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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
tetralogy of fallow physical exam findings
- 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
tetralogy of fallot Dx, prognosis
- clinical evaluation - echocardiography <><> prognosis very poor
26
endocarditis clinical presentation
- fever - often intermittent - tachycardia, tachypnea, weight loss, anorexia, depressed, demeanor - +/- heart murmur (increased likelihood if fever and new murmur) - +/- arrhythmia - unexplained, shifting lameness
27
endocarditis pathophysiology - are valves involved? which? - causes / lesions
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
endocarditis treatment, prognosis
- 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
pericarditis - what is it - most common reason - exam findings
- inflammation in pericardial sac - most often idiopathic <><> Examination - tachycardia - weak rapid pulse - muffled heart sounds - venous hypertension - jugular vein distension - ventral edema
30
pericarditis ECG findings
- Decreased amplitude of QRS > less conduction through fluid - electrical alterans (alternate large and small complexes) > heart moving around in sac
31
pericarditis US findings
- fuzzy around the heart = fibrin
32
pericarditis - effusive and constrictive - what are these? findings and sequelae? - sound
Effusive: - fluid accumulation > decreased distensibility, impaired filling > cardiac temponade - muffled heart sounds <><> Constrictive: - restricts filling of the right heart - sequelae to effusive pericarditis
33
pericarditis treatment and prognosis - how serious? - what can we do? - prognosis for effusive and constrictive
temponade - life-threatening emergency - pericardiocentesis - careful - antibiotics - anti-inflammatory medication <><> prognosis - effusive: poor - constrictive: grave
34
ruptured chordae tendinae - usually which valve? - leads to...
- usually mitral valve - acute valve failure > acute left heart failure > pulmonary edema - sudden death common
35
myocarditis - what is it - what happens
- inflammation of cardiac muscle - myocardial cell damage / death and inflammatory infiltrate - myocardial dysfunction - necropsy - scars, fibrosis
36
myocarditis possible causes
- toxic insults - infectious processes - neoplasia - trauma - degeneration - inflammation - infarcts
37
Myocarditis - usually Kennery thinks about what being the cause? - result - clinical signs
- 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
mycarditis Dx, ancillary testing
- routine blood analysis - ECG - ultrasound - cardiac troponin I
39
myocarditis treatment, prognosis, persisting effects
- treat primary condition - anti-inflammatory medicatino - supportive care - rest <><> - prognosis depends on cause <><> - myocardial dysfunction may persist
40
toxic myocarditis in horse - common cause, why? pathogenesis - other causes
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
toxic myocarditis treatment
- supportive care - anti-inflammatory medication - diuretics - correct electrolyte abnormalities - anti-arrhythmics (very cautiously) - do not use digoxin in monensin toxicity
42
heart failure causes
- many <> - bacterial endocarditis - ruptured chordae tendinae - cardiomyopathy - myocarditis - developmental defects - pericarditis <> - dynamic condition - may have sufficient reserve at rest
43
heart failure clinical signs
- tachycardia - weak pulses - syncope may occur - left and/or right heart signs - atrial dilation - atrial fibrillation is common - cardiac cachexia
44
left heart failure signs - acute vs chronic?
- 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
right sided heart failure signs, prognosis
- jugular distension - ventral edema - ascites - common in small animals; uncommon to find in horses - prognosis is poor
46
heart failure treatment
Decrease preload and edema - furosemide - nitroglycerin? <><> Improve cardiac output - digoxin <><> Decrease afterload - ACE inhibitors - Nitroglycerin, nitroprusside, hydralazine?
47
what is cor pulmonale? how does it arise? signs?
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
aorto-iliac thrombosis - what is it? when do we see it? - signs - Dx?
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
aorto-iliac thrombosis - Dx - prognosis - Tx
- 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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