Making a diagnosis Flashcards

1
Q

Causes of systolic murmurs in horses

A

Physiological flow murmurs

Mitral insufficiency

Tricuspid insufficiency

Ventricular septal defects

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2
Q

Location of physiological flow murmurs

A

Loudest cranially on left, LIC4

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3
Q

Timing/intesnsity of physiological flow murmurs

A

Early to mid systolic
Tend to be low grade

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4
Q

Importance of physiological flow murmurs

A

None
Important DD for MR

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5
Q

Radiation of physiological flow murmurs

A

Cranio-dorsal

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6
Q

Mitral insufficiency in horses

A

Common, second commonest form of VHD

Most common cause of clinical signs of cardiac disease

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7
Q

Murmur of mitral insufficiency

A

Grade: 1-6

Timing: early, mid, holo, pan-systolic

Shape: band shaped

Loudest: left 5th intercostal space

Radiates: caudodorsally

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8
Q

Signalment for mitral insufficiency

A

All age groups

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9
Q

Clinical signs of mitral insufficiency in horses

A

Incidental findings

Poor Performance

Atrial fibrillation

Left-sided failure (Acute onset)

Right-sided failure

Collapse, fainting or sudden death

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10
Q

Mitral insufficiency disease progression

A

Diastole:
- increased ventricular filling
- loud third heart sound

Systole
- increased ventricular work will increase the regurgitant fraction
- Left atrial enlargement > AF

Can have a very loud 3rd sound as increased ventricular filling

Blood will leak back into lungs leading to pulmonary artery being at point of failure

Right sided heart failure

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11
Q

Prognostic indicators in mitral insufficiency

A

Loud murmus (grade 3 and above)

Loud 3rd heart sound

Dysrrhythmia (atrial fibrillation)

Congestive heart failure (left or biventricular)

Bacterial endocarditis

Pulmonary hypertension

Left atrial enlargement

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12
Q

Tricuspid insufficiency in horses

A

May be related to hypertrophy (training)

Generally well tolerated in TB

Less common in other breeds
§ Bacterial endocarditis - secondary to septic jugular thrombosis
§ Dental disease
§ Other causes?

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13
Q

Negative prognostic indicators of tricuspid insufficiency

A

Loud murmurs (4 and above in TB)

Loud third heart sound

Dysrrhythmia (atrial fibrillation)

Congestive heart failure (right sided)

Bacterial endocarditis

Pulmonary hypertension

Right atrial enlargement

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14
Q

Ventricular septal defects in horses

A

Common in welsh ponies

Size of defect determines significance - if small can be athletes

Murmur intensity is not a useful guide to severity

Concurrent systolic murmur on LHS (LIC 4)
§ Relative pulmonic stenosis

Often quieter in summer as pony puts on weight

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15
Q

Negative prognostic signs for VSD

A

Murmur grade not useful

Secondary diastolic murmur

Defect size

Cardiac enlargement

Usually left sided

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16
Q

Causes of diastolic murmurs in horses

A

Ventricular filling murmurs

Aortic insufficiency

Pulmonic insufficiency

Continuous cardiac murmurs

17
Q

Location of ventricular filling murmurs

A

Loudest behind triceps

LIC5 - often towards apex (Sternum)

18
Q

Timing/intensity of ventricular filling murmurs

A

Mid diastolic murmurs

19
Q

Importance of ventricular filling murmurs

A

Physiological
Variable

20
Q

Aortic insufficiency in horses

A

Commonest form of equine VHD

Middle-aged or older horses

Frequently an incidental finding

Progressive condition clinical signs in older horses

21
Q

Murmur of aortic insufficiency

A

Grade: 1-6/6

Timing: Early or holo DIASTOLIC

Shape: Decrescendo

Loudest: Left 4th intercostal space

22
Q

Clinical examination of a horse with aortic insufficiency

A

Bounding (hyperkinetic) pulses
May have concurrent mitral insufficiency

23
Q

Ventricular arrhythmias in a horse with aortic insufficiency

A

Higher prevalence of ventricular arrhythmias in horses with aortic insufficiency compared with other forms of valvular insufficiency

Incidental finding

Concurrent myocardial and endocardial pathology

Catecholamine-induced?

Altered coronary artery blood flow?

24
Q

Echocardiography of a horse with aortic insufficiency

A

Left ventricular enlargement
Mitral valve regurgitation
Jet size

25
Q

Negative prognostic signs for horses with aortic insufficiency

A

Murmur grade is not useful indicator

Secondary MR

Pulse pressure is associated with severity

Congestive heart failure

Left or biventricular

Bacterial endocarditis

Left ventricular enlargement

Defect size and valvular lesions

NIBP pulse pressure >60mmHg

EXERCISING ELECTROCARDIOGRAPHY

26
Q

Pulmonic insufficiency in horses

A

PI is uncommon in the horse

When it occurs it rarely affects performance

A common echocardiographic finding

Cor pulmonale

Right ventricular hypertrophy
§ Pulmonary Hypertensin
§ Alveolar hypoxia
□ Marked respiratory distress
□ PA enlargement and PI

27
Q

Continuous cardiac murmurs

A

Aortic root rupture

Aorto-cardiac fistula

Continuous loud cardiac murmur
§ Grade 4-6/6
§ Often accompanied by ventricular tachycardia (>100bpm)
□ Disruption to interventricular
conduction tissue
§ Usually fatal
□ Acute cardiac failure
□ Collapse
□ Exsanguination

Fresians in scandinavia

28
Q

Valvular pathology in horses

A

Bacterial endocarditis
○ New cardiac murmurs associated with severe disease
○ Clinical signs:
§ Acute onset Congestive heart failure
§ Fever, cardiac murmur, tachycardia, tachypnoea
○ Laboratory data
§ Hyperfibrinogenaemia, anaemia and leucocytosis
§ Blood culture
□ Repeat x3 (false negatives) ideally
□ when pyrexic
□ Sterile procedure (do not use indwelling catheter)

29
Q

Colic and heart murmurs in horses

A

New cardiac murmurs may be heard in horses with colic
○ Flow murmur
○ Regurgitant
○ Quite loud

Occasionally cardiac dysrhythmias also may be identified
○ GI disease
○ Electrolyte imbalances

Horses in acute left sided heart failure show signs similar to colic