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Equine Medicine > Unit 1 - Cardiology (intro to Atrial arrhythmias) > Flashcards

Unit 1 - Cardiology (intro to Atrial arrhythmias) Flashcards

1
Q

What physical exam findings are associated with mild cases of cardiovascular disease?

A

no clinical signs, reduced exercise tolerance

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2
Q

What physical exam findings are associated with moderate cases of cardiovascular disease?

A

tachycardia, tachypnea, dyspnea post exercise, abnormal arterial pulse, jugular distention, edema over ventral abdomen, edema in the distal limbs, and pathologic arrhythmias

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3
Q

What physical exam findings are associated with severe cardiovascular disease?

A

cool extremities, weight loss, reduced capillary refill time, cough, dyspnea at rest, and collapse

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4
Q

What are the reasons for evaluating for cardiovascular disease?

A

obvious signs of heart disease, poor athletic performance, pre-purchase examination, insurance examination

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5
Q

What are the components of a cardiac evaluation?

A

auscultaion, ECG, echo, and exercise testing

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6
Q

What is the normal resting heart rate of the horse?

A

20-40 beats per minute

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7
Q

What is S1?

A

sound 1 - the lub followed by systole

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8
Q

What is S2?

A

sound 2 - the dub followed by diastole

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9
Q

What is S4?

A

the atrial sound

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10
Q

What makes the atrial sound?

A

it arises from ventricular vibrations set up when pressure wave caused by the atrial contraction reaches the ventricle

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11
Q

When arrythmia is an isolated S4 associated with?

A

2nd (and 3rd) degree A-V block

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12
Q

When is S4 absent?

A

in a sinoatrial block

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13
Q

What does S4 immediately preceed?

A

lub

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14
Q

When and where does S1 come from?

A

It arises mostly from the ventricle, after AV valve closure

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15
Q

What does the atrial-S1 interval depend on?

A

the P-Q interval

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16
Q

What is S2 made by?

A

closure of semi-lunar valves and rapid reversal of blood flow

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17
Q

What is S3 made by?

A

early, rapid ventricular filling

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18
Q

Where anatomically is S3 heard? In what percent of horses?

A

left side, 30-50%

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19
Q

What are the semi-lunar valves?

A

aortic and pulmonic valves

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20
Q

Where is S1 the loudest on auscultation?

A

over the mitral valve - in the intercostal space between ribs 5 and 6, right at the caudal edge of the triceos

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21
Q

Where is S2 the loudest on auscultation?

A

over the aortic valve - in the intercostal space between ribs 4 and 5

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22
Q

What makes the P wave on an ECG?

A

right atrial depolarization with a wave spreading from the S-A node across the right atrium, the interatrial septum, and then the left atrium

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23
Q

At rest, how does the P wave appear?

A

it is often bifid

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24
Q

What does the first small ‘hump’ of the p-wave represent?

A

mostly right atrial depolarization

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25
Q

Is the QRS wave due depolarization as a wavefront like the p wave is?

A

No, the depolarization is NOT as a wavefront across the chambers due to much branching of the conducting system

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26
Q

QRS at body surface reflects about ___ of the depolarization of the myocardial mass.

A

20%

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27
Q

What causes the T wave?

A

repolarization of the ventricles

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28
Q

The equine T-wave is very ____.

A

labile

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29
Q

The T-wave changes polarity with ______.

A

heart rate

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30
Q

What can the T-wave not be used to assess?

A

heart strain

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31
Q

What is ECG only useful for determining?

A

arrhythmias

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32
Q

A.

A

bifid P wave

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33
Q

B.

A

diastole

34
Q

C.

A

S4 - ba

35
Q

D.

A

QRS complex

36
Q

E.

A

systole

37
Q

F.

A

S1 - lub

38
Q

G.

A

T-wave

39
Q

H.

A

Diastole

40
Q

I.

A

S2 - dub

41
Q

J.

A

S3 - ah

42
Q

If a murmur is heard at E, what type of murmur is it?

A

a systolic murmur

43
Q

If a murmur is heard at B or H, what type of murmur is it?

A

a diastolic murmur

44
Q

Where will a atrial arrythmia be heard?

A

at S4

45
Q

Is systole A or B? Diastole?

A

Systole is A, diastole is B

46
Q

What depth is required for echo in horses? What size transducer?

