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MODULE 15 - Cardiorespiratory and Haematopoietic Disease > PATHOLOGY - Equine Dysrhythmias > Flashcards

PATHOLOGY - Equine Dysrhythmias Flashcards

1
Q

What is the normal heart rate at rest for horses?

A

28 - 40bpm

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2
Q

What is the maximum heart rate for horses at maximum exercise?

A

220 - 240bpm

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3
Q

What are the four normal heart sounds in horses?

A

S4
S1
S2
S3

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4
Q

What causes S4 heart sounds in horses?

A

S4 heart sounds are a ‘le’ sound caused by atrial contraction moving blood into the ventricle

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5
Q

What causes S1 heart sounds in horses?

A

S1 heart sounds are a ‘lub’ sound caused by the closure of the atrioventricular (AV) valves

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6
Q

What causes S2 heart sounds in horses?

A

S2 heart sounds are a ‘dub’ sound caused by the closure of the aortic and pulmonary valves

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7
Q

What causes S3 heart sounds in horses?

A

S3 heart sounds are a ‘shh’ sound caused by ventricular filling

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8
Q

Identify the waves in this normal equine ECG

A
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9
Q

Why do horses have a biphasic P wave?

A

Horses have a biphasic P wave due to their large atria which results in slightly ashynchronous atrial depolarisation

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10
Q

What are the five steps to interpreting an ECG?

A
  1. Determine the heart rate
  2. Determine if the rhythm is regular or irregular
  3. Are there P waves present? Are there always P waves preceding QRS complexes and QRS complexes following P waves
  4. Determine the size of the QRS complex
  5. Determine if the P waves are positive in lead II
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11
Q

Which lead do you use to read equine ECGs?

A

Read equine ECGs at lead 1

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12
Q

Why do horses commonly present with non-pathological dysrhythmias?

A

Horses often present with non-pathological dysrhythmias due to their high vagal tone

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13
Q

What are the five most common non-pathological dysrhythmias in horses?

A

Atrial premature contractions
Second degree atrioventricular (AV) heart block
Sinus pause
Sinus arrhythmia
Ventricular premature contraction

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14
Q

What are atrial premature contractions?

A

Atrial premature contractions are where the electrical impulse that triggers the atrial contraction originates in the atrial myocardium rather than the usual sinoatrial node

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15
Q

What is the key characteristic of an atrial premature contraction on an equine ECG?

A

Normal heart beat that occurs earlier than the next expected heart beat

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16
Q

What are atrioventricular (AV) heart blocks?

A

Atrioventricular (AV) heart blocks is a term used to describe dysfunctional conduction of electrical impulses through the atrioventricular (AV) node

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17
Q

What is a second degree atrioventricular (AV) heart block?

A

A second degree atrioventricular (AV) block is an intermittent blockage in the electrical impulse as it travels through the atrioventricular (AV) node

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18
Q

What is the characteristic feature of a second degree atrioventricular (AV) block on an equine ECG?

A

Intermittent P waves that are not followed by a QRS complex

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19
Q

What is a mobitz type I second degree atrioventricular (AV) block?

A

A mobitz type I second degree atrioventricular (AV) block is there is progressive prolongation of the P-R interval prior to the atrioventricular block

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20
Q

What is a mobitz type II second degree atrioventricular (AV) block?

A

A mobitz type II second degree atrioventricular (AV) block is where there is a consistent P-R interval prior to the atrioventricular block

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21
Q

How do you determine if a second degree atrioventricular (AV) block is physiological or pathological in the horse?

A

Physiological second degree atrioventricular (AV) blocks in the horse are due to high vagal tone and this should disappear during exercise when the sympathetic tone is increased

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22
Q

What is an advanced second degree atrioventricular (AV) heart block?

A

An advanced second degree atrioventricular (AV) heart block is a pathological arrhythmia that occurs even during exercise

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23
Q

What is a third degree atrioventricular (AV) heart block?

Always pathological in horses

A

A third degree atrioventricular (AV) heart block is a complete blockage of the electrical impulse as it travels through the atrioventricular (AV) node

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24
Q

What are the characteristic features of a third degree atrioventricular heart block on an equine ECG?

