Lesson 81 - Imaging of the Heart

What can imaging of the heart provide?

1. assessment of overall heart appearance and size

2. visualize major vessel enlargement

3. differential diagnoses

What can be seen on radiographs of a heart with left congestive heart failure?

1. pulmonary venous hypertension

2. cardiogenic pulmonary edema

3. pleural effusion in cats

4. predilection for the perihilar area (not always true)

5. most obvious in caudal lobes, patchy

What does cardiogenic pulmonary edema look like on radiographs?

hazy, unstructured interstitial to alveolar pulmonary pattern

What can be seen on radiographs with right congestive heart failure?

1. Pleural effusion

2. Widened caudal vena cava

3. Hepatomegaly

4. Ascites

5. Pericardial effusion

What can be seen on radiographs with dilated cardiomyopathy?

1. Generalized cardiomegaly

2. Left atrial dilation may be present

3. Pulmonary vein dilation

4. Pulmonary edema

5. Possible pleural effusion, hepatomegaly, and/or ascites from right-sided heart failure

What can be seen on radiographs of pericardial effusion with generalized cardiomegaly?

1. Large round (globoid) cardiac silhouette in both lateral and VD or DV views if the effusion is severe enough

2. The margin of cardiac silhouette may appear indistinct and may touch the thoracic wall bilaterally

3. Signs of right heart failure may be present if pericardial tamponade is present

4. Small to moderate volumes of pericardial effusion are unrecognizable on radiographs

What can be seen on radiographs with a peritoneopericardial diaphragmatic hernia?

fluid/gas filled loops in the pericardial sac and a wide communication between the abdominal and thoracic cavity

What can be seen on radiographs of myxomatous mitral valve disease?

1. Left atrial enlargement

2. Left ventricular enlargement

3. Distended pulmonary veins if venous hypertension has developed

4. Pulmonary edema (left-sided heart failure)

What is the appearance of a heart with severe atrial dilation from hypertrophic cardiomyopathy?

appearance of biatrial enlargement and a characteristic "valentine" heart shape on the VD or DV view

What appears hypertrophied with feline hypertrophic cardiomyopathy?

left ventricle

What can be seen on radiographs with a patent ductus arteriosus?

1. Segmental enlargement (ductus bump) of the proximal aspect of the descending aorta

2. Enlargement of the main pulmonary artery

3. Enlargement of the left atrium, and possibly the left auricle

4. Enlarged left ventricle

5. Enlarged pulmonary arteries and veins caused by volume and pressure overload

What can be seen on radiographs of an aortic stenosis?

1. Enlargement of the aortic arch

2. Elongation of the left ventricle from hypertrophy

3. Left atrial dilation if secondary mitral valve dysfunction develops

4. Pulmonary venous congestion

5. May be normal in early or mild disease

What can be seen on radiographs with heartworm disease?

1. Radiographic signs can change with the extent of infection

2. Right ventricular hypertrophy in response to pulmonary hypertension

3. Dilation of the main pulmonary artery

4. Parenchymal pulmonary artery enlargement and/or tortuosity

5. Peripheral focal or multifocal alveolar pulmonary pattern from pulmonary thromboembolism caused by dead adult worm fragments or secondary allergic pneumonitis

6. Hepatomegaly, ascites, and occasionally pleural effusion caused by right-sided heart failure

What can cause pulmonic stenosis?

typically caused by an abnormal pulmonic valve but can also be associated with narrowing of the pulmonary outflow tract

What can be seen on radiographs with pulmonic stenosis?

1. Dilated main pulmonary artery caused by turbulence

2. Enlarged right ventricle is caused by hypertrophy

3. Parenchymal pulmonary vessels are usually normal in size, but if right-sided heart failure develops, the pulmonary vessels may be small because of reduced cardiac output

4. Pulmonary arteries enlarged and tortious from pulmonary hypertension

What can be seen on a radiograph of a ventricular septal defect?

1. mild right ventricular/atrial hypertrophy from volume and pressure overload

2. pulmonary arteries and veins can be normal or mildly dilated

3. enlargement of pulmonary arteries and veins is typically less than that seen with patent ductus arteriosus

A 1.5-year-old male Shiba Inu presents with exercise intolerance and mild abdominal distension. On physical exam, a right apical systolic murmur is auscultated. Which of the following is the most likely diagnosis based on these radiographs?

tricsupid dysplasia

These are orthogonal views of the thorax of a two-years-old MN beagle presenting with coughing and anorexia. What do the changes in the cardiovascular structures suggest?

heartworm disease

An 11-year-old domestic shorthair cat presents with acute respiratory distress. On exam, the cat has increased respiratory effort and muffled heart sounds. Thoracic radiographs demonstrate marked pleural effusion with lung lobe retraction.

What is the most likely diagnosis based on these radiographic findings?

right-sided congestive heart failure

A 9-year-old male Chihuahua presents with a history of progressive coughing and exercise intolerance. On physical exam, a left apical systolic murmur is auscultated. Thoracic radiographs reveal generalized cardiomegaly, and an alveolar pulmonary pattern.

