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M15: Cardiorespiratory > Congenital murmurs in SA > Flashcards

Congenital murmurs in SA Flashcards

1
Q

List common congenital heart diseases in the dog (8)

A

Aortic/pulmonic stenosis, PDA, VSD, mitral/tricuspid valve dysplasia, tetralogy of fallot, persistent R aortic arch

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2
Q

List common congenital heart diseases in the cat (5)

A

VSD, mitral/tricuspid valve dysplasia, aortic stenosis, persistent R aortic arch

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3
Q

What will a L base murmur relate to?

A

PDA, aortic stenosis, pulmonic stenosis, innocent/functional murmur (systolic)

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4
Q

What will a L apex murmur relate to?

A

Mitral valve dysplasia (systolic)

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5
Q

What will a R sided murmur relate to?

A

Tricuspid valve dysplasia, pulmonic stenosis, VSD, tetralogy of fallot (systolic)

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6
Q

What can be detected by thoracic radiography?

A

Chamber enlargement, pulmonary circulation (vascular congestion or decreased vascularity), great vessel dilation

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7
Q

What can be detected on echocardiography?

A

Chamber dilation, wall hypertrophy, abnormal valve appearance, valvular incompetence, high velocity flow across valve, shunt

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8
Q

How does aortic stenosis cause a murmur?

A
  1. Narrowing at valve
  2. P overload of LV
  3. Concentric hypertrophy of LV
  4. Arrhythmia = syncope/acute death
  5. Diastolic dysfunction = L CHF
  6. Forward failure = exercise intolerance
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9
Q

What are the clinical signs associated with aortic stenosis?

A

Exercise intolerance, syncope, L CHF, dyspnoea, tachypnoea, cough, weak pulse, harsh systolic murmur ar L base, acute death

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10
Q

What findings would be expected on diagnostic imaging and ECG for aortic stenosis?

A 
ECG = tall R wave, VPC, St segment depression
Radiography = normal, may have elongated cardiac silhouette and post valvular dilation of aorta
Echo = LV concentric hypertrophy, aortic valve dysplasia, subvalvular aortic narrowing, high velocity and turbulent flow across aorta
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11
Q

What is the tx for aortic stenosis?

A

Mild cases - no tx, gd prognosis
Severe cases - B blockers, Ca channel blockers, guarded prognosis
*increased risk of bacterial endocarditis

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12
Q

What are the clinical signs associated with a PDA?

A

Exercise intolerance, L CHF, continuous L base murmur, water hammer pulse

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13
Q

What findings would be expected on diagnostic imaging and ECG for PDA?

A 
ECG = tall R wave
Radiography = hyperperfusion of lungs, L enlargement, enlargement of great vessels at base, interstitial and alveolar oedema
Echo = turbulent blood flow in pulmonary artery, visible ductus, continuous high velocity flow in pulmonary artery
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14
Q

What are the tx options for PDA?

A
  • Surgical ligation or coil/Amplatz implant
  • L CHF tx with diuretics and ACE inhibitors
  • excellent prognosis if treat early
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15
Q

What occurs in a ‘reversed’ PDA?

A
  • excessive vol overload of lungs may lead to pulmonary hypertension which causes a R to L shunt
  • present with hind quarter weakness/caudal cyanosis
  • may develop polycythemia de to hypoxia
  • surgical tx may result in R CHF
  • poor prognosis
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16
Q

Describe the pathogenesis of pulmonic stenosis

A
  1. decreased cardiac output = forward failure = exercise intolerance
  2. diastolic dysfunction = increased RA P = R CHF
  3. P overload = concentric hypertrophy of RV = arrhythmias = syncope
17
Q

What are the clinical signs associated with pulmonic stenosis?

A

Exercise intolerance, syncope, acute death, R CHF, weak pulse, harsh systolic L base murmur, ascites

18
Q

What findings would be expected on diagnostic imaging and ECG for pulmonic stenosis?

A 
ECG = deep S wave
Radiography = hypoperfusion of lungs, RV hypertrophy, pulmonic bulge
Echo = thickening of pulmonic valve, RV hypertrophy
19
Q

What are the tx options for pulmonic stenosis?

A

Mild cases - no tx, gd prognosis

Severe cases - B blockers, balloon vasculoplasty, patch graft, guarded prognosis

20
Q

Describe the pathogenesis of VSD

A

Most are small, perimembranous defects
Occasionaly may get overcirculation of lungs, L CHF
Rarely get pulmonary hypertension, R to L shunt, hypoxia

21
Q

What clinical signs are associated with VSD?

A

Exerise intolerance, L CHF (cough, dyspnoea), systolic murmur on R ventral thorax, good pulse

22
Q

What findings would be expected on diagnostic imaging and ECG for VSD?

A 
ECG = tall R waves
Radiography = generalised cardiomegaly, L CHF, congestion of pulmonary vessels
Echo = defect in membranous part of septum, turbulent blood flow across defect
23
Q

How are VSDs treated?

A

No tx in asymptomatic cases
CHF tx with diuretics, ACE inhibitors
No interventional surgical tx

24
Q

What are the components of tetralogy of fallot?

A
  1. VSD
  2. Over riding aorta
  3. Pulmonic stenosis
  4. RV hypertrophy
25
Q

What clinical signs are associated with tetralogy of fallot?

A

Exercise intolerance, collapse, +/- dyspnoea, cyanosis, +/- murmur, +/- cyanosis

26
Q

What findings would be expected on diagnostic imaging and ECG for tetralogy of fallot?

A 
ECG = deep S wave
Radiography = RV enlargement, hypovascularity of lungs, pulmonary artery bulge
Echo = large VSD with over riding aorta, R to L shunt of blood across VSD
27
Q

What are the tx options for a VSD?

A 
Phlebotomy - remove RBC if have polycythaemia
Hydroxyurea - decrease RBC production
B blockers - reduce RV hypertrophy
Palliative sx - poor prognosis
*few live > 3-4 years
28
Q

Describe mitral valve dysplasia

A
  • may have insufficiency or stenosis and insufficiency
  • no stenosis = systolic murmur over mitral valve
  • stenosis = diastolic murmur as well
  • may develop L CHF
  • tx = mitral valve endocardiosis
  • prognosis depends on severity
29
Q

What are the clinical signs associated with tricuspid valve dysplasia?

A

Asymptomatic, exercise intolerance, syncope, +/- R CHF and ascites, systolic murmur R apex

30
Q

What findings would be expected on diagnostic imaging and ECG for tricuspid valve dysplasia?

A 
ECG = splintered QRS, 2 R waves
Radiography = RA enlargement
Echo = abnormal appearance and position of tricuspid valve

M15: Cardiorespiratory (5 decks)

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