SAM 7 & 8

What are systolic regurgitant murmurs associated with?

Mitral or tricuspid regurgitation

What are systolic ejection murmurs associated with?

Aortic or pulmonic stenosis

What do diastolic murmurs suggest?

Aortic or pulmonic regurgitation

What are common red flags for congenital heart disease in puppies?

Loud diastolic or continuous murmur or a thrill

What characterizes an innocent puppy murmur?

Soft grade I-II systolic left-base murmur

When do innocent puppy murmurs often disappear?

12-16 weeks

What does both small pulmonary arteries and veins suggest?

Hypovolemia or right-to-left shunt

What does both large pulmonary arteries and veins suggest?

CHF or volume overload

What does pulmonary artery enlargement suggest?

Pulmonary hypertension

What does pulmonary vein enlargement suggest?

Left-sided CHF

What does VLAS assess?

Left atrial enlargement

Why is VLAS useful?

VHS can miss left atrial enlargement

What does a Valentine-shaped heart indicate in cats?

Biatrial enlargement

What does a small heart with small vessels and dark lungs suggest?

Hypovolemia

What is a focused cardiac ultrasound?

Targeted exam answering specific questions

What can a focused cardiac ultrasound assess?

Effusion tamponade masses and cardiac size/function

What must be enlarged with cardiogenic pulmonary edema?

Left atrium

What does cardiac troponin I indicate?

Myocardial injury

What is an important limitation of cardiac troponin I?

It is not specific for cardiac disease

What does NT-proBNP indicate?

Myocardial stretch

How should cardiac biomarkers be interpreted?

With the history physical exam and other tests

Why can biomarkers cause problems in low-risk patients?

False positives

What blood pressure cuff size should be used?

About 40% of limb circumference

When should blood pressure be measured?

When the patient is calm

What are the main indications for thoracic radiographs?

Cough dyspnea syncope murmur gallop arrhythmia and suspected CHF

What can thoracic radiographs tell you about the heart?

Heart size chamber enlargement and left vs right-sided enlargement

What can thoracic radiographs NOT tell you well?

Myocardial function

Which lateral view is preferred for cardiac cases?

Right lateral

Which lateral view is better for evaluating the right middle lung lobe?

Left lateral

What is the normal VHS in dogs?

What is the normal VHS in cats?

What does VLAS assess?

Left atrial enlargement

What does pulmonary vein enlargement suggest?

Left-sided CHF/increased left heart filling pressure

What does pulmonary artery enlargement suggest?

Pulmonary hypertension

What do enlarged pulmonary arteries AND veins suggest?

Volume overload

What do small pulmonary vessels suggest?

Hypovolemia

What does caudal vena cava enlargement suggest?

Right-sided heart disease

What CVC:A ratio suggests right-sided heart disease?

1.5

What are the 4 major pulmonary patterns?

Interstitial bronchial alveolar and vascular

What is an interstitial pattern associated with?

Early CHF fluid overload interstitial disease fibrosis and metastasis

What does a bronchial pattern look like?

Donuts and tram lines

What is a classic cause of a bronchial pattern in cats?

Feline asthma

What is an alveolar pattern?

Alveoli filled with fluid blood pus or cells

What distribution is typical of bacterial pneumonia?

Cranioventral

What distribution is typical of cardiogenic pulmonary edema?

Perihilar and caudodorsal

What distribution is typical of noncardiogenic pulmonary edema?

Caudodorsal

What is the most common cause of CHF in small-breed dogs?

Chronic mitral valve disease

What is the most common cause of CHF in large-breed dogs?

Dilated cardiomyopathy

What is the most common cause of CHF in cats?

Hypertrophic cardiomyopathy

Do cats commonly cough with CHF?

No

What is an important finding in cats with CHF?

Pleural effusion can occur

What are the 2 major types of cardiac biomarkers?

Leakage markers and functional markers

What is the main cardiac leakage marker?

Cardiac troponin I

What does increased cTnI indicate?

Myocardial injury

Is cTnI specific for cardiac disease?

No

What are functional cardiac biomarkers?

Natriuretic peptides

Where is ANP produced?

Atria

Where is BNP produced?

Ventricles

What is the important clinically measured BNP marker?

NT-proBNP

What is the main use of NT-proBNP?

Distinguishing cardiac from pulmonary disease

What does high NT-proBNP generally suggest in a dyspneic patient?

Cardiac disease/CHF

What does low NT-proBNP generally suggest?

Pulmonary disease

What is a major use of NT-proBNP in Dobermans?

Detection of occult DCM

What can NT-proBNP predict in dogs with mitral disease?

Risk of CHF within 6-12 months

What is the normal feline NT-proBNP cutoff from this lecture?

What feline NT-proBNP level supports CHF?

265 pmol/L

What does echocardiography evaluate?

Cardiac structure and function

What does 2D/B-mode echo show?

Real-time cardiac structures

What does M-mode evaluate?

Motion and measurements including fractional shortening

What does Doppler evaluate?

Blood flow and velocity

What does color Doppler detect?

Regurgitation and abnormal/turbulent flow

What does fractional shortening assess?

LV contractility

What is normal fractional shortening in dogs?

25-45%

What is normal fractional shortening in cats?

35-55%

What does low fractional shortening suggest?

Poor contractility especially DCM

What can high fractional shortening be associated with in cats?

HCM

What does thickened LV wall suggest in cats?

HCM

What does thickened LV wall suggest in dogs?

Subaortic stenosis

Why is left atrial enlargement important?

It supports left-sided CHF and indicates increased risk of CHF

What is pericardial effusion on echo?

Fluid around the heart

What does right-sided chamber collapse with pericardial effusion indicate?

Cardiac tamponade

When is a focused echo useful?

Respiratory distress collapse confusing radiographs murmurs arrhythmias or suspected effusion

What does a Holter monitor detect?

Intermittent or hidden arrhythmias

What breed is classically screened for ARVC with a Holter?

Boxer

What is the key difference between Holter and event monitoring?

Holter is continuous and event is targeted

What test is best for determining the type of heart disease?

Echocardiography

What test is most important for determining if a dog is in CHF?

Thoracic radiographs