Which of the following is the most likely underlying pathophysiologic mechanism responsible for the pulmonary findings?

increased pulmonary capillary hydrostatic pressure due to left-sided heart failure

A 7-year-old Labrador Retriever presents with progressive abdominal distension and lethargy. Physical exam reveals jugular venous distension and a right-sided systolic murmur. Thoracic radiographs show marked pleural effusion with retraction of lung lobes.

Which of the following is the most likely diagnosis?

right-sided congestive heart failure

A 5-year-old mixed breed dog from the southeastern United States presents with exercise intolerance and mild coughing. The dog is not on heartworm prevention. On physical exam, a right-sided systolic murmur and mild jugular distension are noted. What features of these radiographs support a diagnosis of heartworm disease?

1. kinking aorta

2. inflammed bronchial tree

3. rounding of the right atrium

4. bulging main pulmonary artery

5. right side has a larger than 2 to 1 ratio to the left side

What is being shown in this radiograph of heartworm disease?

curled, tortuous caudal lobar vessels

A 1-year-old Golden Retriever presents for evaluation of exercise intolerance and occasional syncope. On physical exam, a harsh left basilar systolic murmur is auscultated. Thoracic radiographs show an enlarged aortic arch. What is the most likely diagnosis?

aortic stenosis

A 10-month-old English Bulldog presents for evaluation of exercise intolerance and occasional syncope. On physical exam, a harsh left basilar systolic murmur is auscultated. What is the most likely diagnosis based on these radiographs?

pulmonic stenosis

A 9-year-old Golden Retriever presents with acute lethargy, weakness, and abdominal distension. On physical exam, the dog has muffled heart sounds, weak pulses, and jugular venous distension. What features of this radiograph most strongly support pericardial effusion rather than dilated cardiomyopathy?

globoid cardiac silhouette with smooth borders and absence of pulmonary venous congestion

A 6-year-old Doberman Pinscher presents with progressive lethargy, decreased exercise tolerance, and intermittent coughing. What findings on this radiograph would support a diagnosis of dilated cardiomyopathy?

generalized cardiomegaly, dorsal displacement of the trachea, prominent pulmonary veins, and an alveolar pattern

These are right lateral and ventro-dorsal radiographs of an 8-year-old mixed breed dog presenting with lethargy, exercise intolerance and coughing. Physical examination revealed left apical systolic murmur. What is the radiographic diagnosis?

myxomatous mitral valve disease (MMVD)

These are radiographs of a 4-year-old, MN chocolate Labrador Retriever presenting with acute onset of dyspnea. What are the radiographic findings?

1. alveolar lung pattern

2. generalized cardiomegaly

3. venous congestion

These are radiographs of a 4-year-old, MN chocolate Labrador Retriever presenting with acute onset of dyspnea. What is the most likely diagnosis based on these radiographic findings?

dilated cardiomyopathy

A 1-year-old domestic shorthair cat presents for evaluation of intermittent lethargy and mild tachypnea. Physical exam reveals muffled heart sounds but no obvious murmur. Which of the following is the most likely diagnosis based on these radiographs?

peritoneopericardial diaphragmatic hernia

A 10-year-old small breed dog (Cavalier King Charles Spaniel) presents with a chronic cough and decreased exercise tolerance. On physical exam, a left apical systolic murmur is auscultated. What is the most likely diagnosis based on these radiographic findings?

myxomatous mitral valve disease (MMVD)

An 8-year-old domestic shorthair cat presents with acute onset dyspnea and open-mouth breathing. On physical exam, the cat is tachypneic with possible gallop rhythm. Which radiographic finding most strongly supports feline hypertrophic cardiomyopathy (HCM) as the underlying cause?

valentine-shaped cardiac silhouette due to left atrial enlargement

A 6-month-old female mixed-breed dog presents with poor growth and exercise intolerance. On physical exam, a continuous "machinery" murmur is auscultated at the left heart base. What is the most likely diagnosis based on the clinical presentation and the radiographic findings?

patent ductus arteriosus

What ultrasound view of the heart is this?

right parasternal long-axis (RPLA)

What are the normal parameters that can be assessed in a right parasternal long-axis (RPLA) - 4 chamber view of the heart?

1. The two atria should be equal in size

2. The right ventricle is crescent in shape and the left ventricle is bullet shaped

3. The right ventricular wall should be half of the left ventricular wall, while the right ventricular chamber diameter should be 1/3 of the left ventricular chamber diameter

4. Both the atrial septum and interventricular septum (IVS) should be intact, where the IVS should be slightly bowing to the right

5. No valvular lesions

1 right parasternal long-axis (RPLA) - 4 chamber view

intraventricular septum

2 right parasternal long-axis (RPLA) - 4 chamber view

right ventricle

3 right parasternal long-axis (RPLA) - 4 chamber view

tricuspid valve

4 right parasternal long-axis (RPLA) - 4 chamber view

right atrium

5 right parasternal long-axis (RPLA) - 4 chamber view

left ventricle

6 right parasternal long-axis (RPLA) - 4 chamber view

mitral valve

7 right parasternal long-axis (RPLA) - 4 chamber view

left atrium

8 right parasternal long-axis (RPLA) - 4 chamber view

left ventricular wall

9 right parasternal long-axis (RPLA) - 4 chamber view

pericardium

What are the normal parameters that can be assessed in a right parasternal long-axis (RPLA) - 5 chamber view of the heart?

