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SA DX & TX I > Exam 4 - Congenital Heart Disease > Flashcards

Exam 4 - Congenital Heart Disease Flashcards

1
Q

what is a PDA?

A

very common congenital heart disease with a persistent communication between the aorta & pulmonary arteries

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2
Q

why does a PDA cause a continuous murmur heard best at the left base of the heart in the axillary region?

A

the abnormality is a tube - nothing stops it!

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3
Q

why does PDA cause bounding pulses?

A

big discrepancy between the systolic & diastolic pressures - felt well on the femoral artery

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4
Q

what pathology does PDA cause to the heart? why?

A

eccentric hypertrophy - volume overload to different parts of the cardiovascular system

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5
Q

what are the characteristics of a PDA?

A
  • continuous murmur - heard best at the left base
  • bounding pulses
  • volume overload
  • left heart enlargement
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6
Q

T/F: PDA & sub-aortic stenosis are both common congenital abnormalities of the heart

A

true

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7
Q

why does sub-aortic stenosis cause a pressure overload?

A

the ventricle is consistently having to generate high pressures to get across the stenotic part of the aorta causing a concentric hypertrophy of the left ventricle

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8
Q

why do you hear a systolic murmur associated with pulmonic stenosis?

A

obstruction of flow during systole - flow is accelerated causing a murmur

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9
Q

why do you see right ventricular concentric hypertrophy in pulmonic stenosis?

A

pressure overload - right ventricle is consistently having to generate high pressures to get past the stenotic aspect of the pulmonary artery causing a concentric hypertrophy of the right ventricle

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10
Q

what are 2 less common congenital abnormalities that cause abnormal communication?

A

atrial septal defect & ventricular septal defect

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11
Q

with the atria both being low pressure, of left & right, which is higher?

A

typically left - why you see a left to right shunt

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12
Q

why do you not hear a murmur with atrial septal defects?

A

you have blood flowing from a slightly higher pressure chamber to a slightly lower pressure chamber - not a huge difference between pressures

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13
Q

why do you hear a murmur associated with ventricular septal defects?

A

the ventricles have a much larger difference in chamber pressure! so, the higher difference causes turbulent flow, resulting in a murmur

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14
Q

T/F: a loud murmur in a VSD, means you have a small defect which is a better prognosis

A

true - the larger the hole, the quieter the murmur

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15
Q

why don’t you typically see right-sided cardiac enlargement in VSD? why do you see left-sided heart enlargement instead?

A

the defect between the left & right ventricle is located just below the pulmonic valve, so the blood immediately goes back through the lungs & into the left side of the heart causing left-sided signs

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16
Q

what is tetralogy of fallot?

A

VSD, pulmonic stenosis, right ventricular concentric hypertrophy, & overriding aorta that receives blood from both ventricles

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17
Q

what signs are associated with ASD?

A
  • no murmur or soft left base systolic murmur
  • left to right shunt, can reverse
  • right heart enlargement
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18
Q

what are the characteristics associated with VSD?

A
  • right sternal systolic murmur
  • left to right shunt, can reverse
  • left heart enlargement, or both
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19
Q

what are the characteristics of pulmonic stenosis?

A
  • systolic murmur left base
  • normal pulses
  • increased pressure load
  • right heart enlargement
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20
Q

what are the characteristics associated with sub-aortic stenosis?

A
  • systolic murmur left base
  • normal to reduced pulses
  • increased pressure load
  • left heart enlargement
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21
Q

what is pulmonic stenosis?

A

common congenital abnormality that usually has valve dysplasia & stenosis of the pulmonary artery which is obstructive to flow - causes an increased pressure load to the right side of the heart

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22
Q

what is the most common congenital cardiac abnormalities in cats?

A
  1. valve dysplasia
  2. septal defects
  3. PDA - can be ligated!!
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23
Q

what should you do if you have a kitten with a murmur, heart failure, & cyanosis?

A

do an echo & consider referring to a cardiologist

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24
Q

what is the typical clinical presentation of congenital heart disease that is causing pathology?

A

heart failure & cyanosis - varying degrees of severity, can see congenital disease in an older animal

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25
Q

what are the risks associated with a congenital heart disease going undiagnosed & left untreated?

A
  • developing symptoms
  • heart failure
  • arrhythmias/sudden death - particularly with sub-aortic stenosis
  • endocarditis with SAS & VSD
  • change in shunt direction (goes to right to left)
  • cyanosis: right to left shunt or shunt reversal
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26
Q

what are the 7 guiding questions that should be used when assessing a patient for congenital heart disease?

A
  1. is there a murmur that suggests the presence of congenital heart disease?
  2. do the murmur characteristics (location/timing), & pulse quality provide insight into the most likely CHD?
  3. does the signalment provide information for identifying the most likely CHD?
  4. is there a known history of CHD in a littermate, sire, dam, or relative?
  5. do the current clinical signs suggest the presence of CHD?
  6. do the clinical signs require stabilization of the patient prior to referral to a specialist
  7. what are the next steps for imaging: thoracic rads, echo, CT angiography
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27
Q

what is the murmur location, timing, & pulse quality of a PDA?

A

left base (cranial, axillary), continuous murmur, & bounding pulses

28
Q

what is the murmur location, timing, & pulse quality of SAS?

A

left base, systolic murmur, & decreased pulse quality

29
Q

what is the murmur location, timing, & pulse quality of PS?

