Murmurs in Pupppies and Kittens Flashcards
Common problems in puppies
Aortic stenosis Patent ductus arteriosus Pulmonic stenosis Ventricular septal defect Mitral valve dysplasia Tricuspid valve dysplasia Tetralogy of Fallot Persistent right aortic arch
Common problems in kittens
Ventricular septal defect Mitral valve dysplasia Tricuspid valve dysplasia Aortic stenosis Persistent right aortic arch Tetralogy of Fallot
Genetic predispositions
Aortic stenosis-
Newfoundlands – autosomal dominant with modifiers
Patent ductus arteriosus –
Poodles – polygenic
Tetralogy of Fallot –
Keeshounds – polygenic
Pulmonic stenosis
Beagles – polygenic
Persistent right aortic arch
German Shepherd - polygenic
murmur types and locations
Left base (“machinery”) murmur:
- Patent ductus arteriosus (continuous)
- Aortic stenosis (systolic)
- Pulmonic stenosis (systolic)
- Innocent/functional murmurs (systolic)
Left apex
-Mitral dysplasia (systolic)
Right side
- Tricuspid dysplasia (systolic)
- Ventricular septal defect (systolic)
- Tetralogy of Fallot (systolic)
What to look for on echo
- Chamber dilation
- Wall hypertrophy
- Abnormal valve appearance
- Valvular incompetence
- High velocity flow across valves
- Shunts
Aortic Stenosis
- pathophysiology
- CS
- treatment
pathophysiology:
- decrease CO : forward failure :exercise intollerance
- pressure overload on LV: concentric hypertrophy of LV: arrhythmia: syncope/death
CS:
- harsh left base murmur
- weak pulse
treatment:
- Mild cases – no treatment, good prognosis
- Severe cases – beta-blockers, calcium channel blockers, guarded prognosis
Patent ductus arteriosus
- pathophysiology (common and rare)
- CS
- radiography
- treatment
- prognosis
Commonly
- Left to right shunt
- Volume overload of lungs
- Left sided CHF
Rarely
Pulmonary hypertension
Right to left shunt
Caudal cyanosis
CS:
- Continuous murmur left heart base
- Water–hammer pulse
Radiography:
- Over perfusion of the lungs
- Aortic, pulmonic and left auricular bulge on DV view
Treatment:
- Surgical ligation or coil/Amplatz implantation
- Treat left sided CHF if present with diuretics and ACE inhibitors
-Prognosis excellent if treated early
Reversed PDA
Excessive volume overload of lungs may lead to pulmonary hypertension
Right to left shunting occurs due to pulmonary hypertension
Present with hindquarter weakness/caudal cyanosis
May develop polycythemia due to hypoxia
Surgical treatment may result in right sided CHF
Prognosis is poor
Pulmonic Stenosis
- pathophysiology
- CS
- diagnostics
- treatment (mild and severe)
Pathophysiology:
- decrease CO : forward failure : exercise intollerance
- diastolic dysfunction : incraese RA pressure : RHS CHF
- Pressure overload
- Concentric hypertrophy right ventricle
- Arrhythmias
- Syncope
CS:
- Weak pulse
- Harsh systolic left heart base murmur
- Ascites
Diganostiscs:
Radiograph: hypoperfusion of lungs, hypertrophic RV, pulmonic valve buldge
ECG: deep S wave
Echo: hypertrophy of LV, Thickening of pulmonic valve
Treatment:
Mild cases
-no treatment, good prognosis
Severe cases
- beta-blockers
- balloon valvuloplasty
- patch graft
- guarded prognosis
Ventricular septal defect
- pathophysiology
- CS
- diagnostics
- treatment
- Over circulation of lungs
- Left sided CHF
rarely:
- Pulmonary hypertension
- Right to left shunting
CS:
- Systolic murmur right ventral thorax
- Good pulse
diagnostics:
- radiograph: Cardiomegaly, left sided congestive heart failure, Congestion of pulmonary veins and arteries
- ECG: tall R wave
Treatment:
- Asymptomatic cases require no treatment
- CHF is treated with diuretics and ACE inhibitors
Tetralogy of Fallot
- pathophysiology
- CS
- physical exam
- diagnostics
- treatment
Pathophysiology
- Pulmonic stenosis
- Large VSD
- Over riding aorta
- Right ventricular hypertrophy
CS
- Collapse
- Dyspnoea
- Cyanosis
- Exercise intolerance
Physical examination
+/- murmur depends on presence of polycythemia
+/- cyanosis
+/- dyspnoea
Diagnostics:
- Radiographs: Right ventricular enlargement, -hypovascularity of lungs, pulmonary artery bulge
- ECG: deep S wave
Treatment:
- Phlebotomy for polychthemia
- Hydroxyurea to decrease RBC production
- Beta blockers to decrease right ventricular hypertrophy
- Palliative surgery
Prognosis is guarded
Mitral valve Dysplasia
- pathophysiology
- physical exam
- treatment and prognosis
May have insufficiency only or stenosis and insufficiency
Systolic murmur over mitral valve but if stenosis present diastolic murmur also present
May develop left sided CHF
Treatment similar to mitral valve endocardiosis
Prognosis depends on severity
Tricuspid valve dysplasia
-CS
-physical exam
diagnostic
Asymptomatic
Exercise intolerance
Syncope
+/- Ascites
Systolic murmur over right apex
+/- signs of right sided CHF
radiograph: RA enlargement
