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Equine murmurs Flashcards

(61 cards)

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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
What does the length of a murmur indicate?
long murmur = likely diastolic short murmur = likely systolic
26
Explain a late diastolic murmur?
hearing atrial contraction, pushing of blood into ventricle physiological flow murmur S4-S1
27
Explain a systolic murmur?
hearing aortic ejecting of blood, fast rushing out common in fit horses physiological flow murmur right after S1
28
Explain a early diastolic murmur?
hearing ventricular filling physiological flow murmur S2-S3
29
What are categories of pathological murmurs?
incompetent valves abnormal communication stenotic valves
30
What are the types of systolic right heart murmurs in horses?
tricuspid regurgitation (incompetent valve) ventricular septal defect (abnormal communication)
31
What are types of systolic left heart murmurs in horses?
mitral regurgitation (incompetant valves) aortic ejection (physiological flow) aortic/pulmonic stenosis (stenosis)
32
What are types of diastolic murmurs in horses?
aortic regurgitation (incompetent valve) filling (physiological flow) tricuspid or mitral stenosis (stenosis)
33
How can we differentiate Lsided systolic murmurs? aortic ejection vs mitral regurgitation
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
How can we differentiate Rsided systolic murmurs? tricuspid regurg vs VSD
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
How can we differentiate diastolic murmurs? aortic regurgitation vs filling murmur
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
What are the clinical signs associated with murmurs in horses?
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
How does echocardiography help with evaluation of murmurs?
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
How does ECG help with evaluation of murmurs?
allows ID of concurrent arrhythmias especially during exercise recommended in cases of aortic regurgitation
39
What can we see with 2D and M-mode echocardiography?
assess valve structure and function assess chamber size assess myocardial thickness assess myocardial function
40
What can we see with doppler of echocardiography?
semi-quantative assessment of valvular regurgitations
41
What are causes of murmurs not assoviated with valve pathology?
functional murmurs in horses functional/physiological valve regurgitation in horses
42
What are causes of murmurs associated with valve pathology?
valve degeneration (endocardiosis) valve prolapse rupture chordae tendineae valve regurgitation secondary to ventricular dilation bacterial endocarditis
43
What are causes of murmurs congenital abnormalities?
ventricular septal defects persistent ductus arteriosis valvular dysplasia
44
What is a haemic murmur?
without structural abnormality hypovolaemia and/or systemic inflammation anaemia usually resolve once primary disease is treated
45
What is an early diastolic/filling murmur?
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
what is a functional/physiological valve regurgitation murmur?
mainly training thoroughbreds quiet, under grade 3 not clinically significant does not progress over time mitral>tricuspid>aortic
47
What is degenerative valvular disease?
most common form of valve pathology in horses not associated with obvious valve pathology
48
What is a valve prolapse murmur?
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
What is a ruptures chordae tendinae murmur?
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
What is a change in ventrical size murmur?
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
What is bacterial endocarditis murmur?
secondary to bacteraemia healing/scarring of valve can worsen regurgitation large proliferative "vegetative" lesions may develop without prompt treatment
52
What are examples of congenital abnormal communications causing murmurs?
ventricular septal defects atrial septal defects atrioventricular canal defect patent ductus arteriosus tetralogy of fallot
53
What are the characteristics of tetralogy of fallot?
Pulmonary stenosis, RV outflow obstruction RV hypertrophy VSD Over-riding aorta
54
What is the difference between R and L side VSD murmurs?
Rside: shunt L to R ventricle, harsh sound Lside: RV overload, functional or relative pulmonic stenosis
55
What does the VSD murmur sound level indicate?
inversely proportional to size of defect louder murmur = smaller hole = less blood
56
What are the characteristic of a R VSD murmur?
holo/pansystolic coarse plateau grade 3-6 PMI tricuspid valve
57
What are the characteristics of a L VSD murmur?
holo/pansystolic cresc.-decresc. grade 3-6 PMI pulmonic valve
58
What is a patent ductus arteriosus?
communication between aorta and pulmonary artery in animals pre-birth normally closes within 3 days of birth
59
What is a PDA murmur?
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
What are examples of acquired abnormal communications causing murmurs?
aortic root rupture/ aortic-cardiac fistula aorto-pulmonary fistula pulmonary artery rupture
61
Are murmurs in horses always clinically significant?
no (functional murmur, functional valve regurg) resting tachy always warrants further investigation

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