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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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