How is a grade I murmur described?
Soft murmur heard in only 1 valve location, only in very quiet room, may only be intermittent
How is a grade II murmur described?
Soft murmur heard consistently, but only in 1 valve area
How is a grade III murmur described?
Moderate murmur heard in multiple valve locations on one side of the chest
How is a grade IV murmur described?
Loud murmur heard on both sides of the chest
How is a grade V murmur described?
Loud murmur heard at all valve locations associated with precordial thrill
How is a grade VI murmur described?
Loud murmur heard at all valve locations, even with stethoscope held 1 cm from chest wall
What are the locations for describing murmurs?
L apical, L basilar, R apical, parasternal
What are the timing categories for murmurs?
Systolic, diastolic, continous, to-and-fro
What are ways to describe the quality of a murmur?
Regurgitant (plateau), ejection (crescendo-decrescendo), machinery, decrescendo
What are "innocent" puppy/kitten murmurs?
physiologic murmurs without structural heart disease
Why are physiologic murmurs common in puppies and kittens?
They have larger SV than adults --> turbulence in Ao/PA
Thinner chest walls
Higher SNS tone
Anemia (lower blood viscosity)
What are characteristics of innocent murmurs?
Soft (grade I-III), L-sided, early or mid-systolic, disappear by 4-6 months
What are the most common congenital heart diseases in puppies?
PDA, PS, SAS
What is a PDA?
patent ductus arteriosus;
Failure of closure of ductus arteriosus (descending Ao --> MPA)
What are the consequences of a PDA?
L-R shunt --> LV volume overload --> L-CHF
What is the signalment for PDA?
Poodle, Sheltie, Pomeranian, Cocker, Maltese, Yorkie, GSD
Female > male
What kind of murmur is heard with PDA?
Continuous "washing machine" murmur at L heart base
What is the prognosis of PDA with and without treatment?
With = normal life
Without = POOR
What are the 2 types of treatment for PDA?
Interventional catheterization (ACDO)
Surgical ligation (thoracotomy)
What is PS?
Congenital narrowing/thickening of the pulmonic valve
What are the consequences of PS?
RV pressure overload --> R-CHF, syncope, arrhythmias
What is the signalment for PS?
Smaller breeds (3 Bs: Boxer, Beagle, Bulldog), Chihuahua, Schnauzer
Male = female
What murmur type is heard with PS?
Systolic ejection murmur at the L heart base
What is the prognosis of PS?
Depends on severity;
Mild = normal lifespan
Severe = guarded with no treatment, good with balloon valvuloplasty
What are the treatment options for PS?
Mild/moderate = atenolol
Severe = balloon valvuloplasty
When should you refer a systolic L-sided murmur to a cardiologist?
If it is LOUD (grade IV or higher);
If it is soft, recheck and refer if still present >6 months
What is SAS?
Congenital ridge/narrowing below aortic valve
What is unique about SAS?
The lesion continues to pregress throughout growth
What are the consequences of SAS?
LV pressure overload --> LVH --> syncope, arrhythmias, sudden death, L-CHF, endocarditis
What is the signalment for SAS?
Large breeds (Newife, Boxer, GSD, Gonden, Rottie)
Male = female