Large Animal Cardiology II- CardioRush

V tach
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V tach
What is this rhythm?
Image: V tach
False (less frequent than atrial arrhythmias)
True or false: Ventricular arrhythmias are more common than atrial arrhythmias in large animals
Weak pulses
What is the pulse quality of V tach?
Paroxysmal, persistent
What are the 2 patterns of ventricular tachycardia?
False (Life threatening not only from the arrhythmia, but from the underlying cause of the arrhythmia)
True or false: ventricular tachycardia is rare, but also rarely life-threatening in large animals
Severe electrolyte disturbances, drug reaction, hypoxia, myocarditis, underlying heart disease, myocardial infarction, toxicity
What are some underlying causes of ventricular tachycardia?
Lidocaine
What is the drug of choice when treating ventricular arrhythmias in large animals?
Hypokalemia
What underlying electrolyte disturbance should be corrected to achieve optimal efficacy of lidocaine?
Cats, horses
What animals are predisposed to lidocaine sensitivity and should be used cautiously in?
Propanolol, Mg sulfate
What other drugs can be used to treat a ventricular tachycardia if lidocaine doesn't work?
Investigate and treat underlying causeOther than using medication to control the arrhythmia, what is a vital component of treating ventricular tachycardia in horses?Seizures, ataxia, CNS depression, increased defibrillation thresholdWhat side effects of lidocaine can be seen in horses?Reduce by 50%How should you adjust the dose of lidocaine in cats and horses due to their sensitivity to side effects?False (Contraindicated, will suppress escape beats)True or false: Lidocaine is indicated in AV blockFalse (Poorly understood)True or false: The etiology of acquired valvular disease is well understood in horsesMitral and aortic regurgWhat type of acquired valvular disease is common in middle age to older horses?Myxomatous degeneration, valvular fibrosis, valvulitisWhat are some possible etiologies of acquired valvular disease in horses?Variable intensity cooing decrescendo holodiastolic murmurWhat are the murmur characteristics associated with aortic regurgitation?HyperdynamicWhat are the pulses associated with aortic regurgitation?Variable intensity holosystolic murmur over mitral PMIWhat are the characteristics of the murmur associated with mitral regurgitation in horses?Jugular venous distension, peripheral/ventral edema, tachypnea, dyspnea, frothy nasal dischargeWhat are the characteristics of CHF in horses?Asymptomtatic murmurWhat is the most common presentation of acquired valvular disease in horses?Reduced athletic performance, exercise intolerance, resp distress, syncope or collapseWhat are the clinical signs of acquired valvular disease in horses if they are severely affected?Chordae tendinae rupture, acute LCHF, pulmonary hypertensionWhat are the causes of respiratory distress in severely affected horses with acquired valvular disease?TrueTrue or false: horses with a holodiastolic murmur should be considered to have aortic insufficiency until proven otherwiseFalse (it is an acquired valvular lesion that slowly worsens with age)True or false: aortic insufficiency is an acquired valvular lesion, but it is nonprogressiveFalse (it only tells you there is insufficiency, not the other effects of disease on the heart)True or false: the intensity of the murmur associated with aortic insufficiency is a good guide to severity of diseaseArterial pulse qualityWhat is a better PE indicator of severity of disease than intensity of murmur in aortic insufficiency?Bounding pulses, means more diastolic runoff (greater insufficiency and thus greater difference between systole and diastole pressures)What is the quality of the pulses in aortic insufficiency if the underlying disease is more significant?VPCsWhat type of arrhythmia is occasionally associated with aortic insufficiency?False (may warrant Holter or exercise stress test to ensure the arrhythmias won't put a rider in danger)True or false: the VPCs associated with aortic insufficiency are harmless and can be ignoredExercise restriction, medical therapy with furosemide, digoxin, possibly ACE inhibitor or pimo (but very expensive)What are the treatments for acquired valvular disease in horses?Horses with more severe mitral regurg will have cardiac enlargement, tachycardia, jugular distension, more likely unsafe to rideWhat is the safety issue for riders of horses with acquired valvular disease?Slow progression, favorable prognosis for life and performanceWhat is the prognosis of aortic or mitral regurg in most older horses?Afterload reducers for palliative careWhat type of treatment may be used in horses with severe valvular regurgitation with ventricular enlargement?False (not safe to ride, can collapse or otherwise injure rider at any time)True or false: it is generally safe to ride a horse that is severely affected with cardiac enlargement as long as they aren't performing at a high level of stressFever of unknown originWhat is a common presentation for endocarditis in horses?Resp disease or recent surgery that caused bacteremiaWhat may be in the history of horses that are diagnosed with endocarditis?Aortic, mitralWhat valves are most commonly affected in endocarditis in horses?TricuspidWhat valve is most commonly affected in endocarditis in cattle?New murmur, intermittent or persistent fever, tachycardia, tachypneaWhat are some common clinical signs associated with endocarditis?Clinical signs, bloodwork, culture, echoHow is endocarditis diagnosed?Elevated