A

a depth of 30 centimeters, 3.5 mHz transducer

47
Q

What is echocardiography useful in detecting?

A

congenital anomalies

48
Q

When should exercise testing take place?

A

cardiac evaluation should be performed at or immediately after expected level of exercise

49
Q

What are the types of atrial arrhythmias?

A

wandering pacemaker, premature sinus beats, premature atrial beats, sino-atrial block, sinus bradycardia, post exercise sinus arrhythmia, and atrial fibrillation

50
Q

Is wandering pacemaker a true arrhythmia?

A

not really, it is an ECG finding

51
Q

How does a wandering pacemaker present on ECG?

A

the p-wave shape may change from beat to beat, but the rhythm is regular

52
Q

Is wandering pacemaker clinically significant?

A

no

53
Q

How do premature sinus beat arrythmias present on ECG?

A

P waves are earlier than normal, but of normal conformation. The QRS wave is normal

54
Q

When do premature sinus beats disappear?

A

with exercise

55
Q

When do premature sinus beats suggest myocardial disease?

A

when there are frequent ones - it is not significant if there is one occasionally every 5 minutes

56
Q

What is the recommended treatment for horses that have frequent premature sinus beats?

A

to rest the horses and reevaluate in 4-6 months

57
Q

How do premature atrial beats appear on ECG?

A

the same as premature sinus beats, but the P waves are of abnormal conformation

58
Q

What causes the abnormal conformation of P waves in premature atrial beat arrhythmias?

A

there is an ectopic focus in the atrial muscle

59
Q

When do premature atrial beats suggest myocardial disease? Treatment?

A

If they are very frequent, it suggests myocardial disease. Rest these horses, and then reevaluate in 4-6 months.

60
Q

How do sino-atrial blocks appear on ECG?

A

There is no P-wave and a twice normal diastolic pause (2 dubs)

61
Q

What horses are sino-atrial blocks more common in?

A

ponies

62
Q

What abolishes sino-atrial block?

A

exercise

63
Q

What mediates sino-atrial block?

A

it is vagally mediated

64
Q

Is sino-atrial block clinically significant?

A

not usually

65
Q

What horses typically have sinus bradycardia?

A

mostly ponies - it is rare

66
Q

How does sinus bradycardia present?

A

as a very slow irregular atrial rhythm

67
Q

What clinical signs are associated with sinus bradycardia?

A

reduced exercise or even lethargy

68
Q

What may reslove sinus bradycardia?

A

rest

69
Q

When are post exercise sinus arrhythmias common?

A

after light trotting exercise in fit horses

70
Q

How do post-exercise sinus arrhythmias occur?

A

As the heart rate slows, there are sudden pauses, and then a gradual return to the pre-pause rate

71
Q

Are post-exercise sinus arrhythmias significant? How can they be abolished?

A

Not usually significant, abolished by more rigorous exercise

72
Q

What clinical signs are associated with atrial fibrilation?

A

they are variable - they could have none up to heart failure, they may have pulse deficits

73
Q

On auscultation, how does atrial fibrilation sound?

A

there are no atrial sounds, irregularly spaced group of irregular beats, S1 and S2 vary in intensity due to variable ventricular filling

74
Q

What heart rate is associated with atrial fibrilation?

A

the heart rate can range from 30-40 up to 80-100

75
Q

What treatment is recommended for atrial fibrillation?

A

It is best if it is done early in the disease - oral quinidine is a drug of choice

76
Q

How is oral quinidine administered?

A

via a nasogastric tube

77
Q

What is the protocol for oral quinidine treatment for atrial fibrillation?

A

Give a test dose of 5 grams on day 1, if no adverse reaction then proceed to day 2

On day 2, give 20 grams as a start up dosage and give an additional 10 grams every 2 hours (make sure to perform an ECG before giving each dose)

78
Q

What dosage should you not exceed for oral quinidine per day?

A

do not exceed 90 grams/day in a 1000 pound horse

79
Q

What toxic signs are associated with atrial fibrillation treatment of quinidine?

A

Depression (often), tachycardia, diarrhea (often), colic (often), urticaria, nasal edema, weakness, ataxia, and death

80
Q

Aside from oral quinidine, what can be used to treat atrial fibrillation?

A

IV quinidine (expensive and risky), Digoxin (if heartrate is greater than 60 bpm), and electrical cardioversion (shocking)

Equine Medicine (27 decks)

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