Transcript Name of presentation

Basic Echocardiography
Additional Information
Wendy Blount, DVM
Nacogdoches TX
Heartworm Disease
Video
Cardiac Masses
DDx
• Chemodectoma
• HSA
• Myxosarcoma
• Ectopic thyroid carcinoma
• Mesothelioma
• LSA
• fibrosarcoma
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
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
Patent Ductus Arteriosus
Echocardiographic Features
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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
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
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
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
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Thickened (rare)
Decreased movement (rare)
Delay in opening of AV after systole
Excessive systolic fluttering
Sub-Aortic Stenosis
Echocardiographic Features
• Doppler can identify those SAS which can not
be visualized directly
• FS usually normal to slightly increased
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
ASD and VSD
Clinical Features
• Disease is a result of left to right shunting
• This causes pulmonary hypertension and right
heart failure
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caudal caval distension, hepatic vein distension
jugular vein distension/pulses/reflux
Ascites
Pericardial effusion
Pleural effusion
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
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
Boxer Cardiomyopathy
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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
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
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
Right to Left shunting
Reverse PDA
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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