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Basic Echocardiography Additional Information

Learn about echocardiographic features, clinical signs, and treatment of common heart conditions like cardiac masses, patent ductus arteriosus, and sub-aortic stenosis in animals. Discover how to diagnose and manage ASD, VSD, and other cardiac issues.

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Basic Echocardiography Additional Information

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  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

  16. Right to Left shunting DDx • Reverse PDA • Eisenmeinger’s physiology • Tetralogy of Fallot • AV fistula with pulmonary hypertension Diagnosis • Bubble study • Pulse oximetry for reverse PDA

  17. Right to Left shunting Bubble Study • Place venous catheter • Shake 5-10 cc saline vigorously • Place US probe where you can look for shunting • Long 4 chamber view • Abdominal aorta • Inject IV quickly • Watch for bubbles on the right • False negatives when bubbles disperse quickly

  18. Right to Left shunting Reverse PDA • Often do not have a murmur • Often present for cyanosis or seizures/neuro • Rads similar to PDA • Treatment • Periodic phlebotomy (10 ml/lb + IV fluid therapy) • Prognosis • Can do well in the short term • Depending on how long phlebotomy gives relief • Poor prognosis long term

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