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Year 3 MOD > Equine Cardiology and Respiratory Medicine: Diagnostic Approach and Cardiology > Flashcards

Equine Cardiology and Respiratory Medicine: Diagnostic Approach and Cardiology Flashcards

1
Q

What are some common presenting signs of LRT in horses and what could they mean?

A

Cough- Specific for LRT
Physical- foreign material, turbulent air, mucus
Chemical- osmolarity, irriant
physical and chemical and inflammation stimulate irritant receptors
Stimulation causes inhalation and forced expiration

Bilateral nasal discharge
Airway inflammation
increased/altered mucus
Mucopurulent discharge
Anything behind the eyes leads to bilateral

Tachypnoea/dyspnoea
hypoventilation
V/Q mismatch
impaired gas diffusion in alveolus
hypercapnia, acidaemia, hypoxaemia

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2
Q

What history and signalment would you want from a horse with respiratory disease?

A

Disease time course and features

Herd or individual problem

Age and use of horse

Managment and environment

Coexisting problems

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3
Q

What should be observed from a distiance when trying to diagnose LRT in horses?

A

Posture- extended head and neck with severe respiratory disease

Abdominal effort

RR

Respiratory Depth

Pattern

Hypertrophy of external abdominal oblique- Heave line

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4
Q

What should be assessed with a general clinical examination for a horse with respiratory disease?

A

All systems

Temp/HR

Ventral oedema

Guttural pouch/lymph nodes

Nares and nasal passages

Auscultation- treachea and triange-

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5
Q
A
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6
Q

How can you know whether URT or LRT collapse is more likely?

A

Inspiratory noise- URT

Expiratory noise- LRT

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7
Q

What is ‘normal breathing sounds’ in a horse?

A

Turbulent air in large animals

Soft blowing sound

Inspiration is louder then expiration

Faster air = louder

Low frequency sounds travel best through normal lung

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8
Q

What are adventitious breathing sounds?

A

Wheezes

Crackles

Pleural rubs

Cough

Expiratory grunt/groans

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9
Q

What creates a wheezing breathing sound?

What anatomical abnormalities can lead to wheezing how can they differ?

A

Wheeze is caused by airway narrowing and vibration

Thickened wall- oedema, inflammation
Intraluminal obstructions- mucus/foreign body
Bronchospasm
Extraluminal compression

Can be monophonic (one sound) or Polyphonic (lots of wheeze sounds

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10
Q

What is the bernoulli effect and why does it cause further narrowing of the airway?

A
  • Narrowed airway causes higher velocity air created a lower pressure in bronchi
  • Lower pressure causes further narrowing of the airway

LRT- most common end expiratory
URT- most common inspiratory

Shower Curtain Effect

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11
Q

What different crackles can be made with respiratory disease?

A

Coarse crackling-
bubbling mucus
Inspiration or expiration
Radiate widely

Fine crackles-
Popping open of collapsed small airways
Most common: early inspiration

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12
Q

What are pleural friction rubs and how can they sound?

A

Inflammed parietal and visceral pleural membranes rubbing together

Variable- fine crackles to sand paper rubbing together

Usually inspiration and expiration at same point in respiratory cycle

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13
Q

How can auscultation be done when a horse has increases RR?

A

Re-breathing- bag over head

Increases CO2

Increases respiratory rate and tidal volume
Increases normal and abnormal resp sounds

Cough- abnormal

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14
Q

What is used for thoracic percussion and what does it do?

A

Use fingers or pleximeter (spoon) and plexor

Checks for pinging- distension etc

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15
Q

What further diagnostic tests can be done after a clinical exam for respiratory disease?

A
  • Lab and clinical pathology
  • nasopharyngeal swab
  • Endoscopy and transendoscopic tracheal aspirate
  • Percutaneous tracheal aspirate
  • Bronchoalveolar lavage
  • Thoracocentesis
  • Imaging- radio, ultra
  • Lung biopsy
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16
Q

What clinical pathology can be done for diagnosis of respiratory disease?

A

Blood sample-
Inflammatory profile- WBC/proteins/fibrinogen/Serum amyloid A
Lactate- tissue hypoxia
Blood gas profile

PCR to idenfity agent

Paired serology

Bacterial culture/ID

Virus isolation

17
Q

What can be used to directly assess the URT?

What three LRT samples can be taken?

A

Endoscopy- Trachea, carina

Tracheal aspirate
Bronchoalveolar lavage
Thoracocentesis

18
Q

What are the different techniques of tracheal aspirate collection?

What are the adv and dis adv of each?

A

Transendoscopic or Transtracheal (puncture through skin)

Transendo-
Adv- easy, non-invasive, sample represenitive of whole lung
Dis- sample contaminated by nasopharyngeal flora, specialist equipement

Transtracheal-
Adv- no containation, no equip, good for foals (too small for endo)
Dis- May cough catheter into pharynx, invasive- cellulitis, subcut emphysema

19
Q

How are tracheal aspirate samples analysed?

