11. Left vs Right Heart disease

left atrial enlargement, left ventricular enlargement, pulmonary edema, pulmonary venous enlargement, tracheal deviation, compression of mainstem bronchus

Which signs are consistent with left heart disease/failure?

15-20

normal tracheal position on lateral radiographs is at a _______ degree angle

right or left atria

Enlargement of which part(s) of the heart can deviate the trachea dorsally?

left ventricular border

In early feline heart disease the tracheal position is not as helpful, but the rounding of the ______________________ is a significant finding

normal indented cardiac waist

Is this heart normal or abnormal?

systemic hypertension, heart base mass

What are some differentials for a loss of cardiac waist that are NOT from an enlarged heart

enlarged right atrium, right auricular appendage, main pulmonary artery, ascending aorta, cranial vena cava

What structures can be enlarged that will lead to a loss of cardiac waist in canines?

aorta, ascending aorta, descending

In the dog, the size and shape of the ________ is a sentinel sign of cardiovascular disease. If the __________ is much bigger than the _________, we likely have disease.

12-1 oclock

Where on a VD would you see the aorta?

aortic bulge

The presence of an __________ on VD images can assist with the diagnosis of congenital heart disease like patent ductus arteriosus or with chronic hypertension

loss of caudal cardiac waist; L atrial enlargement

What is happening here? And what does this indicate?

dorsal deviation and compression of the left caudal mainstem bronchus

What sign of left atrial enlargement is seen here?

cool

Here is that dorsal deviation of the left caudal mainstem bronchus outlined if you struggled to see it before

cool?

backpack sign, severe left atrial enlargement

What sign do we see here and what does it mean?

between the mainstem bronchi, between 5-7 oclock

Where does the normal left atrium live on a VD view of the heart?

caudal border of the atrium has a double opacity sign

With mild left atrial enlargment in a the canine, you will be able to see what change on the VD/DV view?

double opacity; left atrial enlargement

So, what sign do we see here and what does it indicate?

normal

We can see the main stem bronchus at the bottom of the heart in this VD view... is this normal or abnormal placement?

bow-legged cowboy

As the left atrium enlarges, copression and deviation of the left caudal mainstem bronchus will cause what sign to be observed?

left auricle, atrium double opacity

As left heart disease in a dog advances, what else will enlarge? Seen here as the bulge at about 2-3 oclock. And what original sign becomes more clear?

false, the left atrium is the same on laterals, but is located at 1-2 oclock on the VD/DV images

true/false; cat radiographs have the left atrium located in the same place on both laterals and VD/DV images

heart base widens

Okay, so cats hearts are different on VD. How does the cat's VD image look when you start to get left atrial enlargement?

aorta

What is located at 12-1 oclock on the canine VD heart image?

main pulmonary artery

What is located at 1-2 oclock on the canine VD heart image?

left auricular appendage

What is located at 2-3 oclock on the canine VD heart image?

left ventricle

What is located at 3-6 oclock on the canine VD heart image?

right ventricle

What is located at 6-9 oclock on the canine VD heart image?

right atrium

What is located at 9-12 oclock on the canine VD heart image?

descending aorta

What is outlined here?

left ventricle slopes right, and takes over the right side

When there is mild enlargment of the left ventricle in dogs, what does the VD image look like?

ventral, central

Lobar VEINS are located _______ and _______ compared to the bronchus and arteries

left

There are two sets of artery/bronchus/veins, is the left or right set located more cranially on a lateral image?

