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equinee > Day 8 - cardiac diseases > Flashcards

Day 8 - cardiac diseases Flashcards

1
Q

General steps of exam of cardiac diseases

A
  • Detailed physical examination at rest
  • Exercise test/performance analysis (is the cardiac problem the cause?, subclinical and transient problems)
  • Echocardiography: murmurs, pericardial effusion
  • ECG: arrythmias (exercise test)
  • Laboratory parameters (hematology, biochemistry, microbiology, cytology (pericardial effusion))
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2
Q

Left-sided congestive heart failure (CHF)

A

acute: lung-edema,
chronic: cardiac cachexia

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3
Q

Right-sided heart failure:

A

ventral oedema, venous pulsation

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4
Q

consequence of unilateral HF

A

will become bilateral

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5
Q

Most common congestive HF

A

Valvular heart disease (+ atrial fibrillation)

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6
Q

CS of HF

A

Exercise intolerance
Slow return to resting values
Weight loss
Cough
Tachycardia
Tachypnoea
Ventral edema
Pulmonary congestion, edema
Colic-like signs

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7
Q

CHF - Tx (4)

A
  • Digoxin
  • Furosemide
  • Potassium chloride
  • ACE inhibitors
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8
Q

Congenital diseases

A
  • Ventricular septal defect, atrial septal defect
  • Abnormal valves
  • Complex cardiac defects
  • Vascular malformations (Patent ductus arteriosus)
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9
Q

Vascular septal defect - Tx

A
  • Most common, Inherited
  • Basal area
  • Signs depend on size: > 2,5 cm: Left to right shunt
  • Cardiac murmur: Holo- or pansystolic, grade 3-5/6, point of maximum intensity (PMI) below tricuspid opening
  • Dx: 2D and Doppler echocardiography
  • Tx: as CHF or euthanasia
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10
Q

Ventricular septal defect - Eisenmengers syndrome

A

right to left shunt

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11
Q

Acquired heart diseases - Endocardium and valves

A

Bacterial/vegetative endocarditis (infective)
Degenerative thickening of the valves
Valvular dysfunction, secondary to myocardial disease Ruptured chordae tendinea
Prolapse of valves
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation
Pulmonary regurgitation

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12
Q

Acquired heart diseases - Myocardium

A
  • Myocarditis (equine influenza, herpesvirus, rhinopneumonitis, bacterial)
  • Myocardial fibrosis (Ischemic or strongylosis)
  • Myocardial degeneration/necrosis (Toxic or Se/Vit E def.)
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13
Q

Acquired heart diseases - Neoplasia and Dilated cardiomyopathy

A

Lymphosarcoma, melanoma, haemangio(sarco)ma

(idiopathic) - rarely

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14
Q

Acquired heart diseases - Arrhytmias

A
  • Atrial, junctional and ventricular premature complexes
  • Atrial tachycardia, flutter, fibrillation
  • Ventricular tachycardia, flutter, fibrillation
  • Second and third degree atrioventricular blocks: 1st degree always physiological
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15
Q

Grade 5 L-sided murmur (holosystolic)

A

mitral regurgitation/aortic stenosis –> a. stenosis Ø common in adult horses

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16
Q

Grade 5 L-sided murmur (holodiastolic)

A

Ø have to think about mitral stenosis

17
Q

Bacterial endocarditis - Pathogens and CS

A

o Streptococcus Equii ssp equi, Streptococcus Equi ssp zooepidemicus, Actinobacillus equuli, Rhodococcus equi

  • Mitral, aortic, tricuspid, pulmonary (high to low)
    CS: Bacreremia, Resp signs, Cardiovasc signs (grade 3-6/6 murmur)
18
Q

Bacterial endocarditis - ancillary and lab

A

o ECG, phonocardiography, echocardiography
o Aortic regurgitation —> diastolic, decrescendo murmur

o Leukocytosis, neutrophilia, hyperfibrinogenemia, hypergammaglobulinemia
o Blood culture (aseptic venous blood sample before starting AB treatment)

19
Q

Bacterial endocarditis - Dx and Tx

A

o Suspicion based on clinical signs, echocardiography

o AB: initially broad spectrum
o Treatment of congestive heart failure
o Antiarrhythmic drugs if necessary
o Flunixin meglumine
o Low molecular weight heparin
o Strict box rest

20
Q

Aortic valve insufficiency

A
  • Most common, older horses
  • Not always leading to exercise intolerance
  • Prolapse, nodules, thickening, fenestrations of valve leaflets
  • Holodiastolic, decrescendo, grade 3-6/6 murmur on left side
  • Strong, short pulse
  • Compensation: hypertrophy (stronger contraction stronger pulse), MVI, left atrial dilation, AF
  • Mosaic pattern = regurgitation
21
Q

Mitral valve insufficiency

A
  • Pan- or holosystolic murmur on left side, PMI: 5th ICS
  • Can continue to diastole: enhancement of 3rd heart
    sound, fast early filling
  • Acute/peracute MVI: ruptured chordae tendinea
  • Left atrial dilation, jet lesions (erosion development in
    atrial endocardium / endothelial abnormalities)
  • Echo on left side due to large heart and thickened chest
    wall
22
Q

Rupture of chorda tendinea

A
  • Peracute cardiac failure
  • Pulmonary edema: Can give huge amounts of digoxin - help pump function of the heart + large dose of furosemide
  • Grave prognosis
23
Q

Tricuspid and pulmonary valve insufficiency

A
  • Tricuspid valve insufficiency
    o Bacterial or secondary together with MVI
    o Systolic, grade 3-5 murmur of right side
    o Dilated jugular vein, positive venous pulse (due increased pressure/regurgitation into RV –> vena cava —> jugular vein)
  • Pulmonary valve insufficiency
24
Q

Atrial premature complex - Tx

A

Ausc, ECG

abnormal P-wave, narrow QRS,

Tx: Box rest, Arrhytmic drug (Quinidine, procainamide),
Dexamethadone
Correction of electrolytes

25
Q

Atrial fibrillation - Tx

A

Myocardial disease, not alter CO, cons of other cardiac disease

ECG: Variable, irregular RR intervals, No P wave, F wave instead
Tx: Quinidine, Digoxin

26
Q

Atrial flutter

A
  • Can be a stage after atrial fibrillation
  • Higher P wave
  • Lower contraction rate of atria compared to fibrillation
  • Can go to normal sinus rhythm
27
Q

Ventricular tachycardia - Tx

A
  • 4 or more consecutive VPCs, life-threatening, Fast HR

ECG: Abnormal QRS complex and T wave, QRS is independent from preceding P-wave, P wave may merge into QRS or T wave o “R-on-T” phenomenon - Torsades de pointes

Tx:
o Lidocaine IV
o Procainamide IV/PO
o Propranolol IV/PO
o Propafenone IV/PO
o Flecainide acetate IV
o Magnesium sulphate IV/nasogastric tube
o Bretylium IV

equinee (24 decks)

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