Test 1: lecture 11+ 12: congenital Flashcards
pressure overload in heart will cause
concentric hypertrophy
thick, smaller volume can fit
what congenital outflow tract obstruction can cause pressure overload in the heart
Pulmonic stenosis
sub-arotic stenosis
high afterload can be caused by
systemic HTN
pulmonary HTN
leads to increased pressure in LV→ concentric hypertropy
clinical signs of outflow tract obstruction in heart
weakness and fainting, arrhythmia and sudden death
reduced ventricular filling from concentric hypertrophy
what types of dogs get pulmonic stenosis
small to medium
beagle, bulldog, boxer, spaniel, bullmastiff
Pulmonic stenosis (PS) refers to a dynamic or fixed anatomic obstruction to flow from the — to the — vasculature.
right ventricle (RV)
pulmonary arterial
pulmonic stenosis is caused by
valve issue
can sometimes be subvalvular or supravalvular obstruction as well
type A pulmonic stenosis
fusion of the leaflets
type B pulmonic stenosis
hypoplastic valve annulus and thickened leaflets
english bulldogs can have — coronary malformation that leads to pulmonic stenosis
aberrant left coronary artery that encircles PA- causes narrowing
clinical signs of mild to moderate Pulmonic stenosis
no clinical signs
clinical signs of severe pulmonic stenosis
exercise intolerance
syncope
systolic murmur 4-6/6 loudest over left 3rd ICS
what kind of mumur for PS
systolic murmur
4-6/6 loudest over left 3rd ICS
physical exam of PS
murmur, pulse, membranes?
Systolic murmur 4-6/6 loudest over left 3rd ICS
* Arterial pulses: normal
* Mucous membranes: pink
* Ascites (rare)
xray of PS will show
bulge at pulmonic artery (post stenotic bulge)
reverse D: enlargement of the RV
PS will have — velocity
high: 6.5 m/s
measured with doppler
bernoulli equation will meaure pressure difference between right ventricle and pulmonary artery
pressure gradient: 4x velocity²
4 x (6.5^2)= 170 mmHg
normal velocity of blood past pulmonic valve
1-2 m/s
PS will cause increased velocity
prognosis of mild PS
mild (0-50 mmHg)= no intervention,
can treat with beta blocker to decrease HR during exercise and reduce RV hypertrophy
prognosis of moderate PS
moderate 50-85 mmHg
+/- valvuloplasty
prognosis of severe PS
> 85 mmHg
death in 1 year without intervention
balloon dilation valvuloplasty
english bulldogs and some boxers can have a anamolous — arising from a single — associated with PS
left main coronary artery
single right coronary artery
artery can rupture during valvuloplasty
breeding advice for PS
do not breed
watch siblings
— is the most common heart defect in dogs
subaortic and aortic stenosis
what breeds will get subaortic stenosis and aortic stenosis
golden, newfoundland, boxer, german shepherd, rotti, bull terrier, bloodhound
breeding of SAS
mild SAS affected parents can produce severely affected pups
Do not recommend breeding
what is subvalvular aortic stenosis
ridge below the aortic valve causes narrowing
heart has to work harder to pump, which leads to permanent long term damage
SAS severe clinical signs
exercise intolerance, syncope, sudden death
Subvavlular aortic stenosis physical exam
systolic murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries
murmur appears/increases until 1 year old
femoral pulses can be weak if severe stenosis
murmur of SAS
systolic murmur (1-6/6) loudest over left 3rd or 4th ICS, may radiate to right side and up carotid arteries
can get worse until full grown (1 year old)
why will echo have bright sections with SAS
increased pressure causes increased work and increased oxygen requirement
leads to ischemia→ fibrosis which is white on echo
how to measure pressure in LV if peak flow is 5.24m/s
4 x (5.24)²
=109 mmHg
109= LV-aorta
assume aortic pressure is 120
LV= 109+120=229 mmHg
prognosis of SAS mild
<50 mmHg
good prognosis, no intervention needed
normal life span
prognosis for SAS moderate
50-80 mmHg
normal: 10 years+
prognosis of sever SAS
80-130 mmHg
3 years vs 8 years if graduent less then 133
severe SAS over 130 mmHg will have what prognosis
70% mortality in 3 years
treatment of severe SAS
can do surgery or balloon
but does not actually lengthen life span, may improve quality of life
complications of SAS
sudden death from arrhythmias
infective endocarditis on the aortic valve
CHF
Dogs with mild and moderate SAS (— mmHg) have a good long- term prognosis with a normal or near-normal life expectancy.
< 80
Dogs with severe disease (— mmHg) have a fair prognosis, although cardiac-death remains a possible outcome.
80 – 130
Dogs with very severe SAS (— mmHg) are more likely to have a poor prognosis and are most likely to benefit from the development
of effective therapeutic interventions.