A

P waves that are unrelated to the junctional and ventricular escape beats

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25
Which diagnostic test can be done to determine if an atrioventricular (AV) block has a cardiac aetiology or is due to high vagal tone?
Atropine response test
26
What are three possible causes of an advanced second degree atrioventricular (AV) heart block and third degree atrioventricular (AV) heart block in horses?
Electrolyte imbalances Digitalis toxicity Atrioventricular (AV) nodal disease
27
What is digitalis toxicity?
Digitalis toxicity is digoxin toxicity which can occur is horses due to ingesting foxglove plants
28
How do you treat advanced second degree and third degree atrioventricular (AV) heart blocks in horses?
Correct any electrolyte imbalances Supportive care for digitalis toxicity Implant a pacemaker if there is an atrioventricular nodal disease
29
What is the prognosis for a third degree atrioventricular (AV) heart block?
Poor prognosis. The horse will likely collapse thus making them unsafe for riding
30
What is a sinus pause?
A sinus pause is a brief cessation of electrical impulse formation by the sinoatrial (SA) node
31
How do you determine if a sinus pause is physiological or pathological in the horse?
A horse with a physiological sinus pause should have a heart rate within the normal range *(usually towards the slower end)*, and the sinus pause is due to high vagal tone so should disappear during exercise when the sympathetic tone is increased
32
What are ventricular premature contractions?
Ventricular premature contractions is where the electrical impulse originates in the ventricle, rather than the usual sinoatrial node - triggering the ventricles to contract prematurely
33
What are the characteristic features of ventricular premature contractions on an equine ECG?
- Wide and abnormal QRS complex morpholgy - No P waves preceding the abnormal QRS complexes - Often the abnormal QRS complexes are followed by an abnormal T wave *(sometimes orientated in the opposite direction to normal)* - These abnormal QRS complexes will interrupt the normal heart rhythm
34
What are monomorphic premature ventricular contractions?
Monomorphic premature ventricular contractions have an identical morphology, indicating the electrical impulses are coming from one site within the ventricles
35
What are polymorphic premature ventricular contractions?
Polymorphic premature ventricular contractions have a varying morphology, indicating the electrical impulses are coming from more than one site within the ventricles
36
How do you differentiate between physiological and pathological premature ventricular contractions in horses?
If the premature ventricular contractions are frequent, polymorphic and occur during exercise, this suggests they are pathological
37
What can you use to monitor the frequency of premature ventricular contractions in horses?
24 hour holter ECG
38
What are seven possible underlying causes of pathological premature ventricular contractions in horses?
Myocardial inflammation Myocardial degeneration Myocardial necrosis Myocardial fibrosis Myocardial hypoxia Endotoxaemia Electrolyte imbalances
39
What investigative tests should you do for a horse presenting with pathological premature ventricular contractions?
Serum electrolyte levels Look for markers of cardiac damage *(cardiac troponin I)* Look for evidence of infection
40
How do you treat pathological premature ventricular contractions in horses?
Correct any electrolyte imbalances Corticosteroids if there is evidence of an inflammatory aetiology Prolonged rest Antiarryhthmic drugs
41
What is the main indicator for the administration of antiarryhthmic drugs for premature ventricular contractions?
Frequent premature ventricular contractions with a heart rate over 100bpm ## Footnote Will also be beneficial to consider referral and further investigation at this point
42
Which antiarrhythmic drug can be used to manage pathological premature ventricular contractions?
Phenytoin
43
What is atrial fibrillation?
Atrial fibrillation is where there are uncoordinated supraventricular ectopic electrical impulses. These electrical impulses bombarde the atrioventricular (AV) node, and since the AV node acts as a filter, only intermittent atrial electrical impulses will be conducted through the atrioventricular (AV) node, causing an irregular rhythm
44
What are the characteristic features of atrial fibrillation on an ECG?
No P waves Fibillatory (F) waves Narrow, normal QRS complexes with an irregular rhythm
45
Why are horses at an increased risk of developing atrial fibrillation?
Horses are at an increased risk of developing atrial fibrillation due to their high vagal tone and their large atrial size
46
How does high vagal tone increase the risk of atrial fibrillation?
47
Which cardiac diseases can increase the risk of atrial fibrillation in horses?
Atrial enlargment due to mitral or tricuspid valve regurgitation
48
What are the clinical signs of atrial fibrillation in horses?
No clinical signs at rest Poor performance
49
When would you want to auscultate a horse to hear atrial fibrillation?
Auscultate a horse at rest to hear atrial fibillation. You are much more likely to miss atrial fibrillation if you auscultate just after the horse has exercised
50
What are the signs of atrial fibrillation on auscultation?
Irregulalrly irregular rhythm No detectable S4 heart sound
51
How can atrial fibrillation cause poor performance in horses?