A

Differential cell counts-
Abnormal >20% neutrophils, presence of mast cells, eosinophils

Presence of mucus, amount, curschmann’s spirals

Gram stain- intracellular organisms

Bacterial culture/ sensitivity

20
Q

Describe broncheoalveolar lavage

What is it useful for and not?

What are the Adv and Dis?

A

Small area of distal airway lavaged with saline, surfactant ‘washing up liquid’ is a sign of a good sample

Useful for cytology, unsuitable for bacteriology

Adv-
Sample from distal airways- more commonly affected
Best corelation with pulmonary function and histopath
Equipment cheap

Dis-
Site may not be appropriate- abscess, pneumonias
Pharyngeal contamination
Invasive

21
Q
  1. When should BAL be performed?
  2. BAL v TA?
A
  1. Is LRT present- poor performance investigations, undiagnosed dull
    Characteristic LRT- severe, chronic, treatment failures
    Monitoiring response to treatment
  2. BAL- better correlation with obstruction, excercise induced hypoxaemia, lung histopath
    TA- bacteriology, focal lung lesions (abscess), tracheal inflammation
22
Q

What is abnormal about this thoracic ultrasonography?

A

Pleural effusion

23
Q

When is thoracocentesis indicated?

A

Whenever there is a pleural effusion

Increased RR
Dull thoracic percussion ventrally
Pleurodynia
Ultrasound

24
Q

How can cardiac disease present in horses?

A

History of poor performance- depends on use

Clinical signs of cardiac failure- rare

Systemic illness- secondary heart disease

Incidental finding- vetting

25
Q

What is the aim of a CV investigation?

A

Establish the significance of any findings-
currently and in the future, cardiac murmurs/arrythmias are common

Interprest findings according to use of the horse

26
Q

What is assessed with cardiac disease in horses?

A

Effect of the cardiac condition on:

Athletic performance

Risk of collape

Risk of CHF

Resale value

27
Q

What are the different ways of cardiac investiagation?

A
  • Clinical exam/ auscultation
  • ECG +/- excercise/24h
  • Echocardiography
  • Clinical pathology
  • Excercise testing
28
Q

What should be collected from a clinical examination for a horse with suscpected cardiac disease?

A

History and signalment- performance history, fitness, concurrent diseases

Systems- resp, body condition, concurrent disease

Cardiac abnormalities can be incidental or secondary
(neoplasia causing anaemia leading to murmur)

Peripheral arterial pulses- regular, strength, whilst auscultating

Pulse pressure

Jugular distension

CV system- RR, Oedema, MM, Hydration, peripheral perfusion

29
Q

After a clinical exam what should be checked for with a cardiac examination?

Describe auscultation

A

HR

Rythm- regular, regular irregular, irregularly iregular

Pulse- quality, defecits

Murmurs

Auscultation

  • Quiet, take time
  • Find apex beat- mitral valve
  • Move stethoscope- dorsal/cranial
  • Right- pull leg forward, under triceps just dorsal to elbow point- tricupsid
30
Q

How can clinical pathology be used for diagnosis of cardiac disease?

A
  • Detecting underlying disease
  • Electrolyte abnormalities
  • Cardiac biomarkers
    • Cardiac isoenzymes replaced by troponin- myocardial disease
    • Natriuretic peptides- minimal use
31
Q

What are the basic normal heart sounds in horses?

What is the normal order and period?

Where is alterial pulse palpated

A

Ventricles contract- S1- shutting of AV valves- mitral/tricupsid- LUB

Ventricles relax- S2- shutting of semilunar- aortic/pulmonic- DUB

Atrial contraction- S4 ‘B’- common in horses- just before S1

End of rapid ventricular filling- S3 ‘D’- less common- just after S2

Order- S4, S1, S2, S3
Systole much shorter the Diastole in normal HR

Pulse- palmar, median, great metatarsal artery

32
Q

When is ECG use indicated?

A

Suspected non-physiological arrythmia detected

Chamber dilation onf echocardiography

Poor performance

Monitoring of patients with CVS compromise- GA

33
Q

What sounds of the heart coordinate to the ECG complex?

A

P- atrial depolrisation/ contraction- S4- ‘B’

QRS- ventricular depolarisation/contraction- S1- ‘LUB’

T- Ventricular repolarisation- S2- DUP

34
Q

Where are leads places for base apex ECG?

A

Record on Lead I

Red- negatvie on right arm (bottom of brachiocephalic)

Yellow- positive- left arm (behind limb on trunk)

Lellow left, red right

35
Q

When is a telemertic ECG used and why?

A

Used for 24h and Excercise- no wired between horse and machine

Allows for excercsie and continuos assessment and therefore detection of arrythmias that may otherwise be missed

36
Q

When is echocardiography indicated?

A
  • Previously diagnosed with physiological murmur which is louder on serial examinations
  • Grade 3-6 mitral/aortic valve or 4-6 tricupsid murmurs
  • Any aortic regurgitation in ridden horse
  • Suspected VSD or other congenital lesions
  • Any continuous murmur
  • Any pathological arrhythmias
  • Signs of CHF
  • Poor performance after musk/resp ruled out

Year 3 MOD (42 decks)

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