PG ≥ 130
pulses for PS vs SAS
PS: normal
SAS: weak (takes longer to leave aortic valve)
PDA is
patent ductus arteriosis
connection between PA and aorta did not close at birth
allows for left to right shunt
what breeds get PDA
bichon, german shepherds, maltese, yorki
females > males
clinical signs of PDA
75% no symptoms
coughing, exercise intolerance (CHF)
continuous murmur (loudest over left heart base)
bounding femoral pulse
PDA will have — murmur
continuous
loudest over left heart base
femoral pulse for PDA
bounding
higher pulse pressure gradient (120/40) from blood shunting back through PDA to Pulmonary artery
Xray of PDA
cardiomegaly: LA and LV
pulmonary over-circulation (increased size of lobar vessels (arteries and veins) and increased vascularity )
triple bump (big aorta, PA, Left side)
amplatz device is used for
close PDA
minimally invasive (through catheter)
used for medium duct
how to repair PDA
small dogs: coil embolization
medium: amplatz canine duct occluder (ACDO)
german shepherd or toy breed: surgical ligation
VSD
ventricular septal defect
shunt from one side of the heart to the other side
VSD is the — most common congential defect in cats and dogs
cats: #1
dogs: 4th or 5th
what breeds get VSD
Engl. Springer Sp., WHWT, Cocker, Engl. Bulldog, Basset Hound, Akita, Shih tzu, Husky
what kind of murmur for VSD
systolic murmur loudest over the RIGHT 3rd intercostal space
VSD will have blood flow
from left to right
high to low pressure
VSD can causes
pulmonary overcirculation
eccentric LV hypertrophy from volume overload
+/- eccentric RV hypertrophy
dilated left atrium
Xray of VSD
left sided (LV,LA) enlargement
RV enlargement
pulmonary over circulation → CHF
echo of VSD will show
high velocity get from left to right
small hole may be hard to see
treatment for VSD
usually no treatment
can do surgery invasive or catheter(amplatzer duct occluder ADO) if severe
ASD
atrial septal defect
left to right shunting
what kind of murmur for atrial septal defect
no murmur
because pressure between right and left atrium are similar
how to treat atrial septal defects
small= no treatment
large: can cause volume overload and CHF:
Transcatheter occlusion for PFO and secundum defects with AMPLATZER®
Atrial Septal Occluder
open heart surgery very rare in animals
what is complete AV canal defect
opening to all 4 chambers
very bad: need to fix with open heart
rarely done: high mortality
can do bubble test: will look like snow
what can cause right to left shunt
reverse PDA
tetralogy of fallot
malposition of great arteries
clinical signs of a right to left shunt
exercise intolerance, weakness, fainting
cyanosis
reverse PDA, tetralogy of fallot, malposition of great arteries
reverse PDA will cause
right to left shunt
exercise intolerance, hind limb weakness, seizures, polycythemia
differential cyanosis (mouth pink, prepuce blue)
how to treat reverse PDA
closure is not recommended
would cause right heart failure and death
phlebotomy to decrease hematocrit keep PVC > 75%
chemo to try to decrease production of RBC
low oxygen in lower half, body trys to compensate by making more RBC, can make too many and cause problems
reverse PDA will have what murmur
no murmur: pressure similar
right to left shunting
echo of reverse PDA
right to left
right wall will be very thick from increased pulmonary pressure
bubble test: will see airbubbles in abdominal vena cava: this means blood skipped the lungs
tetralogy of fallot will have what 4 things
VSD
pulmonic stenosis/hypoplasia
overriding aorta
RV hypertrophy
what breeds get tetralogy of fallot
keeshond and english bulldog
what kind of shunt for tetralogy of fallot
right to left across VSD
treatment of tetraology of fallot
ballon valvuloplasty for the PS
beta blockers to decrease RV hypertrophy
Phlebotomy to decrease hematocrit (PVC 70-75%)
open heart surgery
tricuspid valve dysplasia is common in
labs, shepherd, great danes
mitral valve dysplasia is common in
bull terrier, great dane, weimaraner
what kind of murmur for tricuspid valve dysplasia
systolic murmur 2-6/6
loudest over right 3rd ICS
symptoms of tricuspid valve dysplasia
systolic murmur 2-6/6 loudest over right 3rd ICS
ascites
puppy usually asymptomatic
treatment of tricuspid valve dysplasia
will cause right heart failure leading to ascites
treat with diuretics, ACE-I, pimobendan, venodilators
can do open heart surgery- valve repair or replacement
grossly tricuspid valve dysplasia will look
thickened, short or elongated valve with wierd chordae tendineae and papillary muscles
valve may be tethered to septum (unable to open or close)
mitral valve dysplasia symptoms
CHF
cough in dogs
dyspnea in cats
mitral valve dysplasia will cause — murmur
systolic and diastolic murmur over left 5-6th ICS
mitral valve dysplasia prognosis
poor
causes huge LA pressure that leads to CHF very early in life
can try to manage on drugs or repair surgically
cats and dogs
