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Equine Med- Cardio 1

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kelseyfmeyer's version from 2016-10-03 18:54

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Question Answer
is 1* or 2* cardiac dz in the equine pt rare?Primary cardiac disease is rare
what is the most common presenting complaint for equine cardiac dz?Exercise intolerance
What are some non-specific and some specific CSs of cardiac dz in equine pts?Non-specific: lethargy, anorexia, weight loss, exercise intolerance. Specific: Ventral edema, distension of jugular vein, jugular pulse, cyanotic membranes, inspiratory crackles
4 mechanisms which cause ventral edema?dec oncotic pressure, inc hydrostatic pressure, inc vascular permeability, lymphatic issue.
how can you figure out if the ventral edema is high BP (inc hydrostatic pressure) vs dec oncotic pressure vs vasculitis?If it is due to high BP, when you ascult the heart you should hear a murmur bc high pressure--> inc turbulence. If you suspect dec oncotic pressure as the cause, check the TP! if both are normal, then prolly vasculitis
how might you be able to tell jugular distension from like, a thrombus, apart from jugular distension due to heart dz?If heart problem, OTHER vessels will be distended too (see pic). If thombus, can also palpate it and feel it (firm, warm, painful).
When is jug pulse normal vs abnormal?If the horse has their whole head down, then a jug pulse for the full length is normal. If the horse has its head up and the jug pulse is in the BOTTOM 1/3, this can be normal. But if the horse is standing with its head up and the whole length of the jug is pulsing, THIS IS ABNORMAL.
what abnormal lung sound might hint towards heart problems?Inspiratory crackles (bc pulm edema)
which heart sound= beginning of systole? End?Beginning= S1 (lub, AV valves). End= S2 (dub, SL valves)
what are the 4 heart sounds, and what is happening to make these sounds? *how many of them can you hear in the horse?In the horse you can hear 3 or even all 4 heart sounds (S3 least common). S1, S2, and S4. THE SOUNDS: (1) S1: This "LUB" which happens because of AV valve closure. it indicates the start of systole. It is the longer and louder sound. (2) S2: This is "DUB". This is the semilunar valves closing, indicates end of systole. (3) S3: sound of rapid filling in early diastole, best heard over MV area (apex) just after S2. Present in 50% of normal horses! (4) S4: Vibration of ventricular wall following atrial contraction. Over heart base, just preceding S1. Present in most normal horses
what is causing the sound of S3 again? where can you hear it best?rapid filling in early diastole. best heard over apex (MV area). Sound present in 50% of horses.
what is causing the sound of S4? where is it best heard? Vibration of ventricular wall following atrial contraction. Over heart base, just preceding S1. Present in most normal horses.
So we know that 2* AV block can be normal in horses...so you're asculting and you hear the dropped beat, but then in the middle of the dropped beat, woah, you hear a fluttery sound!! what is this?lol it's just S4 (thats the ventricle walls vibrating as the atria contract and push blood into them-- and then you arent hearing dub bc the ventricles didn't contract)
what might look weird on a ECG but be normal for horses? (not 2* block)a biphasic P wave
how do the heart sounds compare to the ecg?(the QRS is just inverted here, don't get confused) (basically lub of the AVs closing is by the QRS and the dub of the SLs closing is near the T, S3 (filling) is happening between T and P, and S4 (ventricular vibration bc blood being pushed into it) is happening during P.
where do you ascult to hear the diff valves of the heart?PAM-345 and T on the R. If you wanna hear P really well you should have a friend pull the horses leg forward bc its way up there under the tricep
when you take a pulse, what are you actually looking at or measuring?perfusion
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Question Answer
when do you feel the peripheral pulse, relative to heart sounds and systole/diastole?the pulse occurs between S1 (AVs close) and S2 (SLs close) during systole.
where are the locations you hook up the ECG for a horse?Basically WHITE ON RIGHT shoulder, RED ON NECK on the R, and then on the L put the black on the elbow
what are the things you CAN assess with an ECG in the horse, what can't you?can only asses rate and rhythm. cannot assess chamber size, etc
the horse has a deeply penetrating purkinje system which gives a rapid and explosive depol. in terms of depth/layers of heart, what direction does it go?endocardium-->epicardium
what monitor can you use to monitor a heart's ECG for an extended period of time?holter monitor ( not common tho)
what 3 things does an echocardiogram assess?movement of heart, fxn, structural abnormalities.
what should you know about taking BP in a horse?this is really hard to do in an adult. In a bb you can use cuff on their tail. but for and adult if you wanna use a tail cuff, you will need to correct for height and take several measurements. You can also try distal limb if they're recumbent. Basically the most accurate is jug cath to get CVP (central venous pressure) from the right heart.
what did she mention about the cause of tachyarrythmia in horses?Basically never a 1* prob- so if you see this, do your panels and look for underlying cause
what are the 3 cardiac specific chem things you can look for?cTnI (cardiac troponin I), Cardiac specific CK= MB(myocardial bound) & LDH1
what is an arrhythmia? Disturbance in conductivity. Can be physio or path!
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arrythmias

