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Equine Medicine > Equine Heart Murmurs > Flashcards

Equine Heart Murmurs Flashcards

1
Q

Single cardiac murmur:

A
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2
Q

How is valvular insufficiency/regurgitation localized? What are clinical signs like?

A

auscultation

VARIABLE
- slight = no consequence
- consequences if arrhythmias or other heart changes

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3
Q

What valvular insufficiencies/regurgitations have the most impact on performance?

A

mitral > aortic > tricuspid > pulmonary

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4
Q

What is the diagnostic approach to valvular insufficiencies/regurgitations?

A
  • auscultation
  • echocardiography at rest and exercise to confirm, evaluate severity, and assess consequences
  • ECG at rest and exercise
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5
Q

What 2 things are mitral valve regurgitations likely to do?

A
  1. have an impact on performance
  2. evolve and cause heart failure
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6
Q

What is the etiology of mitral valve regurgitation? What are the 2 consequences?

A

degenerative process leads to dilation of the mitral ring, spontaneous chordal rupture, and eventual endocarditis

  1. MILD: tolerated with minimal compromise
  2. SEVERE: exercise intolerance, heart failure
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7
Q

What is most commonly heard on auscultation in patients with mitral valve regurgitation?

A

holo/pan systolic murmur, grade 2-5

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8
Q

What clinical signs are associated with mitral valve regurgitation?

A
  • none if mild
  • exercise intolerance
  • increased respiratory rate and effort at rest
  • prolonged recovery after exercise
  • coughing
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9
Q

What short-term, acute, and long-term signs are associated with mitral valve regurgitation?

A

SHORT-TERM = left heart failure

ACUTE = fulminant pulmonary edema, collapse

LONG-TERM = evolves to right heart failure

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10
Q

How is mitral valve regurgitation diagnosed?

A

echocardiography and Doppler show blood leaking into LA (flail leaflet)

  • valve anatomy + size of atria, ventricles, and vessels
  • severity of regurgitation
  • LV systolic function
  • degeneration, prolapse, endocarditis
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11
Q

What 4 things does the severity of valvular regurgitation depend on?

A
  1. age
  2. clinical signs
  3. rapidity of onset
  4. performance level
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12
Q

When is prognosis good in patients with valvular regurgitation?

A
  • no clinical signs or exercise intolerance
  • mild insufficiency
  • no functional or morphologic repercussion
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13
Q

What 4 things cause prognosis to be guarded in patients with mitral valve regurgitation?

A
  1. clinical signs, moderate to severe insufficiency
  2. ruptured chordae tendinae, endocarditis
  3. globular apex, LA dilation = risk of AF
  4. pulmonary hypertension = risk of pulmonary edema
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14
Q

In what horses is aortic valve regurgitation most common? What is felt on pulse palpation?

A

older (>10 y/o) - severity not proportional to intensity

bounding, water hammer pulse indicative of ventricular enlargement (decreases prognosis)

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15
Q

What is the etiology of aortic valve regurgitation? What does consequences depend on?

A

degenerative process

severity and presence of arrhythmias (do an ECG!)

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16
Q

What is heard on auscultation in patients with aortic valve regurgitation?

A

holo diastolic, muscial, decresendo murmur

(between S2 and S1)

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17
Q

How is aortic valve regurgitation diagnosed?

A

echocardiography and Doppler show a thickened aortic valve (endocarditis) and backward flow back into the LV

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18
Q

What is the most common finding on ECG in patients with aortic valve regurgitation?

A

VPC arrhythmia

  • no P wave!
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19
Q

What 7 things cause prognosis to be guarded in patients with aortic valve regurgitation?

A
  1. moderate to severe with clinical signs
  2. left ventricular dilation
  3. globular apex
  4. septal hyperkinesia
  5. mitral insufficiency
  6. dilated aorta
  7. arryhthmias
20
Q

In what horses is tricuspid valve regurgitation common? What increases the intensity?

A

athletic horses

training

21
Q

What is the etiology of tricuspid valve regurgitation? What consequence is most common?

A

training and degeneration

uncommon —> cor pulmonale (secondary to pulmonary issues)

22
Q

What is heard of auscultation in patients with tricuspid valve regurgitation?

A

holo systolic murmur audible on the right side, between S1 and S2

(check jugular pulse!)

23
Q

How is tricuspid valve regurgitation diagnosis? What is prognosis like?

A

echocardiography and Doppler

good —> regular rechecks if moderate to severe

24
Q

What is infective endocarditis? What are the 3 most common causes?

A

invasion of the heart valves by bacteria

  1. Strep
  2. A. equuli
  3. Rhodococcus
25
Q

What is the pathophysiology of infective endocarditis? What valves are most commonly affected?

