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Acquired Cardiac Diseases

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sihirlifil's version from 2017-10-11 20:06

Pericardium, Mitral/Tricuspid Valves, Heart Base Tumors

Question Answer
(Causes of right heart failure include)Pulmonary hypertension
Cardiomyopathy
Tricuspid/pulmonary valve disease
(Causes of left heart failure include)Myocardial contractility loss (myocarditis, myocardial necrosis, cardiomyopathy)
Aortic/mitral valve dysfunction
Congenital
Radiographic signs of mitral valve diseaseApex shifted to right
Wide cardiac silhouette
+/- plerual fissure visible
Radiographic signs of right sided enlargementRt sided cariomegaly: increased sternal contact, inverted D shape on DV
CVC wider than aorta on lateral view (RHF: backup of blood into CVC)
Pleural effusion
Check abdomen for liver enlargement & ascites
___-side heart failure
Right (abdominal effusion, RHF from cardiac tamponade) (pericardial effusion)
Radiographic signs of left side enlargementLA & V enlargement
Elevation of terminal trachea
Elecation of left mainstem bronchus on lateral (=splitting of bronchi) (left sits on top of LA)
Divergence of mainstem bronchii on DV view
Severe: cardiac apex may shift to right
___-side heart failure
Left
Elevated left stem bronchus from LA enlargement
Perihilar soft tissue opacity = early pulmonary edema
What's going on here?
Normal mainstem bronchi angle is <60 defrees, but when LA enlarges it increases (LA creeps between the 2 branches)
Main Ddx when you see increase in mainstem bronchi angleLymphadenopathy
LHF: Mild pulmonary edema looks like?Poorly defined increase in opacity (interstitial edema)
LHF: moderate pulmonary edema looks like?More radio-opaque lung fields
LHF: severe pulmonary edema looks like?Alveolar pattern, air bronchograms
LHF: how do the lung fields look on DV?Only see changes when severe. Changes visible at periphery
2 things that can cause microcardiaAddision's, shock
Microcardia in cat (only 2 ICS wide)
Radiographic signs of pericardial effusionSmooth, round, well-defined cardiac silhouette
Tracheal elevation
Pulmonary venous congestion
Enlarged CVC
Hepatomegaly & ascites
Pericardial effusion
US of pericardial disease: what does the fluid do? Looks like?Fluid surrounds heart & separates it from pericardium
May be anechoic or hypoechoic, floccular material within it
Heart oscillates within fluid
RA compromise/'flail' (cardiac tamponade)
Pleural fluid may surround pericardial sac (esp cats)
What is 'p'?
Pericardial effusion
(RV flail, can't fill)
What's going on? Atria?
Pericardial effusion w/ atrial enlargement due to heart failure
Pericardial effusion can also cause...
Pleural fluid (Lung = leaf-shaped, compressed by pleural fluid)
Heart base tumor: radiographic signsElevation of terminal trachea (right angle) a/o esophagus
Trachea may be displaced to right on DV
Cardiomegaly caused by pericardial effusion
Heart base tumor
Heart base tumor: ddx?Hilar lymphadenopathy
Heart base tumor: US looks likePericardial fluid
May ID mass at base of heart around aortic root
Mitral valve disease = most common acq dz in?Small breed dogs (Cavalier King Charles)
Mitral valve radio: LA looks?Enlarged
DV: LA margin visible beyond cardiac outline
Mitral valve radio: left mainstem bronchus looks like?Elevated, +/- compressed
DV: splitting of mainstem bronchi
Mitral valve radio: caudal heart looks like?Upright LV border, loss of caudal cardiac waist
Mitral valve radio: CVC looks like?Runs caudodorsally (has to climb over LA to drop into R side)
Mitral valve radio: Pumonary veins look like?Enlarged
Mitral valve radio: cardiac apex?Shifted to the right
Arrows pointing to?
Thickened, club-shaped mitral valve tips
Mitral valve US: LA looks?Enlarged (same as radio)
Mitral valve US: LA:AO ratio?Increases!
>1.5 in dog, >1.6 in cat on 2-D short axis view
Mitral valve US: Inter-atrial septum looks?Displaced towards right side
Mitral valve US: LV lumen?Enlarged
Mitral valve US: Papillary muscles?May be prominent, chordae tendinae may be malformed (muscle tries to contract more forcefully, increased effort)
Mitral valve US: Valve leaflets look?Thickened extensions, clubbing, may prolapse into LA with doming of MV leaflets into LA lumen (need doppler to prove)
Whats wrong with the IAS? Anything else?
IAS displaced to the right due to increased left side pressures
Mitral valve tip prolapsed into left atrium... which is also HUGE.
Mitral valve US: EPSS (E point to septal separation)? Fractional shortening?Increased EPSS
Fractional shortening may increase initially and decrease as heart failure progresses
Mitral valve CFD: what's happening with the blue jet?
Flows back into LA during systole (blue = away from transducer, which is on R side)
Tricuspid insufficiency radio: RV looks?Enlarged
Tricuspid insufficiency radio: apex looks?Increased sternal contact, shift to the left
Tricuspid insufficiency radio: RA looks?Enlarged, loss of cranial cardiac waist
Tricuspid insufficiency radio: trachea looks?Elevated cranial to carina (left = normal)
Tricuspid insufficiency: signs of RHF?Ascites, pleural effusion
Tricuspid insufficiency US: Inter-atrial septumMay be displaced to left (increased volume in RA)
Tricuspid insufficiency US: RV?Lumen is enlarged (not banana anymore)
Tricuspid insufficiency US: papillary muscles?Enlarged, chordae tendinae may be malformed
Tricuspid insufficiency US: Valve leaflets?Thickened extensions, clubbing, may prolapse into RA with doming of RV leaflets into RA lumen
CFD of tricuspid insufficiency (red turbulent jet extending back into RA during systole, TV are closed)
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DCM, HCM

