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3. Equine > Equine Cardiology 2 > Flashcards

Equine Cardiology 2 Flashcards

1
Q

what is ventricular tachycardia?
- what do we observe?
- on ECG?

A
  • more than 4 consecutive PVCs
  • rapid rate, regular rhythm
  • rate/ rhythm may vary - alternate
  • monomorphic or polymorphic
    > monomorphic: one focis in verticle sending off depolarizations, vs multiple for polymorphic
    <><>
  • QRS, T complexes are wider than usual and fused
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2
Q

ventricular tachycardia causes?

A
  • many idiopathic
  • myocardial and GI disease as primary condition
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3
Q

ventricular tachycardia
- heart sounds
- pulses
- slinical signs

A
  • heart sound vary
    > some loud > bruit de cannon
  • pulses weak or variable, pulse deficits
  • may show signs of heart failure
    > clinical signs:
    tachycardia
    weak pulses
    syncope may occur
    left and/or right heart signs
    may collapse
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4
Q

ventricular tachycardia treatment? severity?

A

EMERGENCY - treat as quickly as possible
<><>
- underlying condition (electrolytes, toxemia, septicemia)
- anti-arrhythmic medication if:
> heart rate > 120 at rest (even over 100 is bad) > hypoxic state for mycardium due to lack of diastolic pause > muscle breakdown
> polymorphic and tachycardic life threatening

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5
Q

ventricular tachycardia medication

A
  • lidocaine
  • Mg sulfate
    > both of these available and can go IV
    <><><>
  • quinidine
  • propranolol, procainamide
  • others
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6
Q

what is torsades de pointes
- what do we observe
- severity
- Tx

A
  • wide, polymorphic ventricular tachycardia
  • very rapid
  • pulse deficits, syncope possible
  • life threatening
  • Mg sulfate
    <><><>
  • ventricular complexes where the morphology is different
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7
Q

heart murmur cloassification

A
  • left vs right
  • systolic vs diastolic
    > holosystolic: between S1 and S2
    > pansystolic: includes S1 and S2
  • diastolic
  • continuous
    <><>
  • blowing
  • coarse
  • musical
    <><>
  • band shaped
  • decrescendo
  • crescendo
  • combination
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8
Q

grading of heart murmurs

A

Benign (in general)
1. very quiet
2. quiet
<><>
3. readily audible
<><>
Pathologic (in general)
4. louder
5. “thrill” = vibration
6. audible w stethoscope held off chest wall

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9
Q

are systolic or pansystolic heart murmurs more common on the left side?

A
  • systolic - common
  • pansystolic - uncommon
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10
Q

types of left sided systolic heart murmurs

A
  • innocent / physiological / functional (common)
  • mitral valve regurgitation (common)
  • other (uncommon) - endocarditis, valve hypoplasia
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11
Q

types of left sided pansystolic heart murmurs

A
  • large mitral valve defect > turbulent blood flow as soon as valve starts to contract
  • VSD - location of defect or change in flow
  • endocarditis
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12
Q

what are innocent murmurs
- other names
- grade, type
- location
- timing
- disease?
- Dx

A
  • innocent, physiologic, functional
  • Grade I or II, systolic murmur
  • left heart base
  • usually early to mid systolic
  • no indications of cardiac disease
  • Dx: echocardiography; diagnosis by exclusion
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13
Q

reasons for left sided diastolic murmurs? sound? age?

A
  • aortic regurgitation
    > decrescendo, “ dive bomber” sound
    > common with age >15 years
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14
Q

types of systolic and pansystolic right sided heart murmurs
- which is common, how serious

A

systolic
- tricuspid regurgitation
> very common, especially STBs
- usually clinically insignificant (slow grade, soft blowing, holosystolic)
<><><>
Pansystolic
- VSD, usually
- other

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15
Q

types of right sided diastolic heart murmurs
- how serious

A
  • aortic fistula aka aortic ring rupture > aneurysm in one of coronary vessels, dissection through heart
    > can be life threatening
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16
Q

aortic root rupture
- signalment
- sequelae

A

aged stallions - most common
<><>
aortic root dissection - sequelae
- aortoventricular fistula
- acquired VSD
- sudden death
> depends where ruptures
> ventricular dysrhythmias
> lesion never heals always risk of sudden death

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17
Q

ventricular septal defeccts
- signs
- PMI
- Dx
- breeding

A
  • small defects not associated with signs (<2.5cm; performance may be normal)
  • decreased exercise tolerance
  • pansystolic murmur
  • PMI - right cranial thorax, usually
  • thrill
  • Dx: clinical examination, ECG
  • Breeding not recommended
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18
Q

locations for VSDs, which is most common

A

perimembranous - most common
subpulmonic
muscular

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19
Q

most frequent cause of continuous murmurs?
- age
- alone or with other conditions
- associated with?
- sounds like?
- how common are other causes?

