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Y4 EQ - Cardio-Respiratory > Equine Cardiac examination Refresher and Murmurs > Flashcards

Equine Cardiac examination Refresher and Murmurs Flashcards

1
Q

How does cardiac disease most commonly present in horses?

A
  • Incidental e.g. pre-purchase exam
  • History of poor performance
  • Systemically ill horse
  • Horse presented with evidence of heart failure (rare)
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2
Q

What are the aims of investigation when investigating cardiac disease in horses?

A

Need to establish significance of any findings:
- Cardiac murmurs/dysrhythmias are COMMON
- Significance for performance?
- Collapse?
- Progression?
- Interpret in context of use/intended use of horse

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3
Q

Describe how to auscultate a horses heart

A
  1. Quiet environment
  2. Take time
  3. Let horse settle
  4. Get into the rhythm
    Listening on the RHS:
    - Pull leg forward
    - Stick stethoscope bell right under triceps just dorsal to point of elbow
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4
Q

The apex beat in horses correlates to which valve?

A

Mitral

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5
Q

Name the valve that lies between the right atrium and ventricles

A

Tricuspid valve

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6
Q

Name the valve that lies between the left atrium and ventricles

A

Mitral

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7
Q

Systole = ?
Diastole = ?

A

Systole = contraction
Diastole = relaxation

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8
Q

Describe the S1 and S2 heart sounds

A

Ventricles contract:
- S1 : Shutting of AV valves (Mitral/tricuspid)
- “ LUB “
Ventricles relax
- S2 : Shutting of Semilunar valves (Aortic/Pulmonic)
- “ DUP “

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9
Q

Describe the other heart sounds heard in a horse

A

S4: atrial contraction
- “ B “ Very common
- Just before S1
S3: end of rapid ventricular filling
- “ D “ Less common
- Just after S2

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10
Q

How does mitral valve regurgitation affect the heart sounds in horses?

A

Causes a loud S3 due to lots of blood going back into the atrium, it is now full of blood, when the ventricle relaxes lots of blood rushes in, causing a loud sound

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11
Q

Describe which heart sounds are loudest in the basal and apical areas of the heart

A

Basal - S1 quieter, S2 louder
Apical - S1 louder, S2 quieter

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12
Q

Describe the lengths of systole and diastole in the normal heart - normal HR

A

Systole is much shorter than diastole

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13
Q

Describe the lengths of systole and diastole in the normal heart - high HR

A

Duration of systole = Duration of diastole

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14
Q

What is a murmur?

A

Turbulence of blood flow

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15
Q

Reynolds number influences?

A

Turbulence

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16
Q

Describe the sound made by normal laminar flow of blood

A

None - silent

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17
Q

Which factors influence turbulence of blood?

A

Stenosis of a vessel
Valve regurgitation
Increased blood flow

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18
Q

List the 6 methods of describing murmurs

A
  • Grade
  • Timing
  • Point of maximal intensity
  • Radiation
  • Shape of murmur
  • Quality of the murmur
19
Q

Describe the 6 grades of heart murmurs

A

1 = barely audible
2 = definite murmur quieter than S1 and S2
3 = obvious murmur as loud as S1 and S2
4 = very loud murmur, louder than S1 and S2
5 = very loud and has a palpable thrill
6 = audible with stethoscope just off chest wall

20
Q

Describe how the timing of murmurs can be used to describe them

A

Systolic / diastolic / continuous
- Early
- Mid
- Late
- ‘Pan’
- ‘Holo’

21
Q

Describe the meaning of the term ‘pan’ used to describe the timing of murmurs

A

Fills up the whole of systole and you can’t hear the heart sounds at either end

22
Q

Describe the meaning of the term ‘holo’ used to describe the timing of murmurs

A

Fills up the whole of systole but can hear the heart sounds at either end

23
Q

How can the shape of the murmur be used to describe it?

A

‘Plateau’
Crescendo
Decrescendo
Crescendo/decrescendo

24
Q

Name the 2 categories of murmurs

A
  • Physiological/functional
  • Pathological
25
Q

Physiological/functional murmurs are associated with..?

A

Normal blood flow through heart

26
Q

Physiological/functional murmurs are associated with..?

A

Normal blood flow through heart

27
Q

Pathological murmurs are associated with..?

A

Underlying cardiac disease

28
Q

Name the two main types of pysiological/functional murmurs

A

Flow murmur
Filling murmur

29
Q

Describe the features of flow murmurs

A
  • Early-mid systole
  • Up to 60% normal horses; L>R
  • Localised over heart base (aorta)
  • May change intensity with HR/exercise
  • Always finish before S2
  • Crescendo-decrescendo
30
Q

Describe the features of filling murmurs

A
  • Early diastole, L or R
  • Fit, young animals
  • Squeak / whoop/ click
  • Short duration between S2 & S3
  • Localised over heart base or apex
  • May change intensity with HR
  • Associated with turbulence of blood as it flows into the ventricles in early diastole, but before the walls stop
31
Q

How common is primary valvular stenosis in horses?

A

Rare

32
Q

Describe the murmur caused by Mitral/Tricuspid (AV Valve) regurgitation

A
  • Holo/pansystolic
  • Plateau or crescendo
  • PMI heart apex
  • May radiate dorsal and cranial
33
Q

At what grades of mitral valve regurgitation is it advised to monitor that horse and what grades require further investigation?

A

Grade 1-2: Monitor
Grade 3-6: Advise further investigation

34
Q

At what grades of tricuspid valve regurgitation is it advised to monitor that horse and what grades require further investigation?

A

Grade 1-3: monitor
Grade 4-6: advise further investigation

35
Q

Describe the pathological murmur caused by a ventricular septal defect

A

Loudest on right (occ. left)
Loud – thrill
Radiate cranial/ventral
Pansystolic
Normally young horses

36
Q

Describe the pathological murmur caused by aortic insufficiency

A

Common older horses
Descrescendo, buzzing / cooing
Holodiastolic
PMI left heart base
May radiate ventrally

37
Q

Which murmur of horses is referred to as the ‘teenage murmur’?

A

Aortic regurgitation

38
Q

Name the pathological continuous ‘machinery’ Murmur of horses

A

Patent Ductus Arteriosus

39
Q

When is a PDA murmur normal?

A

In neonates up to 5do

40
Q

Describe the murmur caused by a patent ductus arteriosus

A

PMI left heart base, also loud right heart base
Waxes and wanes in intensity during cardiac cycle

41
Q

Name 2 physiological murmurs of horses

A

Aortic flow murmurs
Ventricular filling murmurs

42
Q

Name 4 pathological murmurs of horses

A

Mitral/tricuspid valve regurgitation
Aortic regurgitation
Ventricular septal defect
(Patent Ductus arteriosus)

43
Q

Name two left and two right systolic murmurs

A

Left
- Mitral valve regurgitation
- Aortic flow murmur
Right
- Tricuspid regurgitation
- Ventricular septal defect

44
Q

Name two left diastolic murmurs

A
  • Aortic valve regurgitation
  • Ventricular filling defect

Y4 EQ - Cardio-Respiratory (6 decks)

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