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Equine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Symptoms of cardiac murmur

A

Physiological murmur or congenital abnormality

Poor performance - rare - considerable cardiac reserve so unless at maximal performance dont need all

Collapse/sudden death - rare - concurrent (secondary ventricular dysrrhythmias)

Congestive heart failure - rare

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2
Q

Jugular distention + heart murmur indicates..

A

Reduced cardiac return
- Right sided cardiac failure - reduced RHS cardiac output into lungs - backs up
- Thoracic disease - mediastinal mass, pressure on vessels - drainage
- Pericardial disease - pressure of fluid in pericardium - reduced fill so RHS reduced pressure so squeezed so right sided failure

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3
Q

Peripheral oedema + heart murmur indicates..

A

Right sided heart failure
Hypoproteinaemia
Vascular diseases

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4
Q

Jugular pulsation + heart murmur

A

Normally visible in distal 1/3 neck, dependant on head and neck position
Shouldnt see this further up neck
Dysrrhythmias

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5
Q

Left sided heart failure

A

Pulmonary oedema
- Ruptured chordae tendonae
- Bacterial endocarditis
- Congenital cardiac disease

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6
Q

Right sided heart failure

A

Peripheral oedema
- Chronic endocardial disease
Can see liver engorgement, fluid within abdominal, pleural cavity, peripheral interstitial tissue

Left sided quickly progresses to right sided - so miss the pulmonary oedema phase

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7
Q

Where to listen to heart

A

Start on left
Listen just behind triceps
- Halfway between shoulder and elbow - ICS 5 mitral valve
- Under triceps - ICS 4 - aortic and pulmonic valve
Listen on right under triceps - move leg forward

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8
Q

What is s4 shh sound

A

Onset of atrial systole - audible in 60% TB

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9
Q

What is S1 lub sound

A

Onset of ventricular systole
Closure of AV valves, opening of semilunar valve
Loudest over LICS5
- Hypertension, adrenaline, MVD

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10
Q

What is S2 dub sound

A

Onset of diastole
Closure of semilunar valves, open AV
Loudest over LICS4
- Fever, adrenaline, anaemia

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11
Q

What is S3 de sound

A

Rapid ventricular filling
Loudest over cardiac apex - Low LICS5
40% TB

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12
Q

What makes the heart sounds

A

Causes by turbulence
Closure of cardiac valves
High velocity flow - young excitable or fit
Rapid outflow through aorta - normal

Murmurs - forward or reverse flow

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13
Q

2nd degree AV block

A

2nd degree AV block – associated with high vagal tone to control HR, should go away with exercise
- Significance? Only when in advanced 2nd degree AV block – blocking multiple in a row so not contracting for long periods or not going away with exercise so cannot meet requirements – collapse

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14
Q

Assessment of cardiac murmurs

A

Timing - systole or diastole and PMI - point maximal intensity
Determine valve affected
Determine a tentative diagnosis

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15
Q

LICS 5 murmur indicates …

A

Mitral valve (Left AV valve) regurgitation

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16
Q

LICS 4 murmur indicates…

A

Aortic (left semi lunar) valve regurgitation

17
Q

RICS5 murmur indicates…

A

Tricuspid regurgitation

18
Q

Which horses with a cardiac murmur need further investigation?

A

Poor performance and new murmur or new loud murmur

Use echocardiography to confirm, prognosis, and safety

Electrocardiography - concurrent dysrrhythmias and safety

Look for structural secondary changes

19
Q

Grade murmurs

1, 2, 3, 4, 5, 6

A

1 - Quiet murmur hard to identify
2 - Murmur quieter than heart sounds
3 - Murmur as loud as S1 and S2
4 - Murmur louder than S1 and S2
5 - Loud cardiac murmur with pericardial thrill
6 - Murmur audible with stethescope off thoracic wall

20
Q

Holo systolic murmur (or diastolic)

Timings

A

Between cardiac sounds
Lub-shhh-dub

21
Q

Pan systolic murmur
Timings

A

Across heart sounds

Lshhhh Lshhhh

22
Q

Mid systolic murmur timings

A

Lub shh dub

23
Q

How to assess cardiac function

A

ECG
Blood pressure
Cardiac output
- Ultrasound
- VO2 max
Maximum tissue uptake - high speed treadmill with expired gas analysis