Question Answer
**2* AV block: is this common? what CSs will you see?Common, no symptoms
**2*AV block: what will you see on ECG/ what will you hear on auscultation? what will HR be like?you will see a dropped beat, which is a P wave followed by no QRS. You will hear S4 (the flutter of the ventricular wall as the atria pump it full of blood). normal HR.
**if you see a 2* AV block, is it pathologic? What should you do if you see one?NOT pathological. Exercise the horse-- after a little physical activity, listen again, it should be gone now (dropped beat due to high vagal tone bc super athletic)
Sinus block: Is this common? what CSs will you see? what will you hear on ascult/ what will you see on ECG?there will be long pauses of no activity. And you WON'T hear S4 (in 2*AV you will bc atria still contract. In this the atria don't contract bc the SA node is slacking, so you wont hear S4 either)
what is HR like with sinus block? is it pathologic? what do you do?HR normal. NOT PATH (like 2*AV) you should exercise the horse, and see if it goes away (like 2*AV)
3* heart block: is this common? what are the symptoms you will see? what will you see on the ECG/ what will you hear?not common, you can see exercise intolerance and syncope. On the ECG the p and qrs will not be associated with each other. but the hear will seem to have a regular rhythem upon ascultation **but HR will be low
3* heart block: what will HR be like? is it pathologic? what should you do?HR LOW. IS PATHOLOGIC (they are exercise intolerant and fainting. blurp.) YOU SHOULD REFER.
**Atril fib: is this common? what are the symptoms of Afib? What will it look like on ECG?YES it is common, and the CSs can be variable: anywhere from none to to congestive heart failure. ON ECG: the pattern will be irregular, and you will see a baseline flutter but no p waves.
**what will HR be like with Afib? is this arrhythmia pathologic? what should you do?HR can be normal to high. it IS pathologic--> so find cause/ refer for conversion
APC (atrial premature complexes) are these common? are there CSs associated with them? what will it look like on ECG? what will it sound like?This is common post-exercise, and the CSs can be none or +/- exercise intolerance. on ECG you will see P's without a QRS and the beats will sound sooner.
APC (atrial premature complexes) what will HR be like? is it pathologic? what should you do?HR depends- can be normal or high. its NOT pathological-- UNLESS there are >3/hr. you can either do nothing or find cause or refer.
VPC (ventricular premature complexes) are these common? are there CSs associated with them? what will it look like on ECG? what will it sound like?This is common post-exercise, and the CSs can be none or +/- exercise intolerance. You will hear beats sooner than expected on auscultation. On the ECG you will see a long pause after a QRS with no P (compensatory pause)
VPC (ventricular premature complexes) what will HR be like? is it pathologic? what should you do?HR depends- can be normal or high. its NOT pathological-- UNLESS there are >3/hr (then consider looking for a Vtac). you can either do nothing or find cause or refer.
Ventricular tachycardia: is this common? what are the symptoms? what is the pattern you will see?not common, the symptoms are variable: they can be none to congestive heart failure. This can be considered if there is >4 VPCs (per hour i think), can be uniform or multiform (uniform is rapid and regular, multiform is rapid and irregular).
Ventricular tachycardia: what will HR be like? is it pathologic? what should you do?high HR- IS PATHO. you should find cause/ tx if HR>120bpm, / refer
what's this? This is ****V-tach! Recognize it bc they can drop dead from it ((in this pic its stretched out so you can see it better- rhythem strip. There is no P! or the P is squished somewhere. and the QRSs look like weird
what's this? This is a VPC. look how soon it came after the the T, and you don't see a P either
what's this? 2*AV block! DEF KNOW WHAT THIS LOOKS LIKE IT IS SUPER COMMON. Basically just a dropped QRS somewhere.
what's this? This is an APC. The beat is sooner than it should be (p w/o QRS)
what's this? this is afib (look at all those fluttery p's all over the place)
what's this? 3*AV block. Uhhh where are the QRS's? just a bunch of biphasic Ps. Bc not getting through.
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Murmurs

Question Answer
murmurs are described by what 4 things?PMI (point of maximal intensity), timing, grade, quality.
(said in class) what are the main reasons horses get murmurs?either have holes where you shouldnt have them or valves are crapping out.. dont really get stenosis and all that stuff
explain how timing of the valve murmur can tell you about what the problem isWhen you are doing your PE and you are looking for PMI, timing, grade, and quality. With the PMI, timing, and grade you can narrow your ddx list down a lot-- like if you thought it was tricuspid insuff, but then the murmur is in diastole, you know that can't be the case.
What murmur (1) or problem (1) do you think it is if you hear a Left sided murmur near the heart base during DIASTOLE which is a grade III or more in an older horse?aortic insufficiency or endocarditis (if grade I or II prolly just phys flow- if at the apex near the mitral valve on the L during diastole, it's prolly phys flow too)
what murmur (1) or problem (1) do you think it is if you hear a LEFT sided murmur near the apex during SYSTOLE?MI (mitral insufficiency) or endocarditis. (if near heart base/semilunars, prolly phys flow)
what prob is it if you hear a RIGHT sided SYSTOLIC murmur in a foal?VSD!! (if it's an adult, could be TI or VSD) (if diastolic on R side, prolly phys flow)
what are the 3 main (starred) causes of murmurs horses get?Aortic INSUFFICIENCY, Mitral INSUFFICIENCY, VSD (esp in foal)
how old is the foal if you wanna say it's prolly a foal murmur? how common are foal murmurs?<1mo. Foal murmurs are super common
if you hear a Systolic left sided murmur in a healthy foal-- what do you think this is? what should you do?This is just PHYSIOLOGICAL FLOW and is very common esp when theyre excited. ignore it.
If you hear a Continuous grade III or louder left sided murmur in a foal, what do you think it is, and what should you do?This is likely a PDA. It is normal for them to have this up to a week of age (7d) so if it's <7d old, recheck after its a week old and see if it's gone away. If after 7d old it is still there, refer
at what point should you start to worry about a PDA in a foal?<7d old foal and a PDA can be normal. >7d old and you should refer
If you see a foal with a Pansystolic, grade IV or higher, thrill, murmur, what do you think it is? what should you do?Tetralogy of fallot. They will be cyantoic, weak, and not growing. you should euthanize.
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