Congenital Heart Disease III- CardioRush

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Aortic stenosis
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Aortic stenosis
What disease causes narrowing of the aortic outflow tract?
Valvular, subvalvular, supravalvular
What are the 3 types of aortic stenosis?
Subvalvular
What are the most common types of aortic stenosis in dogs?
Narrow opening of aortic valve, LV creates more pressure to compensate, pressure overload causes concentric hypertrophy in LV, post stenotic dilation of aorta and possible jet lesion, often mild aortic regurg
What is the pathogenesis associated with aortic stenosis?
Dogs
In what animal is aortic stenosis most common?
Newfie, GSD, Boxers, Goldens, Bloodhounds, GSP
What breeds are predisposed to developing subaortic stenosis?
Boxers
What breed often has an aortic root that is smaller than predicted for their body weight?
Autosomal recessive
What pattern of inheritance is associated with subaortic stenosis in dogs?
Isolated aortic stenosis
What type of aortic stenosis is rare in cats?
Supravalvular AS
In cats with aortic stenosis, what type is more likely to occur?
False (has been identified in swine, but rare in other species besides dogs)True or false: aortic stenosis only occurs in small animalsUsually asymptomatic with cardiac murmur, possible syncope, bacterial endocarditis, LCHF, or sudden deathWhat is the typical presentation associated with subaortic stenosis?Subaortic stenosisWhat is the only congenital heart disease that is associated with an increased risk of bacterial endocarditis?Loud, harsh ejection quality systolic murmur, PMI at left heart base, loud at right base and carotids, prominent left apex beatWhat are the characteristics of the murmur associated with subaortic stenosis in dogs?Weak arterial pulsesWhat are the characteristics of the pulses in subaortic stenosis?May be normal, LVE pattern or left axis shift, ST segment depression, sometimes VPCsWhat ECG characteristics are typical of aortic stenosis?Subendocardial region or papillary musclesWhat areas of the heart are most likely to have compromised blood flow in aortic stenosis?VPCs, hard to generate enough pressure to keep aortic valve open, VPC isn't a full strokeWhat type of arrhythmias are more likely to cause sudden death in aortic stenosis and why?Most times normal, possible prominent aorta cranial to the heart as disease progresses, concentric hypertrophy of LV doesn't show wellWhat changes would we see on radiographs in subaortic stenosis?Aortic enlargementWhat change is seen on this radiograph?<40mmHgWhat pressure gradient seen on doppler is associated with mild subaortic stenosis?40-80mmHgWhat pressure gradient seen on doppler is associated with moderate subaortic stenosis?>80mmHgWhat pressure gradient seen on doppler is associated with severe subaortic stenosis?False (there isn't a good way to manage it, lots of different things are tried)True or false: there are many reliable ways to manage subaortic stenosisBalloon valvuloplasty, surgical removal of fibrous ring, atenolol (beta blockers)What are some possible ways to manage subaortic stenosis?TrueTrue or false: Atenolol (a beta blocker) is widely used to manage subaortic stenosis but there is no proof of efficacyCoronary arteries branch right after stenosis, in systole they collapse and always rely on diastole for filling, in SAS when HR gets too high, there isn't enough filling of arteries, hypoxia and ischemia results, causes sudden deathHow does aortic stenosis cause sudden death?Concentric hypertrophy of LV, aortic subvalvular ring hyperechoicWhat are the classic findings associated with subaortic stenosis on echo?Confirms anatomy, allows balloon valvuloplastyWhat is cardiac catheterization used for in subaortic stenosis?>12 monthsWhat age dogs do we screen for subaortic stenosis?TrueTrue or false: to screen for subaortic stenosis, animals over 1 year are ausculted. If there is no cardiac murmur, then there is no evidence of congenital heart disease. If there is a murmur, echo with doppler is recommended for followupVentricular septal defectWhat is the congenital disease in which there is communication between the right and left ventricle?High near aortic valveWhere is the VSD most commonly located in the septum?Left to rightWhich way does blood typically flow in a VSD?Opening between RV and LV, blood follows gradient from LV to RV, overcirculation to lungs, volume overload in LA and LVWhat is the pathogenesis of VSD?LA, LV, PA, sometimes RVWhat parts of the heart most commonly become enlarged in VSD?Location of defect in septumWhat does development of enlarged right heart depend on in VSD?Horses, ruminants, sometimes catsWhat animals most commonly have VSD?Bulldog, KeeshondWhat dog breeds are predisposed to VSD?VolumeWhat type of overload occurs in VSD: volume or pressure?CHFWhat is a possible sequelae to VSD?Pulmonary edemaHow does CHF manifest in dogs with VSD?Pulmonary edema, pleural effusionHow does CHF manifest in cats with VSD?TrueTrue or false: concurrent congenital defects in animals with VSD may alter the clinical findingsHarsh systolic, loudest at right sternal border, possible pulmonic stenosisWhat type of murmur is associated with VSD?Relative stenosis due to volume overload through pulmonic valveWhat causes pulmonic stenosis in VSD?Often normal, brisk with large defect, weak if CHFWhat are the characteristics of the arterial pulses in VSD?Often normal, possible LVE or LAE, arrhythmias, conduction disturbances depending on location of defectWhat are the ECG findings consistent with VSD?Size of defectWhat does the appearance of the heart on radiographs depend on in VSD?LH or generalized cardiomegaly, pulmonary overcirc, possible CHFWhat are some common radiographic findings of VSD?Pulmonary overcirculationWhat do these radiographs indicate?False (Small VSDs are usually of limited clinical importance)True or false: even small VSDs can cause serious clinical signs and require intervention as early as possibleCHFWhat is the result of a large VSD?>2.5Over what ratio of pulmonary to systemic flow can cause a problem from a large VSD?Pulmonary artery banding, surgical repair, monitoring and managementWhat are some possible therapies for VSD?Create higher RV pressure to prevent backflow across defectWhat is the purpose of pulmonary artery banding in VSD?Defect often too close to aortic valve, can catch it and cause it to remain openWhy can't an amplatz occluder be used in a VSD?Turbulent systolic jet across defect high in IVS from L to RWhat are the classic findings of VSD on color flow doppler?Generalized cardiomegaly with pulmonary overcircWhat are the classic findings of VSD on rads?Systolic murmur loudest at R cranial sternal borderWhat are the classic findings of VSD on PE?Confirm echo anatomy, allow calculation of shuntWhat is the purpose of cardiac catheterization in VSD?Ostium primum, ostium secundumWhat are the 2 types of atrial septal defects?Low in atrial septumWhere is an ostium primum ASD located?Middle to high in atrial septumWhere is an ostium secundum ASD located?Left to rightWhich way does blood flow across an ASD?Blood flows across defect from LA to RA, extra blood pumped from RV to lungs, LV unaffectedWhat is the pathogenesis of ASD?False (most frequently seen with other defects)True or false: ASD is typically seen as an isolated defectStandard poodle, Sheepdog, Dobies, SamoyedWhat breeds are most likely to have an ASD?Cats, ruminantsWhat animals are most likely to get ASD?Fixed splitting of S2, relative tricuspid and pulmonic stenosis and regurgWhat auscultatory findings are typical of ASD?False (no sound generated from flow through the ASD)True or false: the blood flow through the ASD creates a continuous murmurASDWhat is this echo showing?Echo, Bubble studyWhat are some ways to diagnose ASD?Saline injected into peripheral vein, microbubbles show in RA, RV, PA, bubbles should be cleared by lungs, but if in L heart, indicate shuntingWhat is done in a bubble study?