PowerPoint - Echocardiography 2

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PowerPoint - Echocardiography 2

  1. 1. Basic Echocardiography Additional Information Wendy Blount, DVM Nacogdoches TX
  2. 2. Heartworm Disease Video
  3. 3. Cardiac Masses DDx • Chemodectoma • HSA • Myxosarcoma • Ectopic thyroid carcinoma • Mesothelioma • LSA • fibrosarcoma
  4. 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. 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. 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. 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. 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. 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. 10. Sub-Aortic Stenosis Echocardiographic Features • Doppler can identify those SAS which can not be visualized directly • FS usually normal to slightly increased
  11. 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. 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. 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. 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. 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

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