the left ventricle

60
Q

what breeds are effected by ventricular septal defects

A

bulldog

keeshond

cocker spaniel

and common in cats

61
Q

what is seen on history with ventricular septal defect

A
  1. asymptomatic
  2. exercise intolerance
  3. left sided congestive heart failure (dyspnea, cough)
62
Q

what is seen on clinical exam with ventricular septal defect

A
  1. systolic murmur right ventral thorax (usually) –> the smaller the VSD, the louder the murmur
  2. good pulse
63
Q

what are the signs of tetralogy of fallot (4)

A
  1. collapse
  2. dyspnea
  3. cyanosis
  4. exercise intolerance
64
Q

what is seen on the physical exam with tetralogy of fallot (3)

A
  1. +/- murmur depends on presence of polycythemia
  2. +/- cyanosis
  3. +/- dyspnea
65
Q

what is the pathology of tetralogy of fallot (4)

A

abnormal spinal septum formation

abnormality formation of the spiral septum which is in the embryo divides the trunkus arteriosus into the aorta and pulmonary –> deviated to the right which leaves a large VSD

  1. pulmonary stenosis
  2. large VSD
  3. over-riding aorta
  4. right ventricular hypertrophy
66
Q

what is mitral valve dysplasia

A

insufficiency only OR stenosis and insufficiency

67
Q

how does mitral valve dysplasia present

A

systolic murmur over mitral valve but if stenosis present diastolic murmur also present

may develop left sided CHF, +/- arrhythmias

68
Q

how is mitral valve dysplasia treated and what is the prognosis

A

similar to mitral valve endocardiosis

prognosis depends on severity

69
Q

what is seen on echo with mitral valve dysplasia

A

dysplastic valve

leaking valve

70
Q

how does tricuspid valve dysplasia present (8)

A
  1. asymptomatic
  2. exercise intolerance
  3. syncope
  4. may develop rapid supraventricular tachycardia
  5. +/- ascites
  6. systolic murmur over right apex
  7. +/- signs of right sided CHF
  8. +/- episodic weakness/tachypnea if arrythmia
71
Q

how is tricuspid valve dysplasia treated (3)

A
  1. treat CHF as usual
  2. surgery (replacement/repair) has been performed in dogs
  3. manage arrhythmia if present: medical or ablation of accessory pathway

Module 15 (27 decks)

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