Question Answer
Dilated cardiomyopathy (DCM): common in?Most common cardiac condition of large breed dogs
DCM radio: what gets enlarged?Cardiomegaly
LA (& elevation of left mainstem bronchus, splitting on DV view)
LV (blood left behind)
Pulmonary veins
DCM radio: cardiac waist?Loss of caudal (left side)
DCM radio: what happens with the lungs?Pulmonary edema, starting in hilar region, spreads peripherally & symmetrically
Mainstem broncii split on DV view
DCM radio: signs of ___ side heart failureLeft
DCM radio: trachea?Elevated
DCM US: LV looks?Lumen is enlarged, free wall is thinner than normal
DCM US: LA looks? how does it relate to the aorta?Variably enlarged
Increased LA:Ao valve ratio because of enlarged LA
DCM US: IVS looks?Thinner than normal (like LV wall), displaced to the right
DCM US: what happens to the fractional shortening?Normal initially, then becomes reduced when heart really starts to fail (contractility of LV goes down)
What is this M-mode showing?
Reduced posterior wall movement compared to IVS (fractional shortening =15%, norm = 23-45%)
This dog is basically only alive because...
The IVS is contracting (LV wall basically flatlined)
DCM US: what happens with EPSS?Gradually increases as LV lumen increases in size (increased distance between valve leaflets)
DCM US: Doppler indicates ___ pulmonic & aortic velocitiesReduced
DCM US: What's the blood flow like?MV regurgitation with turbulent blood flowing back into the LA during systole
DCM US: Inter-atrial septum?Displaced to the right (enlarged LA bulges)
DCM M-mode trace: what can happen with the IVS & posterior wall contractions?Can be asynchronous hypercontractility
What's going on here?
Dilated cardiomyopathy: IVS is contracting but PVW (LV free wall) is not
Hypertrophic cariomyopathy (HCM): common in dogs?RARE
HCM US: LV looks?Lumen reduced in size because of marked thickening of the IVS & LV free wall
HCM US: LA looks?Usually enlarged (blood cant get into lumen, too small)
HCM US: anything special in the lumen?May be echogenoic masses (blood clots)
What are these images?
Diastolic & systolic frames of HCM. LV lumen is tiny, LV walls thickened
HCM US: fractional shortening?May be normal or increased
Most common form of feline cardiomyopathy? (associated with?)Hypertrophic (hyperthyroidism)
When do you usually see changes in feline cardiomyopathy?Late stages
Feline cardiomyopathy radio: How does the heart look?Enlarged atria, valentine heart shape
Cardiomegaly, cardiac silhouette lies more obliquely on sternum
Feline caridomyopathy with valentine shape, enlarged atria
Feline cardiomyopathy radio: trachea?Elevated
Feline cardiomyopathy radio: lungs look?Pulmonary infilatration, asymmetric edema
Pleural fluid
Feline cardiomyopathy radio: what happens to the CVC?Directs craniodorsally instead of horizontally
What's the circle? waht else going on?
Late stage feline cardiomyopathy: circle = all LA!
Gross cardiomegaly, tracheal elevation, CVC directed craniodorsally instead of horizontally
Feline cardiomyopathy US: IVS?Thickens, may obstruc aortic outflow tract during systole (dynamic outflow obstruction which causes large murmur)
What is happening with the IVS?
Protruding into aortic outflow tract (dynamic outflow obstruction
Feline cardiomyopathy US: Posterior Ventricular wall?Thickened (>7mm)
Feline cardiomyopathy US: what happens with the anterior/septal leaflets?May prolapse into aortic outflow tract
Feline cardiomyopathy US: fractional shortening?Markedly increased to 50-60% (normal 26-45%) (heart working really hard to move blood out)
Feline cardiomyopathy: whats the thing that can make a cat unable to walk?Saddle thrombi formation may occur within LA or distributed along the aorta
Feline cardiomyopathy: How does a thrombus look on US?Hypoechoic round mass
Arrow pointing at?
Thrombus (Feline HCM)
Dilated cardiomyopathy: common in cats?Not so much anymore, since proprietary diets are now supplemented with taurine
Feline DCM: radiographic signs?Cardiac silhouette rounded & enlarged (LA & LV lumen distension) (like HCM)
Right sided enlargement
Valentine shape more dramatic
Pulmonary edema (asymmetric) in heart failure
Feline DCM: how do the chambers look on US? walls?LV lumen enlargement
Atrial enlargement
Thin ventricular walls
Mitral inusfficiency
Feline DCM: fractional shortening?Decreased (same as dog)
Feline DCM: thrombi?May occur within LA or distributed along aorta (same as HCM), saddle thrombi in aorta may occur
Endocarditis happens in who? Looks like?Common in cattle (especially right side)
Aortic valve thickening
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