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Cardio > Equine murmurs > Flashcards

Equine murmurs Flashcards

1
Q

What does the P wave represent?

A

Atrial contraction

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2
Q

What does the QRS represent?

A

AV valves closing
Semilunar valves open
Ventricle contracts

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3
Q

What does the T wave represent?

A

Semilunar valves close
AV valves open
Ventricles relax and fill

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4
Q

What ECG waves are associated with which heart sounds?

A

QRS: during S1
P: right before S4
T: slightly before S2

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5
Q

What does S4 represent?

A

The atrial contraction

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6
Q

What does S1 represent?

A

AV valve closure
Start of systole

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7
Q

What does S2 represent?

A

Semilunar valve closure
Start of diastole

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8
Q

What does S3 represent?

A

End of rapid ventricular filling

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9
Q

What are the important characteristics to note about cardiac murmurs during auscultation?

A
  1. timing (systolic-diastolic)
  2. duration (early, mid, late, holo, pan)
  3. intensity (grade 1-6)
  4. Shape ( crenscendo, decrescendo, band, plateau, diamond)
  5. Character (soft blowing, harsh, squeaking, honking, etc)
  6. Point of maximum intensity PMI
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10
Q

What is the approximate location of the pulmonic valve in the horse?

A

ICS3 L side

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11
Q

What is the approximate location of the aortic valve in the horse?

A

ICS 3-4 L side

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12
Q

What is the approximate location of the mitral valve in the horse?

A

ICS 5 L side

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13
Q

What is the approximate location of the tricuspid valve in the horse?

A

ICS 3-4 R side
harder to hear

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14
Q

What is more likely cause of murmur in foals?

A

PDA

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15
Q

What is more likely cause of murmur in welsh section A?

A

VSD

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16
Q

What is more likely cause of murmur in arabians?

A

congenital dz

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17
Q

What is more likely cause of murmur in friesans?

A

AoPu fistula

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18
Q

What is more likely cause of murmur in athletes?

A

AV regurgitation

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19
Q

What Hx can give info about murmur?

A

performance
collapse
weakness
epistaxis

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20
Q

What signs in clinical exam can give info about murmur?

A

dyspnea
oedema
pyrexia
synovitis

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21
Q

What circulatory signs can give info about murmur?

A

mucous membranes: pallor, cyanosis
peripheral pulses: rate and rhythm, pressure (Ao regurg, Ao fistulae)

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22
Q

What heart rate and rhythm signs can give info about murmurs?

A

resting rate: cardiac function
rhythm: brady or tachy
resting/exercise rate

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23
Q

What lab results can give info on mumur?

A

increase liver enzymes
azotemia
infl. marker
electrolytes

cardiac troponin I
Atrial natriuretic peptide

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24
Q

What are the normal sounds in a horse heart beat?

A

S1 and S2 but normal can be with S3 or S4

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25
Q

What does the length of a murmur indicate?

A

long murmur = likely diastolic
short murmur = likely systolic

26
Q

Explain a late diastolic murmur?

A

hearing atrial contraction, pushing of blood into ventricle
physiological flow murmur
S4-S1

27
Q

Explain a systolic murmur?

A

hearing aortic ejecting of blood, fast rushing out
common in fit horses
physiological flow murmur
right after S1

28
Q

Explain a early diastolic murmur?

A

hearing ventricular filling
physiological flow murmur
S2-S3

29
Q

What are categories of pathological murmurs?

A

incompetent valves
abnormal communication
stenotic valves

30
Q

What are the types of systolic right heart murmurs in horses?

A

tricuspid regurgitation (incompetent valve)
ventricular septal defect (abnormal communication)

31
Q

What are types of systolic left heart murmurs in horses?

A

mitral regurgitation (incompetant valves)
aortic ejection (physiological flow)
aortic/pulmonic stenosis (stenosis)

32
Q

What are types of diastolic murmurs in horses?

A

aortic regurgitation (incompetent valve)
filling (physiological flow)
tricuspid or mitral stenosis (stenosis)

33
Q

How can we differentiate Lsided systolic murmurs? aortic ejection vs mitral regurgitation

A

aortic ejection
- at the aortic/pulmonic valve
- early/mid-systolic
- cresc.-decresc. or decresc.
- usually grade 1-3

mitral regurgitation
- at the mitral to aortic valve
- holo/pan, mid-late systolic
- plateau or mid-late cresc.
- grade 1-6

34
Q

How can we differentiate Rsided systolic murmurs? tricuspid regurg vs VSD

A

tricuspid regurgitation
- at tricuspid valve
- holo/pan systolic
- crescendo or band shaped
- grade 1-6, soft/blowy

VSD
- at ventral to tricuspid valve
- holo/pansystolic
- plateau/band shaped
- grade 4-6, harsh

35
Q

How can we differentiate diastolic murmurs? aortic regurgitation vs filling murmur

A

Aortic regurg
- at the aortic valve
- holo/pan diastolic
- decrescendo, musocal
- grade 1-6

filling
- at mitral/tricuspid valve
- early or late diastolic
- musical/squak/rub
- grade 1-3

36
Q

What are the clinical signs associated with murmurs in horses?

