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C & R II - wk1 > acquired valvular disease in LA > Flashcards

acquired valvular disease in LA Flashcards

1
Q

what does a diastolic murmur usually mean and characteristics

A
  • aortic regurgitation
  • grade 1-6/6, decresdcendo, often musical
  • > 10 yrs, usually older
  • bounding peripheral pulse (not grade)
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2
Q

when does AR need further evaluation (echo)

A
  • when aterial pulses bounding
  • when horse is young
  • when horse has other signs of heart dx (excersize intolerance, HR, RR effort, ventricular arrhythmias, mitral regurgitation murmur, VSD murmur, atrial fibrilation)
  • when horse has unknown fever
  • prepurchase exam
  • athlete
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3
Q

what does AR need if its moderate or severe

A

excercising ECG

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4
Q

what is arrhythmogenesis in AR & exercise

A
  • ventricular enlargemenet & remodeling
  • decreased coronary perfusion
  • shortened diastole cause by high HR
  • increased oxygen demand
  • increased sympathetic tone caused by the exercise
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5
Q

what is the clinical relevance of AR

A
  • clinically irrelevant
  • excercise intolerance
  • safety concerns
  • heart failure
  • endocarditis
  • echo
  • exercise ECG
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6
Q

what is pulmonic valve dx

A
  • often clinically insignificant
  • except: endocarditis and severe pulmonic stenosis
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7
Q

what is mitral regurgitation

A
  • a loud L sided systolic murmur is MR until proven otherwise
  • grade 1-6/6 - no correlation with severity
  • often incidental but also most common cause of CHF
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8
Q

what are the signs of MR

A
  • exercise intolerance
  • increase HR
  • increase RR and effort
  • cough
  • edema
  • arrhythmias (AF)
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9
Q

what is the predisposing factor to AF in MR and equine CHF

A

atrial enlargement

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10
Q

development of AF can tilt into CHF in severe MR due to:

A

loss of atrial contraction

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11
Q

when does AF in MR and quine CHF occur

A

increased rate = needs rate contool

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12
Q

why is cardioversion contraindicated

A

due to tx complications while in CHF & almost certain recurrence

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13
Q

ruptured chord is a marker of ____

A

severity

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14
Q

when do horses with a L sided murmur need an echo

A

all cases unless physiologic murmur or retired horse in which owner understands all monitoring

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15
Q

what is tricuspid regurgitation (TR)

A
  • most common cause of R sided systolic murmur
  • frequent in standardbred
  • grade and severity correlated
  • rarely causes performance problems or heart failure
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16
Q

what are exceptions to TR

A
  • very severe TR or atrial enlargement that predisposes to atrial fibrillation
  • endocarditis
  • secondary to MR and PH
17
Q

what are the most common causes of jugular pulses in horses

A

ventricular tachycardia and TR

18
Q

TR needs further evaluation (echo) if…

A
  • 4-6/6 holo or pansystolic
  • other signs of heart dx (exercise intolerance, HR, atrial fibrilation, jugular pulses)
  • FUO or thrombophlebitis
  • secondary to MR and PH
19
Q

what is the clinical relevance of TR

A
  • clinically irrelevant most of the time
  • rarely causes performance problems, safety concerns or HF
  • echo
20
Q

what is severe TR in horses with CHF

A
  • often secondary to L side disease (MR & AR)
  • right sided CHF
  • venous distention, jugular pulsations, ventral edema
  • pleural effusion, hepatic congestion, ascites (rare)
  • AF and tachycardia (>60/min) often present
21
Q

continuous murmurs

what is aortocardiac fistula

A
  • connection from aortic root-RV, RA or LV
  • signs may be distress, arrhymia or colic
  • associated with ventricular arrhythmias
  • unsafe to ride/risk of sudden death
  • life expectancy days-months
22
Q

continuous murmurs

what is patent ductus arteriosus (PDA)

A
  • murmur may be present physiologically < 72-96 hrs
  • very rare in “non-neonate”
23
Q

treatment of CHF

A
  • diuretics: furosemide - torsemide
  • ACEI: benazepril
  • rate control: digoxin mainly in AF
  • pimobendan: little info and expensive
  • inotropes (dubutamine), sedation for dyspnea, oxygen, sildenafil, brochodilators, spironolactone, nitroglycerine
24
Q

what to watch for with horses with CHF

A

tolerance to exercise, HR, RR and effort

25
Q

how to monitor horses with valvular disease

A
  • mild - moderate: recheck every 6-24 months
  • physical exam
  • echo
  • exercising ECG if moderate or severe disease progression, AF or premature arrhythmias
26
Q

what is endocarditis

A
  • mitral or aortic valve more common in horses and carries a grave prognosis
  • tricuspid or pulmonic valve more common in ruminants and guarded prognosis
27
Q

what are the signs of bacterial endocarditis

A
  • horses: fever, tachycardia, shifting lameness, synovial effusion
  • cow: anorexia, tachycardia, decreased rumen contractions, decreased milk production
  • murmur or no murmur
28
Q

what is the clin path of bacterial endocarditis

A
  • increase in acute phase proteins (fibrinogen and SAA)
  • hyperglobulinemia
  • leukocytosis
  • neutrophilia
  • anemia
29
Q

blood cultures with bacterial endocarditis

A

bacteremia can be intermitten - 3 cultures at least one hour as an option

30
Q

how to tx bacterial endocarditis

A

antimicrobial therapy

  • based on culture & sensitivity
  • bactericidal IV antibiotic
  • broad spectrum antibiotics should be initated prompty (penicillin and gentamicin)
  • platelet aggregation inhibitors
  • aprin

C & R II - wk1 (13 decks)

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