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Study Notes
There is no texHeart – clinical examination
Auscultation
Frequency
Intensity of heart sounds
Rhythmicity
Demarcation
Heart murmurs
systolic (early-, mid-, late-, holo-)
diastolic (early-, holo-, presystolic)
Final Exam materials
Equine Medicine
Dr. Turke Shawaf
Heart - auscultation
Heart Sounds
First heart sound or “lubb”
Atrioventricular valves and surrounding fluid vibrations as valves close at
beginning of ventricular systole
Second heart sound or “dupp”
Results from closure of aortic and pulmonary semilunar valves at beginning of
ventricular diastole, lasts longer
Third heart sound (occasional)
Caused by turbulent blood flow into ventricles
and detected near end of first one-third of
diastole
Fourth heart sound (A sound)
It called the atrial sound, atrial contraction
sound. It is heard immediately prior to S1.
Diagnosis of heart diseases
further diagnostical approach
Frequent clinical signs
often increased frequency at rest
Cardiac murmurs
missing sinus rhythm at work
lack of work capacity
Further diagnostics
ECG at rest and at work
Blood pressure measurement
Echocardiography
Pericardiocentesis
Laboratory diagnostic
Electrical conduction system of the heart
Action potentials through myocardium during
cardiac cycle produces electric currents than
can be measured
Sinoatrial node
Atrioventricular node
His bundle branches
Purkinje
The SA node is richly innervated by parasympathetic nervous system fibers
(Rest and Digest)(CN X: vagus nerve) and by sympathetic nervous system
fibers (Fight ans Flight) (T1-4, spinal nerves)
Electrocardiography ECG
Electrocardiography is the recording of the
electrical activity of the heart.
ECGs in the horse are recorded using a base-apex
lead
Negative electrode placed over the jugular groove
Positive electrode placed just behind the left
Earth electrode attached at a site remote to the heart
Electrocardiography ECG
Pattern:
P wave
Atria depolarization
QRS complex
Ventricle depolarization
Atria repolarization
T wave:
Ventricle repolarization
Electrocardiography ECG
Blood pressure measurement
Bloodless determination
Oscillometry
Doppler-technical investigation
CUCV (coccygeal uncorrected value)
adult warmblooded horse
sys 85 – 95 mmHg
dias 50 – 60 mmHg
correction / conversion
altitude difference tail root to cardiac basis
(1 cm x factor 0,8)
Echocardiography
B-mode (2D-mode)
morphologic changings
changings in heart dimension
M-mode
changes to myocard
changings in heart kinetics
Color doppler
locate the hole of regurgitation
Spectral doppler
proof of regurgitation quantitatively
Echocardiography
Color doppler
locate the hole of regurgitation
Spectral doppler
proof of regurgitation quantitatively
Echocardiography
B-mode (2D-mode)
morphologic changings
changings in heart dimension
M-mode
changes to myocard
changings in heart kinetics
Echocardiography
Color doppler
locate the hole of regurgitation
Spectral doppler
proof of regurgitation
quantitatively
Color and spectral doppler
Considerable mitral insufficiency
Laboratory diagnostic of CVS
This technique is used to collect and assess pericardial fluid.
The needle is inserted through the chest wall into the pericardial
sac and fluid is allowed to flow or is aspirated using a syringe.
Local anaesthetic is injected into the skin and muscle layers of
the space between the 5th and 6th ribs.
Laboratory diagnostic of CVS
Complete blood count, fibrinogen to identify anemia or
inflammation.
Serum biochemical tests (electrolytes, renal function tests,
muscle enzymes
Cardiac tropinin I provides an excellent cardiac biomarker in
large animals, providing a sensitive and persistent indicator of
cardiac injury.
Arterial Ph, Blood gas analysis to evaluate pulmonary and
renal function and assess acid-base status.
Urinalysis to identify renal injury from heart failure or
endocarditis
Blood cultures for bacteraemia and diagnosis of endocarditis
Diseases of the Heart
Clinical signs of cardiac disease
Mild disease
no clinical signs
reduced exercise tolerance
Diseases of the Heart
Clinical signs of cardiac disease
Moderate disease
tachycardia
tachypnoea
dyspnoea following exercise
abnormal arterial pulse
jugular distension
oedema over ventral abdomen
oedema in distal limbs
pathological arrhythmias
Severe disease
cool extremities
weight loss
reduced capillary refill time
cough (left-sided failure)
dyspnoea at rest
collapse
Diseases of the Heart
Congenital heart defects
Cardiac arrhythmias
Cardiac murmurs
Congenital cardiovascular disease
Ventricular septal defect (VSD): an opening in the
interventricular septum
Patent ductus arteriosus (PDA): Connect the pulmonary
arterial system to the aorta
Tetralogy and pentalogy of fallot: Biventricular origen of
the aorta, VSD, right ventricular hypertrophy, obstruction of
pulmonary arterial flow
Atrial septal defect
Atresia, stenosis, dysplasia and anomalies of valves
Congenital cardiovascular disease
Ventricular septal defect
Ventricular septal defect:
One of the more common congenital cardiac
defects in cattle
Loud, holosystolic murmur
Characterized by poor growth, lethargy,
exercise intolerance
PMI (grade 3/4 – 5/6)
Defects < 2 cm diameter at adult horse
have mostly no relevance
Tetralogy of Fallot
Tetralogy of Fallot: is a complex defect, it has four
elements:
Ventricular septal defect (VSD)
An overriding aorta (the aortic root straddling the
interventricular septum)
Right ventricular outflow obstruction and
Right ventricular hypertrophy.
The cause of the RV hypertrophy may be
pulmonary valve stenosis or PA hypoplasia.
Tetralogy of Fallot
Clinical signs
Owing to the presence of a right to left shunt (central
cyanosis).
Profound exercise intolerance, poor growth and CHF.
Auscultation reveals loud (grade 4-6/6) murmurs on both
sides of the chest, predominantly at the left base.
A thrill is often present.
Tetralogy of Fallot
Diagnosis
Clinical signs (cyanosis)
Echocardiography. 2DE shows a VSD (usually quite
large), an overriding aorta and RV hypertrophy, with
thick walls and marked trabeculation
RV dilation and hypertrophy and pulmonary atresia
was most easily seen in short-axis and olbique
views.
Pulmonary stenosis
Injection of echo-contrast into the jugular vein
results in opacification of the RA, RV and aorta.
Hypoxaemia may be identified by blood gas
analysis; a haemamay reveal polycythaemia.
Tetralogy of Fallot
Prognosis
The prognosis for life with tetralogy of Fallot is poor.
These horses will not become athletes.
Euthanasia is usually warranted.t provided to write study notes for. The text appears to be a series of blank lines and special characters. Please provide a meaningful text or a list of questions to generate study notes.
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