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Cardiovascular > Murmurs in Young Animals > Flashcards

Murmurs in Young Animals Flashcards

1
Q

What causes innocent murmurs?

A

> v TP and v PCV - low viscosity blood
^ CO as animal growing
-> turbulent flow of blood in the absence of pathology

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2
Q

Characteristics of a flow or innocent murmur?

A
  • no clinical signs
  • low intensity <3/6
  • reduces in intensity and disdappears with age (by 6 months)
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3
Q

Which species has highest incidence of congenital heart defects?

A

dogs 1/100 live births

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4
Q

What are the 4 main types of abnormality?

A 
> valvular malformations or dysplasia
- stenosis or insiffuiciency of any valves
> persistence of foetal vessels
- PDA
> malformation of vasculature
- vascular ring anomaly
> Septal defects
* complex defects eg. tetralogy of fallot involve multiple defects (pulmonic stenosis and septal defect)
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5
Q

What clinical signs may congential heart problems present as unrelated to CV system?

A
  • hepatic encephalopathy with PSS

- regurgitation with VRA

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6
Q

What are potential causes of systolic murmurs?

A 
> left
- apex: mitral insufficiency
- base: AS/PS
> right
- sternal border: VSD
- cranial: triceps insusfficiency or aortic stenosis
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7
Q

Other than murmur, what clinical signs may indicate congential heart defects?

A

> cyanosis
- cyanotic heart disease where R-L shunt can occour (BAD)
Pulse quality
- exaggerated (may be PDA, waterhammer pulse)
- poor (may be aortic stenosis > damping effect)

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8
Q

What type of shunt creates volume overload?

A

Left -> Right

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9
Q

What type of shunt causes pressure overload?

A

Stenotic outflow tracts

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10
Q

See lecture for diagrams of the path of the shunting erythrocyte!

A
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11
Q

Which species are VSDs the most common defect in?

A

All except dog!

Dog - PDA `

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12
Q

What type of shunt does VSD cause? So where is murmur heard? Implications of this?

A

Left - right

  • murmur heard loudest on RIGHT with palpable thrill on the R thoracic wall
  • colume overloaded left side and pulmonary circulation
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13
Q

Tx and prognosis of VSD?

A
  • no definitive Tx

- prognosis fair if defect is small and pressure difference maintained across defect

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14
Q

Where specifically is VSD likely to occour?

A

Near great vessels (near top)

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15
Q

How does relative pulmonic stenosis occour?

A

L-V shunt overloads pulmonary circulation as aortic CO is always maintained by homeostatic mechanisms
-> pulmonary artery is relatively too thin for volume of blood passing thorugh

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16
Q

What is the peak left and right ventricular pressure in systole?

A

LV: 120mmHg
RV: 35mmHG

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17
Q

What does speed of flow thorugh a defect indicate?

A

Faster the flow, smaller the defect, better the prognosis!

18
Q

What is a small VSD termed?

A

Restrictive defect

19
Q

What causes cyanotic congenital heart disease? PE findings?

A
  • RV pressure overload and systemic hypoxia

- PE: poorly grown, may be no murmur or quiet murmur

20
Q

Diagnositcs for cyanotic congential heart disease?

A
  • RVH
  • shunting defect
  • polycythaemia may be present (abnormally ^ Hbg conc due to ^RBC or v volume)
21
Q

Tx pulmonic hypertension or pulmonic stenosis (cyanotic congenital heart disease)?

A

no definitive tx

  • palliative tx for certain defects
  • control PCV
22
Q

What is a potential RV systolic pressure with pulmonary hypertension?

A

140mmHg

23
Q

Why may murmurs be less audible with more severe defects?

A

if RV pressure ^, pressure gradiant is less so velocity v and murmur less audible

24
Q

What causes ^ RV pressure?

A

Pulmonic hypertension

25
Q

What is the pathophysiology of tetralogy of fallot similar to?

A

VSD

26
Q

How may VSD occour other than congenitally?

A

Traumatic eg. kicked by a horse

27
Q

Which way does blood flow thorugh the DA in utero?

A

PA -> A

28
Q

What is heard on PE with PDA?

A

continuous left base murmur

bounding pulses

29
Q

How may PDA be diagnosed?

A
  • three knuckles on DV rads (Ao, PA, LA)
  • volume loaded left heart and pulmonary circulation
  • doppler: ductal flow
30
Q

Tx and prognosis for PDA?

A

Ligation or intra-vascular closure

- prognosis good if closed

31
Q

What pathophysiology does aortic/pulmonic stenosis have?

A

Pressure overload LV or RV respectively

32
Q

PE findings with aortic/pulmonic stenosis?

A
  • left base systolic murmur
  • poor pulses (less so with pulmonic)
  • with pulmonic, apex beat may be on the right
33
Q

Diagnostic findings with aortic/pulmonic stenosis?

A 
> aortic
- concentrically hypertrophied LV
- ^ aortic outflow velocity with doppler
> pulmonic
- concentrically hypertophied RV
- ^ pulmonary outflow velocity with doppler
- pulmonary artery dilation
34
Q

Management and potential outocmes of aortic stenosis?

A
  • definitive cure not available
  • medical management best option but evidence not strong
    > sudden death can occour
35
Q

Tx of pulmonic stenosis?

A
  • balloon valvuloplasty (good evidence for efficacy)

- surgical patch grafting

36
Q

How does VRA (vascular ring anomaly) often present?

A
  • malformation of great vessels -> obstruction of thoracic oesophagus
  • puppies weaned begin regurgitating
  • NO murmur!
  • massive distension of oesophagus on rads cranial to heart base
37
Q

Tx and prognosis of VRA?

A
  • surgical relief of compression

- prognosis guarded as persistnet malfunction of oesophagus often seen after

38
Q

Are atrial septal defects often significant? PE findings?

A

Not really (usually found incidentally)

  • left to right shunt possible
  • PE may be normal or soft murmur over pulmonic valve due to relative or functional pulmonic stenosis
39
Q

Tx of atrial septal defects?

A

Rarely required

40
Q

Pathophysiology of mitral and tricuspid dysplasia?

A
  • stenosis OR insufficiency of the valves

- > volume load of left (M) or right (T) side

41
Q

PE findings of AV valve dysplasia? Diagnostic findings?

A
  • murmurs or mitral regurge or tricusp regurge
  • stenosis murmurs less audible
    Dx - enlargement of L/R heart
42
Q

Tx of atrial septal defects?

A

Surgical repair attempted but limited success

Cardiovascular (11 decks)

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