A

Patent Ductus Arteriosus
- neonatal foals > should close on its own, uncommonly persists
- rare as single defect in horses
- usually associated with tetralogy of fallot
- continuous “machinery” murmur
- other causes of continuous murmur - rare

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20
Q

patent ductus arteriosus
- when does function normalize?
- what type of shunt
- can lead to?
- bloodflow?

A
  • normal functional to 3-4 days of life
  • usually left to right shunt
  • may lead to pulmonary hypertension and eventual right to left shunt
  • flow of blood through PDA continuous
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21
Q

PDA
- physical findings
- murmur type, location
- pulses

A
  • physical findings similar to VSD
  • murmur PMI - left ICS 3&4
  • also heard on right
  • bounding pulse due to reduced diastolic pressure
22
Q

tetralogy of fallot components
- what would make up pentalogy?

A
  • overriding aorta
  • VSD
  • pulmonic stenosis
  • right ventricular hypertrophy
    <><>
  • with PDA = pentalogy of fallot
22
Q

PDA Dx, prognosis

A

Dx
- echocardiography - difficult (due to lungs)
- pulmonary arterial catheterization and oxygen saturation studies
<><>
Prognosis
- depends on size
- small defects - may be clinically normal

23
Q

tetraoly of fallot shunt, signs
vs pentalogy

A

Tetralogy
- right > left shunt: hypoxia +/- cyanosis
<><>
pentalogy
- PDA reestablishes pulmonary blood flow and oxygenation is better

24
Q

tetralogy of fallow physical exam findings

A
  • stunted growth
  • moderate to severe exercise intolerance
  • may have resp cyanosis and syncope
  • > grade IV holosystolic murmur over left ICS 4-6
  • pulmonary stenosis
  • VSD
25
Q

tetralogy of fallot Dx, prognosis

A
  • clinical evaluation
  • echocardiography
    <><>
    prognosis very poor
26
Q

endocarditis clinical presentation

A
  • fever - often intermittent
  • tachycardia, tachypnea, weight loss, anorexia, depressed, demeanor
  • +/- heart murmur (increased likelihood if fever and new murmur)
  • +/- arrhythmia
  • unexplained, shifting lameness
27
Q

endocarditis pathophysiology
- are valves involved? which?
- causes / lesions

A

valvular or non-valvular
<><>
valvular
- due to valve trauma (?)
- aortic > mitral > tricuspid
- platelet aggregation / fibrin deposition
- vegetative lesions (platelets, fibrin, bacteria)
- vegetative lesions often friable
- risk of thromboembolism

28
Q

endocarditis treatment, prognosis

A
  • antimicrobial - broad-spectrum combination
    > adjust depending upon bacterial culture and sensitivity
  • reassess if no improvement in 5 days
  • duration of therapy - at least 4 weeks
  • NSAIDs
  • heparin / aspirin
  • prognosis - very poor
29
Q

pericarditis
- what is it
- most common reason
- exam findings

A
  • inflammation in pericardial sac
  • most often idiopathic
    <><>
    Examination
  • tachycardia
  • weak rapid pulse
  • muffled heart sounds
  • venous hypertension
  • jugular vein distension
  • ventral edema
30
Q

pericarditis ECG findings

A
  • Decreased amplitude of QRS > less conduction through fluid
  • electrical alterans (alternate large and small complexes) > heart moving around in sac
31
Q

pericarditis US findings

A
  • fuzzy around the heart = fibrin
32
Q

pericarditis
- effusive and constrictive
- what are these? findings and sequelae?
- sound

A

Effusive:
- fluid accumulation
> decreased distensibility, impaired filling
> cardiac temponade
- muffled heart sounds
<><>
Constrictive:
- restricts filling of the right heart
- sequelae to effusive pericarditis

33
Q

pericarditis treatment and prognosis
- how serious?
- what can we do?
- prognosis for effusive and constrictive