24
Q

What causes murmurs in the heart

A

Normal blood flow - ejection type - normal - rapid outflow through major vessels
Valvular regurgitation - valvular disease - endocarditis, endocardiosis
Cardiac defects - ventricular septal defect

25
Q

Endocardiosis

A

Valvular degeneration - progressive - mitral, aortic, tricuspid

26
Q

Endocarditis - what causes it

Clinical signs

Treatment

A

Bacterial, secondary to bacteraemia
Cattle - liver abscesses, TRP, mastitis
Equine - dental, respiratory, thrombophlebitis

Other causes
- Valve dysplasia
- Valvulitis
- Valve prolapse
- Ruptured chordae tendonae

Clinical signs
- Acute onset cardiac failure
- Fever, cardiac murmur, tachycardia, tachypnoea
Hyperfibronogenaemia, anaemia, leukocytosis,
Blood culture - sterile procedure

US

Treatment
Broad spectrum antibiotics then based off C+S

Prognosis
- Guarded even after bacteriological cure - permanent damage
Septic emboli to distant sites - lungs if RHS, kidney, joints LHS - younger

27
Q

Pericarditis

Clinical signs

Diagnosis

Treatment

Prognosis

A

Aitiology
- Idiopathic, equine viral arteritis, equine influenza, strep pneumoniae, e.coli, actinobacillus

Clinical signs
- Echocardiogram - fluid and fibrin within pericardial sac - compression of cardiac chambers
- Electrocardiogram -small complexes, main differential for this is obesity
Cytology of pericardial fluid - pericardiocentesis

Treatment
- Pericardial drainage and lavage if right atrium is collapsing - cardiac tamponade
Indwelling drain and BID lavage with antibiotic fluid (gentamicin) improves prognosis
Systemic penicillin
Care with IVFT - dont overload heart

Prognosis - early and aggressive - good
Constrictive disease with chronic - fibrin and fibrous tissue with chronic disease and not enough treatment
Full performance possible

28
Q

Jugular thrombosis

Septic and non septic
Aitiology
Clinical signs
Diagnosis
Treatment

A

Non septic - thickening of vein and reduced patency
Septic - hot, painful, discharging tracts - chronic
Venous occlusion possible - swelling in supraorbital area, cheek, lips, tongue - dysphagia - URT obstruction - tracheostomy

IV catheters or injection
Predisposing
- SIRS, MODS, irritant drugs, poor placement, use, care of catheters

Use US to assess thrombus, identify cavitation (sepsis), patency, site for aspiration

Diagnosis
Culture - catheter tip that was in
- US guided, swab from discharging tract, blood

Treatment
- Broad spectrum - penicillin, gentamicin
- NSAIDs
- Systemic aspirin, heparin
Vasodilators - glyceryltrinitrate
Raise head

Embolic disease - lodge elsewhere - bacterial endocarditis, septic pneumonia
Recurrent laryngeal neuropathy
Upper airway oedema

29
Q

Aortoiliac thrombosis

A

Partial or complete occlusion of terminal aorta, and external and internal iliac arteries by thrombus - unknown cause

Poor performace, exercise associated hindlimb lameness - differential for exertional rhabdomyolitis
Breeding failure in stallions
After exercise - cold limbs with weak pulses

Diagnosis
- Palpation or US of thrombus on rectal

Treatment
- NSAIDs - flunixin
- Aspirin
- Fenbendazole

Prognosis - guarded

30
Q

Vascular aneurisms and rupture

Aitiology
Diagnosis
Management
Prognosis

A

Vascular rupture - sudden death
Vascular rupture and haemoperitoneum - differential with severe distress post exercise with colic pain

DDx - stress fractures, exertional rhabdomyolisis, arrhythmias

Pre-existing aneurism, medial degeneration, congenital, parasitic

Manage - conservative, support circulation, analgesic
Limit movement - dislodge clots
Tranexamic acid
Uterine bleeds - poor prognosis

31
Q

Aorto-cardiac fistula

A

Defect of aortic wall to right atrium, intact males
Rupture during exercise or breeding
Sudden death, distress, ventricular tachycardia, loud continuous murmur
Echo diagnosis
Hopeless prognosis

Equine (18 decks)

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