congenital heart disease

Denis

How to narrow down ddx from murmur

Timing, point max intensity, radiation, pulse quality, precordial impulse

Innocent flow murmur gone by

20w/6mon

Innocent flow murmur location

Basilar

Patent ductus arteriosus - effects

Blood from aorta → pul a

→ pul over circulation

→ L vol overload → inc L EDP → LHF

→ dilate mitral annulus → mitral regurgitation

Patent ductus arteriosus - Femoral pulse

Tapping, water hammer

Patent ductus arteriosus - Stethoscope place + sounds

L heart base

Continuous whooshing, MR murmur

Patent ductus arteriosus - Dx

Angiogram

Auscultation

Patent ductus arteriosus - Common signlament + breeds

Bitches

German Shepherd

Collies

Bichon frise

Poodle

CKCS

Irish setter

Patent ductus arteriosus - CS

Collapsing femoral pulse

Patent ductus arteriosus - X-ray

LA+LV enlargment

Triple knuckle of aortic, pul, L aur bulge

Pul over circulation

Patent ductus arteriosus - ECG

P mitrale

Tall R waves

Arrhythmias

Patent ductus arteriosus - US

Dilated pul BV, LA+LV enlargment

Continuous fill into pul a

Patent ductus arteriosus - Tx

L sided Thoracotomy + ligation

Duct occluder

Sub aortic stenosis - breeds

Boxer, Newfoundland, retriever, Rottweiler, bull terrier

Most common congenital defect in dogs

Sub aortic stenosis

Sub aortic stenosis - What to check if found in cats

Not dynamic LVOT obstruction in HCM

Sub aortic stenosis - Effects

Inc LV afterload → concentric hypertrophy

Inc aortic velocity

Coronary perfusion compromised

Myocardial Ischaemia → V arrhytmias

Sub aortic stenosis - Stethoscope

Harsh ejection (loud then soft) systolic murmur radiates up carotids

L basilar murmur radiating from heart base

Sub aortic stenosis - US

Thick LV

Dilated aorta

Fast aortic flow (with subcostal view)

Pressure gradient vs velocity equation

PG = 4 x v²

Sub aortic stenosis - Sev defined by

>80mmHg pressure gradient

Normal aortic velocity

<1.7m/s

Sub aortic stenosis - Tx

Beta blockers (dec myocardial stress)

CHF treatment (diuretics)

Sub aortic stenosis - Which drugs to avoid

Positive inotropes (pimobendan), Arteriodilators

Pul stenosis - breeds (bull breeds some coronary a wrap around pul trunk)

Cockers, CKCS, terriers, beagle, bulldog, bull mastiff, boxer

Pul stenosis - CS

Exercise intolerance, syncope

Pul stenosis - Stethoscope

Systolic murmur cr L heart base radiating dor

Ejection murmur

Pul stenosis - Effect

Inc RV afterload → concentric hypertrophy → myocardial Ischaemia → V arrhythmia

Inc pul velocity

IVS motion altered → LV squashed from pressures

Pul stenosis - US

RV hypertrophy

Septum movment

Valves dome as blood decelerates

Pul stenosis - X-ray

RV enlargment (inc sternal contact)

Reverse D

Post Stenotic dilation

Pul stenosis - ECG ( show RV hypertrophy)

Negative QRS = R axis deviation

Deep S waves

Pul stenosis - Tx

Cardiac catheter with balloon valvuloplasty to break apart valves

Dilate pul annulus with stent

V septal defect - common animals

Cats, cockers, WHWT

V septal defect - Murmur grade meaning

Inversely proportional to severity as large = RV pressure inc → less turbulence → lower grade

V septal defect - Effects

L → R shunt in systole

RV vol overload → pul over circulation → L vol overload → LHF

V septal defect - Stethoscope

Systolic murmur with point max intensity on R

Precordial thrill

Abrupt plateau

Murmur of relative pul stenosis

V septal defect - X-ray

Cardiomegaly

Enlarged pul BV

V septal defect - US

Blood L→R

V septal defect - Sequelae

Asymptomatic if small

LHF

Some close with growth

Aortic valve prolapse into VSD

Pul hypertension → high RV P → shunt reversal

AV valve dysplasia - common in cats or dogs

Cats

AV valve dysplasia - mitral vs tricuspid breeds

M- bull terrier, retriever, Great Dane, German shepherd

T- lab

Mitral dysplasia - gross + effects

Thick mitral valve → mitral regurgitation → L apical systolic murmur + L vol overload

Mitral dysplasia -US + X-ray

Valves stiff

LA enlargement

Tricuspid dysplasia - effects

Tricuspid regurg → R apical systolic murmur

R vol overload → RCHF

Apical valve displacement

Atrial septal defect effect

L →R shunt

Tetralogy of fallot - components (not accurate dividing)

Pul stenosis (narrow BV + weird valves)

RV hypertrophy

VSD

Dextrapossed wide aorta

Tetralogy of fallot - CS as R → L shunt

Cyanosis

Congenital lesions without murmur

Vascular ring anomaly (PRAA)

PPDH