A

left base, systolic murmur, & normal pulse quality

30
Q

what are innocent & functional non-pathological murmurs?

A

innocent - no structural abnormality

functional - physiologic cause, increased flow velocity in great vessels

31
Q

what are the characteristics associated with non-pathological innocent/physiologic murmurs?

A
  • grade 1-2/6 (soft murmur)
  • left basilar
  • disappear by approximately 4ish months of age
32
Q

is a grade 5/6 systolic murmur in a puppy innocent?

A

never

33
Q

does a puppy with a soft murmur & clinical signs of heart disease have an innocent murmur?

A

nope

34
Q

what are some signs associated with left-sided heart failure seen upon physical exam?

A

increased lung sounds & tachypnea

35
Q

what are some signs associated with right-sided heart failure seen upon physical exam?

A

ascites, jugular venous distension

36
Q

why should you do thoracic radiographs in a patient with suspected congenital heart disease?

A

assess heart size & presence of L CHF - limited in ability to diagnose specific congenital abnormality

37
Q

why should you do an echo in a patient with suspected congenital heart disease?

A

characterize the presence of concurrent congenital/acquired heart disease, CHD anatomy, direction of shunt flow, severity of stenosis, secondary chamber enlargement, & acquire measurements for procedural planning

38
Q

where do you listen on your patients for the presence of a congenital cardiac abnormality causing a murmur? what valve are you listening to on the right side?

A

3 ICS, 4 ICS, 5 ICS

tricuspid valve

39
Q

what are the limitations of using an echo for diagnosing congenital cardiac disease?

A

cost, operator skill level, & intent (diagnosis or procedural planning)

40
Q

what are thoracic rads good for assessing congenital cardiac disease?

A

global heart size, chamber enlargement

evaluate pulmonary vasculature & pattern

at risk of CHF

managing CHF

41
Q

if you see concentric hypertrophy of the left ventricle on echo, what congenital abnormality do you suspect?

A

sub-aortic stenosis

42
Q

if you see concentric hypertrophy of the right ventricle on echo, what congenital abnormalities do you suspect?

A

pulmonic stenosis or tetralogy of fallot

43
Q

if you see eccentric hypertrophy of the left ventricle/left atrium on echo, what congenital abnormalities do you suspect?

A

VSD or PDA

44
Q

if you see eccentric hypertrophy of the right ventricle/right atrium on echo, what congenital abnormalities do you suspect?

A

tricuspid valve dysplasia or VSD

45
Q

what congenital defects are associated with causing pressure overload in the heart?

A
  1. pulmonic stenosis
  2. sub-aortic stenosis
  3. tetralogy of fallot
46
Q

what congenital defects are associated with causing volume overload in the heart?

A

PDA, ASD/VSD, or tricuspid/mitral valve dysplasia

47
Q

what are thoracic rads used for in a patient with PDA?

A
  1. assess heart size
  2. pulmonary vasculature
  3. evidence of overcirculation
  4. presence of pulmonary edema
48
Q

what is echo used for in a patient with PDA?

A
  1. assess heart size
  2. confirm PDA
  3. ductal morphology & size
  4. confirm shunt direction, left to right
  5. mitral regurgitation
  6. rule out other congenital defects
49
Q

what are thoracic rads used for in a patient with pulmonic stenosis?

A

assess heart size

50
Q

what is echo used for in a patient with pulmonic stenosis?

A
  1. assess heart size
  2. confirm PS & determine severity
  3. rule out annular hypoplasia
  4. rule out coronary anomalies
  5. rule out other congenital defects
51
Q

what are thoracic rads used for in a patient with sub-aortic stenosis?

A

assess heart size & evaluate for pulmonary edema

52
Q

what is echo used for in a patient with sub-aortic stenosis?

A

assess heart size, confirm SAS, determine severity, rule out endocarditis, & rule out other congenital defects

53
Q

what is echo used for in a patient with VSD?

A

assess heart size, confirm VSD, determine shunt size & direction, rule out endocarditis, & rule out other congenital defects

54
Q

what are some examples of interventional procedural treatment for congenital cardiac disease?

A

PDA occlusion, balloon valvuloplasty for valve stenosis or stenotic membranes

55
Q

what are some examples of surgical procedural treatment for congenital cardiac disease?

A

PDA ligation & PA banding

56
Q

what are some examples of surgical, with cardiopulmonary support, procedural treatment for congenital cardiac disease?

A

valve repair

57
Q

what are some examples of hybrid procedural treatment for congenital cardiac disease?

A

VSD occlusion through the right ventricle

58
Q

what are the most common congenital cardiac defects in the dog?

A

PDA, SAS, PS

59
Q

what congenital cardiac abnormality causes volume overload with eccentric hypertrophy?

A

PDA - eccentric hypertrophy of the left heart

60
Q

what congenital cardiac abnormalities causes pressure overload with concentric hypertrophy?

A

SAS & PS

61
Q

what diagnostic is needed to make a definitive diagnosis for congenital cardiac disease?

A

echocardiogram

62
Q

what congenital cardiac defect is associated with this rad?

A

sub-aortic stenosis

63
Q

what congenital cardiac defect is associated with this rad?

A

pulmonic stenosis

64
Q

what congenital cardiac defect is associated with this rad?

A

PDA

65
Q

what is congenital heart disease?

A

defect of the heart or great vessels present at birth

SA DX & TX I (59 decks)

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