Basic Echocardiography Additional Information

1. Basic EchocardiographyAdditional Information Wendy Blount, DVM Nacogdoches TX

2. Heartworm Disease Video

3. Cardiac Masses DDx • Chemodectoma • HSA • Myxosarcoma • Ectopic thyroid carcinoma • Mesothelioma • LSA • fibrosarcoma

4. Cardiac Masses Echocardiographic Features • Usually at the heart base or in the RA • Careful not to confuse with • Epicardial fat (especially on the AV groove when there is pericardial effusion) • Trabeculae on the right auricle when floating in pericardial effusion

5. Patent Ductus Arteriosus Clinical Features • Unique murmur • May hear holosystolic murmur PMI left apex (MR murmur) due to left volume overload • Continuous machinery mumur is sometimes heard only at the left base (left armpit) • Hyperkinetic pulses • Often left apical heave on precordial palpation • Left CHF may be present if severe

6. Patent Ductus Arteriosus Echocardiographic Features • LV dilation • LA dilation • MPA jet dilation • Aortic dilation • Can see PDA at transverse MPA view • Doppler can find PDAs that aren’t easily visualized • FS hyperdynamic unless myocardial failure

7. Sub-Aortic Stenosis Clinical Features • Large breeds more common than small • Valvular and supravalvular stenosis very rare • Does not lend itself to balloon valvuloplasty • Patch grafts are being tried at TAMU • Anatomic expression may not occur until several weeks to months old • Disease can be progressive or regressive

8. Sub-Aortic Stenosis Clinical Features • Doppler is required to determine severity • Prognosis depends on severity • Mild – 0-50 mm Hg • Moderate – 50-100 mm Hg • Severe - >100 mm Hg

9. Sub-Aortic Stenosis Echocardiographic Features • IVS and LVPW thickening • An echodense ridge or band may be seen on the long LVOT view, especially if severe • Aortic valve may be abnormal • Thickened (rare) • Decreased movement (rare) • Delay in opening of AV after systole • Excessive systolic fluttering

10. Sub-Aortic Stenosis Echocardiographic Features • Doppler can identify those SAS which can not be visualized directly • FS usually normal to slightly increased

11. Sub-Aortic Stenosis Treatment • Treat arrhythmia if present • Atenolol 0.5 mg/kg PO BID • Treat left heart failure if present • Treat aortic regurgitation if present • Hydralazine 0.5 mg/kg PO BID • Titrate up to 2 mg/kg PO BID to reduce systolic BP by 10-20 mm Hg

12. ASD and VSD Clinical Features • Disease is a result of left to right shunting • This causes pulmonary hypertension and right heart failure • caudal caval distension, hepatic vein distension • jugular vein distension/pulses/reflux • Ascites • Pericardial effusion • Pleural effusion

13. ASD and VSD Echocardiographic Features - VSD • In dogs and cats, most VSDs occur in membranous IVS, at the top of the LV near the atria • Need to be 1 cm to reliably seen on echo • Doppler can find those that can not be seen directly • May see abnormal septal motion due to conduction interruption • Occasionally can see right cusp of AV prolapsing, creating aortic regurgitation • Huge RA and MPA; RV dilation

14. ASD and VSD Echocardiographic Features - ASD • ASD much less likely to cause clinical signs than VSD • Do not confuse with drop-out of fossa ovalis • Doppler can confirm • If large enough, may see right volume overload • Enlarged RA and RV • Enlarged MPA

15. Boxer Cardiomyopathy • Can be primarily ventricular arrhythmia • Can be primarily DCM • Can have both • If arrhythmia is primary, treatment of choice: • Sotalol 1-3 mg/kg PO BID • Beta blocker and class III antiarrhythmic