4th rib

normal cranial pulmonary vessels should be less than 3/4 the width of the ________________ on a lateral view

caudal vena cava

The right caudal lobar vein is normally overlying the ____________ on the VD view, so its difficult to determine size

9th rib

caudal lobar arteries should be less than the width of the _______ on VD images

true

true/false: dogs with pulmonary hypertension can have very enlarged arteries that taper to normal size by the time they cross the 9th rib... so make sure to compare the whole visible vessel

left to right shunts (PDA, VSD, ASD), fluid retention from heart failure, fluid overload

What are differentials if both caudal lobar arteries AND veins are enlarged?

undercirculation, pulmonic stenosis, hypovolemia, shock, right to left shunts(tetrology of fallot, VSD, PS)

If both the caudal lobar artery and veins are SMALL, what are differentials?

mitral regurge, primary myocardial disease (cardiomyopathy), noncardiac left atrium obstruction, mass at heart base, thrombus in left atrium

if the caudal lobar vein is larger than the artery, what are differentials?

pulmonary hypertension, heartworms, COPD, pulmonary thormboembolism

If the caudal lobar artery is larger than the vein, what are differentials?

both enlarged

describe the lobar vessels

both small

describe the lobar vessels

vein larger than artery

describe the lobar vessels

compensated

____________________ heart disease is defined as the presence of left heart disease without evidence of pulmonary edema

pulmonary edema, failure

Left heart disease is DECOMPENSATED when __________________ is present and the heart is now considered to be in ___________

pulmonary venous congestion

________ will precede pulmonary edema if the heart is progressing into left failure

hilar regions,

usually, pulmonary edema in a dog starts where?

interstitial, alveolar

pulmonary edema is a continuum, begining as a ____________ lung pattern and progressing into a ________ pattern.

caudal lung lobes

In dogs, generally pulmonary edema is more visible where?

variable in location, patchy

Where is pulmonary edema in cats? and what does it look like?

dorsally deviated trachea, double opacity on VD, compensated disease, not failure

What heart signs does this dog have and if there are signs, is he in heart failure?

straightened cardiac waist, interstitial pattern, yes failure, because edema present

What heart signs does this dog have and is he in heart failure?

yes, variable edema

Is this CAT in heart failure?

right atrial enlargement, pulmonary arterial enlargement, ascites, hepatomegaly, CVC enlargement, tracheal deviation, (sometimes enlargement of main pulmonary artery)

What are the signs consistent with right heart disease/failure?

left (double opacity sign)

left or right heart disease?

right (reverse D sign)

left or right heart disease

true

true/false: the reverse D sign does NOT taper, it stays about the same width for the full length of the heart

artery, vein

In some dogs with right heart disease, the [artery/vein] is larger than the [artery/vein]

they should be the same size

In a normal heart, which should be larger, the caudal vena cava or the descending aorta?

caudal vena cava

Okay, so if the caudal vena cava and the descending aorta are supposed to be the same size, when the ______________ starts to become larger, this marks the progression to right heart failure in a dog

liver, stomach axis

In the very beginning stages of right heart failure, which organ is mildly increased in size? This is due to a subtle shift in the _________

parallel to ribs

The normal stomach axis is where?

caudal vena cava, hepatomegaly, ascites

For right heart failure, an enlarged ______________ will precede ________ and ___________________

abdominal effusion

decompensated right heart failure is when there is any amount of ____________________ present.

right side

Which of these images has abdominal effusion

falciform fat pad

What is the structure outlined in this NORMAL radiograph?

cant see falciform fat, abdominal fluid, right heart failure

What is the abnormality here? Whats it caused by?

left atrial enlargement (if the L atrium is normal, you dont have L sided disease)

What is kind of the KEY thing Dr. Holland told us she uses to determine right vs left heart diease/failure?

cool

Here is that full slilde of differentiations, Cool

mitral regurgitation, dilated cardiomyopathy

Long standing left heart disease is commonly seen with _________ and rarely, can also have _________ documented with it, leading to biventricular failure

left, right

If there is BIVENTRICULAR heart disease, you WILL see [right/left] heart disease signs accompanied by MINIMAL [right/left] heart changes

serial radiography

_____________ is used to evaluate the course of heart disease and to monitor treatment

diuretics

Heart size and vessel size will be altered by ____[which drug class?]_____