A

temponade
- life-threatening emergency
- pericardiocentesis - careful
- antibiotics
- anti-inflammatory medication
<><>
prognosis
- effusive: poor
- constrictive: grave

34
Q

ruptured chordae tendinae
- usually which valve?
- leads to…

A
  • usually mitral valve
  • acute valve failure
    > acute left heart failure
    > pulmonary edema
  • sudden death common
35
Q

myocarditis
- what is it
- what happens

A
  • inflammation of cardiac muscle
  • myocardial cell damage / death and inflammatory infiltrate
  • myocardial dysfunction
  • necropsy - scars, fibrosis
36
Q

myocarditis possible causes

A
  • toxic insults
  • infectious processes
  • neoplasia
  • trauma
  • degeneration
  • inflammation
  • infarcts
37
Q

Myocarditis
- usually Kennery thinks about what being the cause?
- result
- clinical signs

A
  • viral or bacterial respiratory disease
  • result: reduced mycardial sontractility and arrhythmias
    <><>
    Clinical signs
  • prior or concomittant disease, fever, anorexia
  • exercise intolerance, respiratory signs, congestive heart failure, collapse
38
Q

mycarditis Dx, ancillary testing

A
  • routine blood analysis
  • ECG
  • ultrasound
  • cardiac troponin I
39
Q

myocarditis treatment, prognosis, persisting effects

A
  • treat primary condition
  • anti-inflammatory medicatino
  • supportive care
  • rest
    <><>
  • prognosis depends on cause
    <><>
  • myocardial dysfunction may persist
40
Q

toxic myocarditis in horse
- common cause, why? pathogenesis
- other causes

A

Ionohores (monensin, lasalocid, salinomycin)
- most common toxin-induced myocardial disease in horses
- horses are exquisitely sensitive
> facilitate cation (Ca++) movement into cell
> calcium overlad: cellular damage or death
<><>
blister beetle toxicosis (cantharidin)
<><>
- poisonous plants (cardiac glycosides): oleander, milkweed, foxglove

41
Q

toxic myocarditis treatment

A
  • supportive care
  • anti-inflammatory medication
  • diuretics
  • correct electrolyte abnormalities
  • anti-arrhythmics (very cautiously)
  • do not use digoxin in monensin toxicity
42
Q

heart failure causes

A
  • many
    <>
  • bacterial endocarditis
  • ruptured chordae tendinae
  • cardiomyopathy
  • myocarditis
  • developmental defects
  • pericarditis
    <>
  • dynamic condition - may have sufficient reserve at rest
43
Q

heart failure clinical signs

A
  • tachycardia
  • weak pulses
  • syncope may occur
  • left and/or right heart signs
  • atrial dilation
  • atrial fibrillation is common
  • cardiac cachexia
44
Q

left heart failure signs
- acute vs chronic?

A
  • increased respiratory rate and effort
  • coughing
  • acute
  • pulmonary edema
  • large volumes of frothy fluid emanating from both nostrils
  • chronic failure often not obvious, as lungs have substantial lymphatic reserve and the edema is absorbed
45
Q

right sided heart failure signs, prognosis

A
  • jugular distension
  • ventral edema
  • ascites - common in small animals; uncommon to find in horses
  • prognosis is poor
46
Q

heart failure treatment

A

Decrease preload and edema
- furosemide
- nitroglycerin?
<><>
Improve cardiac output
- digoxin
<><>
Decrease afterload
- ACE inhibitors
- Nitroglycerin, nitroprusside, hydralazine?

47
Q

what is cor pulmonale? how does it arise? signs?

A

an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system
<><>
- secondary right heart disease
- primary pulmonary hypertension
> right heart hypertrophy, dilation, failure
> can occur secondary to severe respiratory disease
> can occur secondary to left heart failure
<><>
- ventral edema, tachycardia
- murmur may be present

48
Q

aorto-iliac thrombosis
- what is it? when do we see it?
- signs
- Dx?

A

Obstruction of iliac arteries
- verminous migration?
- Males > females
<><>
Lameness, poor performance
- slightly decreased temperature in affected limb
- slightly decreased peripheral pulse of reduced filling in saphenous vein

49
Q

aorto-iliac thrombosis
- Dx
- prognosis
- Tx

A
  • palpation per rectum (can be asymmetric)
    > aorta and aortic quadrification
  • US per rectum
    <>
    prognosis - poor
    <>
    no effective treatment

3. Equine (17 decks)

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