Atrial contraction contributes to cardiac output as atrial contraction pushes the remaining blood into the ventricles that didn't enter during ventricular filling. With the loss of coordinated atrial electrical activity, the atria fail to contract resulting in inconsistent ventricular filling, resulting in a decreased stroke volume and cardiac output. Because ventricular contraction - while irregular - is normal in atrial fibrillation, cardiac output at rest is not markedly affected, however at exercise, the atrial contribution becomes more important as the demands on cardiac output approach maximum
52
What is cardioversion?
Cardioversion is a procedure used to convert atrial fibrillation into sinus rhythm
53
What are the contraindications for cardioversion?
Concurrent heart chamber enlargement Chronic atrial fibrillation If the horse is coping well with the atrial fibrillation If the horse has had previous, unsuccessful cardioversion
54
Which antiarrhythmic drug is most commonly used for cardioversion?
Quinidine
55
How does quinidine achieve cardioversion?
Sequential doses of oral quindine are administered *(usually 5-6 doses)*. Quinidine is a class 1A antiarrhythmic drugs which blocks the sodium channels in the atrial myocardial cells which slows conduction velocity. Qunidine also increases the refractory period of cells, slowing down the atrial electrical impulses. This allows the ventricles to respond to more of the atrial electrical impulses until eventually the electrical activity reaches sinus rhythm
56
What are the mechanisms of action of some of the side effects of qunidine?
Quinidine is a vagolytic agent which can cause supraventricular tachycardia from the loss of AV blockage of atrial impulses. Quinidine also prolongs action potentials which increases the risk of ventricular tachycardia, and is an alpha adrenoreceptor antagonist, resulting in hypotension
57
What are the side affects of mild quinidine toxicity?
Mild depression Muzzle oedema Diarrhoea
58
What are some of the severe side affects of quinidine toxicity?
Supraventricular tachyarrhythmias Hypotension Colic Laminitis
59
Why is quinidine contraindicated in horses with concurrently enlarged heart chambers?
Quinidine can cause catastophic hypotension and ventricular tachydysrhythmias in horses with pathologically enlarged heart chambers
60
How can quinidine cause hypotension?
Quinidine is an α adrenoreceptor antagonist, resulting in vasodilation and hypotension
61
How can quinidine cause ventricular tachyarrhythmias?
Quinidine can cause ventricular tachyarrhythmias if the ventricles respond to every atrial electrical impulse which can result in ventricular tachycardia which can progress to ventricular fibrillation if the heart beats so fast that the oxygen demand exceeds oxygen supply
62
What can you do to monitor for signs of quinidine toxicity?
Monitor for changes in the ECG
63
How do you manage quinidine toxicity?
Stop quinidine administration Administer mineral oil nasogastrically Administer IV sodium bicarbonate Antiarrhythmic drugs
64
Why would you want to administer nasogastric mineral oil to a horse with quinidine toxicity?
To reduce further absorption of the quinidine
65
Why would you want to administer sodium bicarbonate to a horse with quinidine toxicity?
Sodium bicarbonate will bind to free quinidine to reduce quinidine bioavailability
66
Which first line antiarrhythmic drug would you want to administer to patients with quindine toxicity and why?
Lidocaine infusion to manage the ventricular tacchyarrhythmias
67
When would a lidocaine infusion be indicated for treating ventricular tacchyarrhythmias?
A lidocaine infusion is indicated if the heart rate is above 100bpm
68
Which second line antiarrhythmic drug can be used in patients with quinidine toxicity?
Intravenous (IV) digoxin
69
Which antiarrhythmic should be administered if a horse undergoing quinidine cardioversion develops Torsades de Pointes?
Magnesium sulphate (MgSO4) bolus injections
70
What can be used to treat atrial fibrillation in horses with pathological heart chamber enlargement?
Transvenous electrical cardioversion
71
Which drug can be used following cardioversion to reduce the likelihood of reconversion to atrial fibrilliation?
Sotalol (beta-blocker)
72
What is the approximate cost of transvenous electrical cardioversion?
Approximately £3,000 to £5,000
73
What is the prognosis for atrial fibrillation?
The prognosis of atrial fibrillation is dependent on several factors. For horses that are used for high intensity exercise, the prognosis will be worse compared to leisure horses. If there is an underlying pathological cause, this will also worsen the prognosis. If the atrial fibrillation has been going on for a long time, this will also worsen the prognosis
74
What are the characteristic signs of ventricular tachycardia on an equine ECG?
- Tachycardia - Wide QRS complexes with an abnormal morphology unrelated to any P waves (the P waves are often hidden in the complexes)
75
What are some of the possible underlying causes of ventricular tachycardia in horses?
Electrolyte imbalances Myocardial inflammation Myocardial hypoxia Secondary to endotoxaemia
76
What investigative tests should you do for a horse presenting with ventricular tachycardia?
Serum electrolyte levels Look for markers of cardiac inflammation/damage
77
What can you use to treat ventricular tachycardia?
Correct any electrolyte imbalances Corticosteroids if there is evidence of an inflammatory aetiology Prolonged rest Lidocaine infusions

MODULE 15 - Cardiorespiratory and Haematopoietic Disease (21 decks)

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