A

associated with effect of cardiac re-modelling or perfusion abnormalities in response to murmur and not murmur itself

poor performance
tachycardia
abnormal pulse quality, hyperkinetic
slow capillary refill time
arrhythmias
pulmonary oedema
ventral oedema

37
Q

How does echocardiography help with evaluation of murmurs?

A

confirm site of murmur!!
identify cause of murmur (lesion)
assess severity of lesion and effect on heart
determine prognosis (suitability for ridden exercise, impact on life expectancy)

38
Q

How does ECG help with evaluation of murmurs?

A

allows ID of concurrent arrhythmias especially during exercise
recommended in cases of aortic regurgitation

39
Q

What can we see with 2D and M-mode echocardiography?

A

assess valve structure and function
assess chamber size
assess myocardial thickness
assess myocardial function

40
Q

What can we see with doppler of echocardiography?

A

semi-quantative assessment of valvular regurgitations

41
Q

What are causes of murmurs not assoviated with valve pathology?

A

functional murmurs in horses
functional/physiological valve regurgitation in horses

42
Q

What are causes of murmurs associated with valve pathology?

A

valve degeneration (endocardiosis)
valve prolapse
rupture chordae tendineae
valve regurgitation secondary to ventricular dilation
bacterial endocarditis

43
Q

What are causes of murmurs congenital abnormalities?

A

ventricular septal defects
persistent ductus arteriosis
valvular dysplasia

44
Q

What is a haemic murmur?

A

without structural abnormality
hypovolaemia and/or systemic inflammation
anaemia
usually resolve once primary disease is treated

45
Q

What is an early diastolic/filling murmur?

A

without structural abnormality
less common
short duration, high pitched squeak/whoop
after S2 before S3
PMI at heart base or AV valves
normal especially in young, training thoroughbreds

46
Q

what is a functional/physiological valve regurgitation murmur?

A

mainly training thoroughbreds
quiet, under grade 3
not clinically significant
does not progress over time
mitral>tricuspid>aortic

47
Q

What is degenerative valvular disease?

A

most common form of valve pathology
in horses not associated with obvious valve pathology

48
Q

What is a valve prolapse murmur?

A

can affect any valve, causing audible murmur
mid-systolic crescendo decrescendo
may relate to the function of the valve
non-progressive regurgitation
diagnosed with echocardiography

49
Q

What is a ruptures chordae tendinae murmur?

A

can arise spontaneously or secondary to inflammatory or degenerative changes in chordae
more common for mital valve
severe regurgitation with a rapid change in haemodynamic status
sudden death or signs of acute cardiac failure

50
Q

What is a change in ventrical size murmur?

A

atrio-ventricular valvular regurgitation developed secondary to
- severe ventricular dilation
- cardiomyopathy and myocardial dz
- aortic regurg. and LV volume overload
mitral and/or tricuspid regurg. appear later in dz

51
Q

What is bacterial endocarditis murmur?

A

secondary to bacteraemia
healing/scarring of valve can worsen regurgitation
large proliferative “vegetative” lesions may develop without prompt treatment

52
Q

What are examples of congenital abnormal communications causing murmurs?

A

ventricular septal defects
atrial septal defects
atrioventricular canal defect
patent ductus arteriosus
tetralogy of fallot

53
Q

What are the characteristics of tetralogy of fallot?

A

Pulmonary stenosis, RV outflow obstruction
RV hypertrophy
VSD
Over-riding aorta

54
Q

What is the difference between R and L side VSD murmurs?

A

Rside: shunt L to R ventricle, harsh sound
Lside: RV overload, functional or relative pulmonic stenosis

55
Q

What does the VSD murmur sound level indicate?

A

inversely proportional to size of defect
louder murmur = smaller hole = less blood

56
Q

What are the characteristic of a R VSD murmur?

A

holo/pansystolic
coarse
plateau
grade 3-6
PMI tricuspid valve

57
Q

What are the characteristics of a L VSD murmur?

A

holo/pansystolic
cresc.-decresc.
grade 3-6
PMI pulmonic valve

58
Q

What is a patent ductus arteriosus?

A

communication between aorta and pulmonary artery in animals pre-birth
normally closes within 3 days of birth

59
Q

What is a PDA murmur?

A

blood flows along the PDA in systole and diastole producing a continuous “washing machine” murmur
grade 3-5, wide radiation
PMI left heart base, radiates to RHS

60
Q

What are examples of acquired abnormal communications causing murmurs?

A

aortic root rupture/ aortic-cardiac fistula
aorto-pulmonary fistula
pulmonary artery rupture

61
Q

Are murmurs in horses always clinically significant?

A

no (functional murmur, functional valve regurg)
resting tachy always warrants further investigation

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