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Equine Final > Cardio > Flashcards

Cardio Flashcards

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1
Q

What is happening during S1?

A

Mitral/tricuspid closure

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2
Q

What is happening during S2?

A

Aortic/pulmonic closure

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3
Q

What is happening during S3?

A

Rapid ventricular filling

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4
Q

What is happening during S4?

A

Atrial contraction

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5
Q

What is a common vagally mediated rhythm?

A

2nd degree AV block

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6
Q

What are the common equine cardiac arrhythmias?

A

2nd degree AV block, sinus arrhythmias, atrial fibrillation, occasional premature depolarizations (usually atrial)

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7
Q

What are some less common equine cardiac arrhythmias?

A

High-grade 2nd degree AV block, idioventricular rhythm, ventricular tachycardia

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8
Q

What is a rare equine cardiac arrhythmia?

A

3rd degree AV block

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9
Q

What is the etiology of 2nd degree AV block?

A

High vagal tone at rest

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10
Q

What is the etiology of rare APCs?

A

Atrial size, exercise

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11
Q

What is the etiology of atrial fibrillation?

A

Large atria, APCs, hypokalemia

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12
Q

How will 2nd degree AV block appear on ECG?

A

A P-wave without a QRS complex

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13
Q

Describe a physiologic (normal) 2nd degree AV block

A

Only one (or occasionally 2) dropped beats at a time, goes away with exercise

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14
Q

How will sinus arrhythmia appear on ECG?

A

Variation in R-R intervals (shorter during inhalation, longer during exhalation)

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15
Q

How do you differentiate atrial from ventricular premature contractions?

A

With an ECG; Atrial more common

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16
Q

What diseases should you consider if there are frequent premature contractions or there is concurrent tachycardia?

A

GI disease, electrolyte abnormalities, CHF

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17
Q

What should you tell an owner about a horse with premature contractions?

A

There is an increased risk of developing a dangerous arrhythmia

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18
Q

What does an atrial premature contraction look like on ECG?

A

A single early beat with an associated P wave

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19
Q

What does atrial fibrillation sound like?

A

Shoes in a dryer

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20
Q

What does atrial fibrillation look like on ECG?

A

No P waves, fibrillation on baseline of ECG

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21
Q

What are likely triggers for atrial fibrillation?

A

APCs induced by exercise, increased atrial size, or hypokalemia

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22
Q

What are the two main populations of horses that get atrial fibrillation?

A

Young active horses without structural heart disease; older horses with structural heart disease (big atria) and secondary atrial fibrillation

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23
Q

What effect does chronic duration of atrial fibrillation have on prognosis?

A

Decreases long term success of conversion

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24
Q

What should you do once you diagnose a horse with atrial fibrillation?

A

Evaluate for other signs of cardiac or systemic disease, get medication history (Thyro-L), determine onset

