Radiology, echocardiography

Question 1

What are indications for thoracic radiographs?

Answer 1

1. cough
2. heart murmurs, abnormal lung sounds
3. exercise intolernce
4. neoplasia
5. dyspnea, tachypnea
6. arrhythmias

Question 2

What is the value of thoracic radiographs for cardiology?

Answer 2

1. determine cardiomegaly, vascular status, heart failure, lung changes

Question 3

Which species are radiographs more diagnostic in?

Answer 3

dogs (in cats may not see change in heart outside–concentric hypertrophic cardiomyopathy but still diagnostic for heart failure in both species)

Question 4

What is a major problem with radiographs (compromised patient)

Answer 4

can be fatal!

Question 5

What are the standard positions for radiographs?

Answer 5

right lateral (LATERAL), VD or DV

Question 6

When in resp cycle should a thoracic radiograph be?

Answer 6

full inspiratory

Question 7

Why is anesthesia not a good time to do radiographs?

Answer 7

if they are breathing, not breathing in enough, if ventilating not reflective of actual breathing and there is atelectasis

Question 8

Why would you think the heart is enlarged with expiratory radiograph?

Answer 8

the heart appears big because the lung field is smaller

Question 9

Why can breed differences cause issues with thoracic radiographs?

Answer 9

smaller barrel chested dogs have more sternal contact. Hard to judge increased sternal contact in a barrel chested dog!. on a VD, the heart appears more on the left hemthorax (associated with left ventricular enlargement but very difficult to judge on a barrel chested dog)

Question 10

Why might an obese dog appear to have a large heart?

Answer 10

deposition of fat, cannot breath in well, hard to position well

Question 11

What is the most important view for looking at the heart for dogs for the left atrium?

Answer 11

the lateral because the left atrium sits dorsocaudally and as enlarged it gets bigger over a lung field so can see it.
If coughing or have pulmonary edema have to have left atrial enlargement.

Question 12

What happens with left ventricular enlargement?

Answer 12

deviation of the trachea

Question 13

What is the vertebral heart score?

Answer 13

measure vena cava across heart and from bifurcation down the heart and go up to T4 and measure the number of vertebral bodies for each measurement. if greater than 10.5 you have heart enlargement.

Question 14

How can you get an impression of left atrium enlargement on VD?

Answer 14

the splitting of the bronchi. but often hard to see that.

Question 15

Why can it be easier to spot early pulmonary edema in VD?

Answer 15

because travelling only through one lung field. stuff is less dense in that area so can see abnormality

Question 16

How can you detect left ventricular enlarmgenet on VD?

Answer 16

increased heart in left side

Question 17

How can you detect right atrium and ventricle enlargement?

Answer 17

hard on lateral!!–increased ventricular size appears as more sternal contact but hard to judge in barrel dog. On VD, can detect right atrial enlargement and can detect right ventricular enlargement with the reverse D on VD but barrel chested dogs to some extent all look like that! right sided disease very difficult to spot on radiograph unless a deepchested dog but we rarely deal with primary right sided disease

Question 18

If you have pulmonary venous congestion what side is affected>

Answer 18

left side (but doesn’t happen that often)

Question 19

Why is important to know where the pulmonary arteries are?

Answer 19

so you can detect a right sided problem–e.g. heartworm!!!! The changes of heartworm are in the pulmonary arteries

Question 20

Why is looking at vessels not a reliable tool for heart disease?

Answer 20

can be normal in a dog with heart failure

Question 21

What does aspiration pneumonia appear as in dogs?

Answer 21

anterioventral distribution with alveolar pattern (not edema because that would be perihilar)

Question 22

What animals is the bronchial pattern common in ?

Answer 22

older dogs

Question 23

A generalized interstitial pattern think of

Answer 23

1. poor inspiratory
2. obese
3. cancer, fungus, some forms of penumonia

Question 24

What is interstitial/alveolar pattern in the perihilar region with left atrial enlargement indicative of?

Answer 24

pulmonary edema and left sided heart failure?

Question 25

Structures to evaluate with thoracic radiographs?

Answer 25

1. heart
2. vessels
3. lung
4. extra-thoracic structures

Question 26

What must you remember when you look at thoracic radiographs of a dog you suspect has heart disease?

Answer 26

LOOK AT EVERYTHING. e.g. look at everything else first before you look at something you think is wrong

Question 27

What are indications for echocardiography?

Answer 27

1. cardiac dz in cats
2. congenital dz
3. endocarditis suspects
4. early detection of DCM
5. pericardial effusion
6. arrhythmias without obvious cause

Question 28

what is the treatment for hypertrophic cardiomyopathy in cats?

Answer 28

nothing–unless atrium starts getting large–echos are useful

Question 29

Who are endocarditis suspects?

Answer 29

large breed dogs
lab, etc
usually not that cardiac sick, usually systemically ill

Question 30

Why do you need echo for early detection of DCM?

Answer 30

becuase may not see on radiograph but you will use echo because if diagnose will start treating at that time!

Question 31

Why is echo useful with pericardial effusion?

Answer 31

may not be evident on radiograph

look for tumor! hemangiosarcoma or heart base mass

Question 32

What are the types of echocardiography?

Answer 32

2D
M-mode
Doppler

Question 33

What is the use of M-mode

Answer 33

to detect motion–measure–contractility, lumens

Question 34

What does doppler tell us?

Answer 34

velocity and direction of blood flow-good for congenital defects etc

Question 35

What can you see on right parasternal long axis, 4 chamber view

Answer 35

assess wall thickness, mitral valve? etc

Question 36

What can you see on right parasternal ventricular outflow tract?

Answer 36

look for subaortic stenosis, aortic valves

Question 37

What is fractional shortening

Answer 37

how much heart muscle changes with diastole vs systole. if too low hypocontractile (may be DCM) and hypercontractile–hypertrophic cardiomyopathy, hyperthyroidism, fever

Question 38

What can you see on echo with HCM?

Answer 38

large left atrium, small lumen of left ventricle and thick walls of left ventricle