1. Same as the RPLA-4 CH

2. Patent left ventricular outflow tract

3. Normal aortic valve

4. LA and AO are similar in size in dogs

5. LA is up to 1.7 times size of the AO in cats

1 right parasternal long-axis (RPLA) - 5 chamber view

ventricular septum

2 right parasternal long-axis (RPLA) - 5 chamber view

left ventricle

3 right parasternal long-axis (RPLA) - 5 chamber view

aorta

4 right parasternal long-axis (RPLA) - 5 chamber view

left atrium

5 right parasternal long-axis (RPLA) - 5 chamber view

pulmonary artery

6 right parasternal long-axis (RPLA) - 5 chamber view

left ventricular wall

What are the right parasternal short-axis views?

1. Papillary muscle (mushroom)

2. Chordal level

3. Mitral valve (Fish mouth)

4. Left atrial and aortic root

5. Pulmonary artery

What right parasternal short-axis view is this?

papillary muscle (mushroom)

What can be assessed with a papillary muscle (mushroom) right parasternal short-axis view?

1. Uniform shortening

2. Circular outer shape

3. Mushroom LV internal shape

4. Symmetrical papillary muscles

What right parasternal short-axis view is this?

mitral valve/fish mouth view

What can be assessed with a mitral valve/fish mouth right parasternal short-axis view?

1. Uniform shortening

2. Circular outer shape

3. No valvular lesions

What right parasternal short-axis view is this?

left atrium and aorta

What can be assessed with a left atrium and aorta right parasternal short-axis view?

1. Aorta and pulmonary artery are similar in size

2. Left atrium and aorta are similar in size in dogs

3. Left atrium larger in size than aorta in cats

What right parasternal short-axis view is this?

pulmonary artery

What can be assessed with a pulmonary artery right parasternal short-axis view?

1. Aorta and pulmonary artery are similar in size

2. No shunts

This is a RPSA view at the level of the left atrium and aorta of an 8-years-old MBD presenting for health check up. What do the measurements indicate?

normal left atrial size

What echo abnormality is being shown?

left atrial enlargement

What echo abnormality is being shown?

left ventricular enlargement

What echo abnormality is being shown?

left atrial enlargement

What echo abnormality is being shown?

left ventricular hypertrophy

What is the ratio for left atrium to aortic root enlargement in dogs?

> 1.6

What is the ratio for left atrial to aortic root enlargement in cats?

> 1.3

What indicates a left ventricular hypertrophy in cats?

intraventricular septum

What echo abnormality is being shown?

right sided enlargement

What echo abnormality is being shown?

septal flattening

What echo abnormality is being shown?

generalized cardiomegaly

A 12ys old M Griffon presents with a left apical murmur, exercise intolerance and coughing. What abnormalities are seen on echo?

1. mitral valve thickening

2. left atrium and ventricular enlargement

3. mitral regurgitation

A 12ys old M Griffon presents with a left apical murmur, exercise intolerance and coughing. What is the most likely diagnosis?

mitral valve disease

A 8 ys old Caucasian shepherd presents with cavitary effusion and collapse with muffled heart and lung sounds. What abnormalities are seen on echo?

left ventricular dilatation and poor systolic function

A 8 ys old Caucasian shepherd presents with cavitary effusion and collapse with muffled heart and lung sounds. What is the most likely diagnosis?

dilated cardiomyopathy

6 year old M DSH presents with respiratory distress, pulmonary edema, and congestion. What abnormalities are seen on echo?

left ventricular hypertrophy

6 year old M DSH presents with respiratory distress, pulmonary edema, and congestion. What is the most likely diagnosis?

hypertrophic cardiomyopathy

8 year old F DSH presents with dyspnea, pale mm, and collapse. What abnormalities are seen on echo?

left atrial enlargement and pleural effusion

8 year old F DSH presents with dyspnea, pale mm, and collapse. What is the most likely diagnosis?

hypertrophic cardiomyopathy

A 4 month old M Rottweiler presents with dyspnea, ascites and collapse. What abnormalities are seen on echo?

1. right atrial enlargement

2. right ventricular hypertrophy

3. septal flattening

A 4 month old M Rottweiler presents with dyspnea, ascites and collapse. What abnormalities are seen on echo?

thick and fused pulmonic valve

A 4 month old M Rottweiler presents with dyspnea, ascites and collapse. What is the most likely diagnosis?

pulmonic stenosis

This is a RPLA- 4 chamber view of the heart of a 8 years old Chihuahua presenting with exercise intolerance. Heart auscultation revealed a grade 4 out of 6 left apical systolic murmur. What do the changes suggest?

myxomatous mitral valve disease