WBCs, fibrinogen, globulins, possibly troponin I, anemia of chronic diseaseWhat are the bloodwork findings consistent with endocarditis in large animals?3 samples collected 1hr apartWhat is the best way to collect samples for diagnosing endocarditis?Find vegetative lesions on valvesWhat is the purpose of echo in endocarditis?Rapid initiation of IV broad spectrum abx, continue abx for 5-8 weeks, possible antithrombotic, restWhat is the treatment for endocarditis?Poor to guarded for both performance and long term survivalWhat is the prognosis associated with endocarditis?False (some animals recover, especially with minor vegetative lesions and no CHF)True or false: almost no horses survive endocarditis, it isn't worth it to attempt treatmentYoung horses, stallionsIn what populations of horses is pericardial disease more common?Effusive, fibrinous, constrictiveWhat are the 3 types of pericarditis?FibrinoeffusiveWhat type of pericarditis in the most common in horses?Resp diseaseWhat is commonly in the clinical history of horses that present with pericardial disease?Fever, lethargy, depression, tachycardia, jugular distension, ventral edema, weak pulses, muffled heart soundsWhat are the clinical signs associated with pericardial disease?Idiopathic, infectious, neoplastic, asepticWhat are the etiologies of pericarditis in horses?IdiopathicWhat is the most common cause of pericarditis in horses?Bacterial, viral, Eastern Tent caterpillarWhat are some infectious causes of pericarditis?Lymphoma, mesotheliomaWhat type of neoplasia most commonly causes pericarditis?Strep most common, actinobacillus, E. coli, Enterococcus, Corynebacterium, Rhodococcus, mycoplasma, anaplasmaWhat are some examples of bacterial agents that can cause pericarditis?EtiologyWhat does the treatment and prognosis of pericarditis depend on?Drainage, lavage, indwelling catheter, systemic abx, restWhat is the treatment for septic pericarditis?False (it is good prognosis if the underlying cause is treated)True or false: The prognosis for pericarditis is usually poor, even if the underlying cause is successfully treatedRareWhat is the incidence of primary cardiomyopathy in large animals?Idiopathic DCMWhat type of primary cardiomyopathy can very rarely be seen in horses and certain breeds of Holstein Friesian or Hereford cattle?Myocarditis, inophone toxicity, vit E/selenium or Cu deficiency, Cantharidin (blister beetle toxicity), neoplasiaWhat are some secondary causes of cardiomyopathy or myocarditis in large animals?Monensin, salinomycin, lasalocidWhat are examples of common inophone agents?CoccidiostatWhat are inonophores used for in feed?Poultry, cattleWhat species are ionophores commonly used in?Renal and hepatic damage, intravascular hemolysis, skeletal and cardiac myopathyWhat are the effects of ionophore toxicity in horses?HeartWhat is the main organ system compromised in inophore toxicity in horses?Chronic poor performance, weight loss, tachycardia, arrhythmias, CHFWhat are some consequences of ionophore toxicity in horses if they survive?Feed analysis for monesin, echo, cardiac tropnon IHow is myocardial disease from ionophore toxicity typically diagnosed?Supportive care, digoxin, furosemideHow is myocardial disease from ionophore toxicity treated?Guarded, 1/3 horses dieWhat is the prognosis for ionophore toxicity in horses?Ruptured sinus of valsalva, Aortopulmonary fistulaWhat are the 2 ways the aorta can rupture in horses?Breeding stallionsWhat horses are most likely to get a ruptured sinus of valsalva?FriesiansWhat breed is most likely to get an aorto-pulmonary fistula?Aortic ruptureIf an adult horses suddenly develops a continuous murmur, what condition should be suspected?Physiologic (innocent) murmurWhat type of murmur is common in normal foals?Rare (0.8%)What is the incidence of congenital heart disease in horses?Up to 3 daysHow long after birth are continuous murmurs normal in foals?2 months or moreHow long after birth is it normal to hear a soft systolic murmur in foals?Foals >3 days old with loud, widely radiating murmursWhat type of murmur in a foal should make you suspect congenital heart disease?Arabs, standardbreds, Welsh Mountain PoniesWhat breeds of horses more commonly have congenital defects?VSDWhat is the most common congenital defect in all large animals species?ASDWhat defect often accompanies other congenital defects in large animals?AV valve dysplasia, pulmonic or aortic stenosis, complex congenital defectsWhat are some less common congenital heart defects in large animals?TrueTrue or false: VSD is the most common type of congenital heart defect in large animals, being 6x more common that any other cardiac defectMembranous portion of IVS just beneath aortic valveWhere is the defect usually located VSD in large animals?Left to rightWhat type of shunting typically occurs in VSD in the absence of other defects?Harsh, pansystolic murmur with PMI over right 4th ICSWhat type of murmur is associated with VSD?False (may have murmur not from flow through the VSD, but from relative pulmonic stenosis due to increased flow through the pulmonic valve)True or false: You can never hear a murmur associated with VSD on the left heart baseSize and hemodynamic significance of defectWhat do the clinical signs and prognosis of VSD depend on?Larger defects, clinical signs when youngWhat signs are associated with a poorer prognosis in VSD?Failure to thrive, exercise intolerance, peripheral edema, jugular distension, pleural effusion, ascites, pulmonary edema, weakness, syncopeWhat are the clinical signs that can manifest from VSD?