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25
When is conversion of atrial fibrillation warranted?
No/minimal underlying structural disease, AF is interfering with use/activity
26
When is conversion of atrial fibrillation NOT indicated?
When there is significant underlying cardiac disease
27
What are the two ways to convert atrial fibrillation?
Pharmacological- quinidine via NG tube, electroconversion- electrical stimulus under GA
28
What is the success rate for AF conversion?
65-90%
29
What are the recommendations for horses with ventricular arrhythmias or 3rd degree AV block?
Identify underlying cause, recommend NO EXERCISE, recommend referral. After treatment there is still increased risk of recurrence so only ridden by informed adult.
30
What ionophore are horses commonly exposed to when housed near ruminants? What are the clinical signs of ionophore toxicity?
Monensin; if short term- enterocolitis, acute myocarditis, sudden death; if long term- progressive myocarditis and fibrosis, exercise intolerance, sudden death
31
What is the treatment for ionophore toxicity in horses?
Acute- save feed for testing, lavage stomach, administer mineral oil/activated charcoal, vitamin E, rest for 2 months; Chronic- if horse survives initial period, recommend cardiac evaluation, do not ride
32
What is the prognosis for ionophore toxicity?
Poor if showing clinical signs, if they recovery they are likely to be limited by myocarditis
33
What plants have glycosides in them?
Oleander, foxglove, rubber vine, lily of the valley, periwinkle, milkweed, bitter root, christmas rose, azalea, star of bethlehem, sabi star
34
What are the clinical signs associated with glycoside toxicity?
Colic, diarrhea, ventricular arrhythmias, renal disease, sudden death
35
What is the treatment for glycoside toxicity? What is the prognosis?
Activated charcoal via NG tube, supportive care, anti-arrhythmic drugs. Prognosis fair (good if survive short term but 50% mortality)
36
What is the toxic agent in Yew? What are the clinical signs?
Alkaloid (taxine). Colic, arrhythmia, sudden death
37
What is the toxic agent in avocado? What are the clinical signs?
Persin. Colic, arrhythmia, respiratory distress, neurological signs, edema
38
What are potential etiologies of physiologic murmurs?
Anything that increases turbulence (sedation, anemia, stress, excitement)
39
What are differentials for a left sided systolic murmur?
Physiologic, mitral regurgitation, VSD (less common location), PDA
40
What are differentials for a left sided diastolic murmur?
Aortic regurgitation, physiologic
41
What are differentials for a continuous murmur?
Aorto-pulmonary fistula
42
What are differentials for a right sided systolic murmur?
Physiologic, tricuspid regurgitation, VSD
43
What are differentials for a right sided diastolic murmur?
Aortic regurgitation
44
What kind of left-sided murmur should be referred for cardiac evaluation?
Systolic or diastolic, grade 3/6 or louder
45
What kind of continuous/machinery murmur should be referred for cardiac evaluation?
Any unless the patient is <1-2 weeks old
46
What are other indications for referring a patient with a murmur for cardiac evaluation?
A murmur that has changed in character or grade, signs consistent with CHF, murmur identified on pre-purchase exam
47
If you want to refer a horse but there is no referral option, what course of action should you take?
Rule in/out systemic disease, submit cardiac troponin I test, recommend safety guidelines, discuss signs of CHF, recommend regular auscultation
48
Describe how you would perform a basic point of care echo in the field
Using the abdominal probe, place on the right side at the 4th intercostal space. Heart should fit on 30cm screen, L heart should be larger than R heart, L ventricle should contract down during systole, mitral and aortic valve leaflets should close fully, no pericardial fluid should be present
49
What things can be detected on a basic point of care echo?
Moderate-severe heart enlargement, decreased contractility, obvious valvular lesions or pericardial effusion
50
What are the guidelines for mild regurgitation? Moderate? Severe?
Mild- unlikely to cause disease, monitor, no restrictions. Moderate- repeat exam in 6 months to 1 year, make exercise recommendations based on heart structure. Severe- likely to progress, monitor closely and recommend no exercise.
51
What is the most common valve for regurgitation to occur at?
Mitral valve
52
What can severe mitral regurgitation lead to?
Left ventricular and atrial enlargement and eventually atrial fibrillation and CHF
53
How common is tricuspid regurgitation?
Mild- common, severe- rare, leads to a fib and CHF
54
What demographic is predisposed to aortic regurgitation?
Older horses
55
What is the most common cause of a diastolic murmur?
Aortic regurgitation
56
How can aortic regurgitation progress?
Can progress to left ventricular dilation, aortic root enlargement, and secondary mitral regurgitation. May develop ventricular arrhythmias- don't exercise
57
What does "waterhammer" pulse correlate with?
Large difference between systolic and diastolic pulses, left ventricular overload
58
When should PDA close?
Within 96 hours of birth
59
What kind of murmur will a PDA cause?
Continuous murmur loudest on left side, bounding pulses
60
What is the most common congenital heart defect of horses?
Ventricular septal defect
61
What are consequences of a VSD?
Left to right shunt (overloads the right heart)
62
Which has a better prognosis, a loud or soft VSD murmur?
Loud- means a smaller defect
63
Describe an aortic fistula
Aorto-cardiac: rare, older stallions with right sided continuous murmur, causes sudden death or CHF Aorto-pulmonary: Fresians with left sided systolic and diastolic murmur, often concurrent with aortic rupture. causes sudden death of CHF
64
Where does blood back up in right sided CHF?
Systemic circulation (jugular veins, portal veins)
65
Where does blood back up in left sided CHF?
Lungs
66
What are common signs of left sided CHF?
Pulmonary edema, increased RR and effort, crackles, frothy-pink nasal discharge, tachycardia, poor perfusion, weight loss, exercise intolerance
67
What are common signs of right sided CHF?
Jugular vein pulsation, portal hypertension, ventral edema, murmur, tachycardia, poor perfusion, exercise intolerance, weight loss
68
What is the prognosis for horses in fulminant CHF?
Poor to guarded unless the disease is reversible (pericarditis)
69
How is CHF treated?
Diuretics (furosemide or torsemide), ACE inhibitors (benazepril), digoxin (positive inotrope)
70
Describe bacterial endocarditis
Causes fever, depression, anorexia, and weight loss. Diagnose with U/S, CBC, and blood culture. Treat with aggressive antibiotic therapy and supportive care.
71
What is pericarditis most commonly associated with?
Respiratory disease (or mare reproductive loss syndrome)

Equine Final (5 decks)

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