Cardiology

Question 1

Symptoms of cardiac murmur

Answer 1

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

Question 2

Jugular distention + heart murmur indicates..

Answer 2

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

Question 3

Peripheral oedema + heart murmur indicates..

Answer 3

Right sided heart failure
Hypoproteinaemia
Vascular diseases

Question 4

Jugular pulsation + heart murmur

Answer 4

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

Question 5

Left sided heart failure

Answer 5

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

Question 6

Right sided heart failure

Answer 6

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

Question 7

Where to listen to heart

Answer 7

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

Question 8

What is s4 shh sound

Answer 8

Onset of atrial systole - audible in 60% TB

Question 9

What is S1 lub sound

Answer 9

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

Question 10

What is S2 dub sound

Answer 10

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

Question 11

What is S3 de sound

Answer 11

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

Question 12

What makes the heart sounds

Answer 12

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

Murmurs - forward or reverse flow

Question 13

2nd degree AV block

Answer 13

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

Question 14

Assessment of cardiac murmurs

Answer 14

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

Question 15

LICS 5 murmur indicates …

Answer 15

Mitral valve (Left AV valve) regurgitation

Question 16

LICS 4 murmur indicates…

Answer 16

Aortic (left semi lunar) valve regurgitation

Question 17

RICS5 murmur indicates…

Answer 17

Tricuspid regurgitation

Question 18

Which horses with a cardiac murmur need further investigation?

Answer 18

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

Question 19

Grade murmurs

1, 2, 3, 4, 5, 6

Answer 19

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

Question 20

Holo systolic murmur (or diastolic)

Timings

Answer 20

Between cardiac sounds
Lub-shhh-dub

Question 21

Pan systolic murmur
Timings

Answer 21

Across heart sounds

Lshhhh Lshhhh

Question 22

Mid systolic murmur timings

Answer 22

Lub shh dub

Question 23

How to assess cardiac function

Answer 23

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

Question 24

What causes murmurs in the heart

Answer 24

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

Question 25

Endocardiosis

Answer 25

Valvular degeneration - progressive - mitral, aortic, tricuspid

Question 26

Endocarditis - what causes it Clinical signs Treatment

Answer 26

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

Question 27

Pericarditis Clinical signs Diagnosis Treatment Prognosis

Answer 27

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

Question 28

Jugular thrombosis Septic and non septic Aitiology Clinical signs Diagnosis Treatment

Answer 28

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

Question 29

Aortoiliac thrombosis

Answer 29

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

Question 30

Vascular aneurisms and rupture Aitiology Diagnosis Management Prognosis

Answer 30

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

Question 31

Aorto-cardiac fistula

Answer 31

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