Equine murmurs

Question 1

what are the different types of mumurs inthe horse?

Answer 1

physiological
* systolic - ejection murmurs (blood accelerating out of great vessels (aortic and pulmonary) (ICS 4)
* diastolic murmur - filling murmurs (ventricular filling)

pathological:
* systolic:
‣ left - mitral regurgitation (ICS 5)
‣ right - tricuspid regurgitation (higher) or ventricular septal defect (lower)
* diastolic - aortic regurgitation

Question 2

how are equine murmurs classified?

Answer 2

Timing
Grade
Point of Maximal Intensity (PMI)
Radiation
Character and Shape

Question 3

what can be said about the timing of an equine murmur?

Answer 3

Systolic - Diastolic - Continuous
Early/mid/late

Holosystolic – Holodiastolic
Throughout systole/diastole but S1 and S2 still audible

Pansystolic – Pandiastolic
Encompasses S1 and S2

Question 4

how are equine murmurs graded?

Answer 4

Grade 1: Very quiet, localised
Grade 2: Quieter that S1/S2
Grade 3: Similar loudness to S1/S2
Grade 4: Louder than S1/S2
Grade 5: Palpable thrill on chest wall
Grade 6: Audible with stethoscope off the chest wall

Question 5

what are you thininky about when finding the point of maximun intensity in equine murmurs?

Answer 5

Loudest?
Left or Right
Base or apex
Or
Over the valve: Mitral ( LHS ICS 5), aortic (ICS 4), pulmonic (ICS 3), tricuspid (right)

Question 6

what are the options for charater and shape of equine murmurs?

Answer 6

Shape
* Band/Plateau (even throughout the murmur)
* Crescendo (increasing intensity)
* Decrescendo (decreasing intensity)

Character
* Soft
* Harsh
* Musical
* Buzzing

Question 7

what causes murmurs inthe horse?

Answer 7

• Normal blood flow
  ◦ Physiological (ejection type) murmurs
• Valvular regurgitation
  ◦ Valvular disease
  ‣ Endocardiosis
  ‣ Endocarditis
• Cardiac defects
  ◦ Ventricular septal defects

Question 8

what is the …. of mitral regurgitation murmurs?
signalment,
clinical signs,
timing,
grade,
PMI,
radiation,
charater and shape

Answer 8

Question 9

what is the …. of tricuspid regurgitation murmurs?
signalment,
clinical signs,
timing,
grade,
PMI,
radiation,
charater and shape

Answer 9

Question 10

what is the …. of aortic regurgitation murmurs?
signalment,
clinical signs,
timing,
grade,
PMI,
radiation,
charater and shape

Answer 10

Question 11

what murmur is uncommon in horses?

Answer 11

pulmonic:
Pulmonic insufficiency, Uncommon in horses
- Common to see on doppler echocardiography
Rarely affects performance

Question 12

what murmurs are well tolerated in horses?

Answer 12

• Physiological murmurs
• Tricuspid and mitral regurgitation
• Without structural valvular lesions
• Slowly progressive Aortic regurgitation in middle-aged horses

Question 13

what murmurs are poorly-tollerated in horses?

Answer 13

• Acute onset murmurs
  
  • Ruptured chordae tendinae
  • Bacterial endocarditis
  • Valvular disease associated with myocardial disease
• Murmur + Concurrent arrhythmias
• Progressive lesions