A

bacterial injury leads to exposure of valve collagen, which increases risk of thrombosis + leukocyte response = vegetation

  • aortic
  • mitral
  • tricuspid (thrombophlebitis)
26
Q

What are the most common clinical signs associated with infective endocarditis? What concurrent diseases are most common? What is heard on auscultation?

A
  • intermittent fever
  • weight loss
  • depression
  • anorexia
  • intermittent lameness due to synovial distension

thromboplebitis, abscess (Strangles, Rhodococcus)

murmur corresponding to affected valve

27
Q

How is infective endocarditis diagnosed?

A
  • blood work: anemia, inflammatory changes (neutrophilia)
  • blood culture (fever)
  • echocardiography: thickened and shaggy valves
28
Q

How is infective endocarditis treated? Prognosis?

A
  • aggressive, long-term antibiotics
  • NSAIDs
  • Heparin

expectation for long-term survival is poor

29
Q

When should congenital heart defects be suspected?

A
  • young patient
  • holo/pan systolic/diastolic murmur
  • continuous murmur
  • thrill or wide radiation

(longer murmurs)

30
Q

In what 3 situations is cyanosis present with congenital heart defects?

A
  1. right to left shunt
  2. obstructive pulmonary disease
  3. severe stenosis of right heart structures
31
Q

What is the most common cardiac malformation in horses?

A

ventricular septal defect (VSD) - an opening in the interventricular septum caused by developmental issues

32
Q

What are the 3 most common consequences of ventricular septal defect (VSD)?

A
  1. shunt L > R if there are no other CV lesions
  2. increased pulmonary blood flow and pulmonary venous return increases the load in left heart
  3. shunt may reverse over time
33
Q

What do clinical signs of ventricular depend on? What clinical signs are most common?

A

size, direction/location/number of shunts, and concurrent disease

  • poor performance and growth
  • lethargy
  • heart failure
34
Q

What 3 things are typically heard on auscultation in patients with ventricular septal defects? How does intensity relate to severity?

A
  1. loud, harse, plateau murmur with PMI below tricuspid
  2. thrill
  3. relative pulmonary stenosis murmur

intensity of murmur NOT associated with severity

35
Q

How is ventricular septal defects diagnosed?

A
  • history
  • PE
  • auscultation
  • echocardiography: shunt size, velocity, location, direction
36
Q

What is a patent ductus arteriosus (PDA)?

A

fetal vessel that shunts from pulmoary artery to the descending aorta and constructs at birth remains intact

37
Q

How should the ductus arteriosus act after birth of a foal?

A

constricts at birth due to increased blood oxygen and decreased prostaglandins and becomes functionally closed in foals after 72-96 hrs

38
Q

What do clinical signs of patent ductus arteriosus depend on?

A
  • length, diameter, and direction of the vessel
  • presence of other abnormalities
39
Q

What 2 things are most commonly heard on auscultation in patients with patent ductus arteriosus? When is this commonly heard and not a problem?

A
  1. continuous machinery murmur + thrill craniodorsal to the aorta
  2. heard on both L and R side, loudest in the left 3rd-4th ICS

foals in the first days of life —> persistent PDA is rare

40
Q

What is the tetralogy (pentalogy) of Fallot?

A
  1. overriding aorta
  2. VSD
  3. obstruction of the pulmonary arterial flow
  4. secondary right ventricular hypertrophy
    (5.) atrial septal defect
41
Q

What are the most common clinical signs seen in tetralogy (pentalogy) of Fallot?

A
  • cyanosis (rare at rest)*
  • marked exercise intolerance, dyspnea, collapse
  • slow growth, small size
  • loud pan systolic murmur and thrill
42
Q

A systolic murmur best heard on the right side is likely…

a. mitral valve regurgitation
b. pulmonic valve regurgitation
c. tricuspid valve regurgitation
d. aortic valve regurgitation

43
Q

What are the most common sites for endocarditis?

a. tricuspid and pulmonic valve
b. aortic and mitral valve
c. aortic and pulmonary valve
d. mitral and tricuspid valve

A

B —> left heart

44
Q

Rupture of the mitral valve leads to which of the following issues?

a. peripheral edema
b. pulmonary edema

A

B —> left-sided heart failure

45
Q

Aortic regurgitation is most frequent in what type of horse?

a. older horses
b. race horses
c. young horses
d. large horses

A

A

  • tricuspid = athletes
  • mitral = affects performance
46
Q

How would you describe this murmur?

A

diastolic plateau

Equine Medicine (33 decks)

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