Cardio3- Semilunar Valve Dz

  1. Pulmonic stenosis is a common ___________ of __________.
    congenital heart disease; dogs
  2. Pulmonic stenosis is typically ___________ due to... (3)
    valvular obstruction; fusions, thickening, or hypoplasia.
  3. What causes secondary pulmonic stenosis?
    subvalvular obstruction due to RV hypertrophy
  4. Pulmonic stenosis is often accompanied by _________.
    patent foramen ovale
  5. What are characteristic lesions of pulmonic stenosis? (4)
    post-stenotic dilatation of PA, RV hypertrophy, +/- patent foramen ovale, +/- tricuspid regurg and RA enlargement
  6. What are Type A and Type B pulmonic stenosis?
    • Type A: fusion of valve leaflets
    • Type B: dysplasia of valve
  7. Describe the adjunct murmur that may be present with pulmonic stenosis.
    tricuspid regurg: holosystolic murmur low on the left
  8. What are historical findings common with pulmonic stenosis? (4)
    young dog, exercise intolerance, syncope, +/- asymptomatic
  9. What are PE findings common with pulmonic stenosis? (5)
    • ejection murmur loudest at left heart base
    • +/- systolic ejection sound (valve doming)
    • +/- murmur of TR on the right
    • jugular pulses
    • [if R-CHF] ascites
  10. Describe the murmur that is most commonly found with pulmonic stenosis. (3)
    • systolic
    • diamond-shaped (crescendo-decrescendo) phonocardiogram
    • left heart base area
  11. What are ECG findings common with pulmonic stenosis? (5)
    • right-axis deviation, small R wave, prominent S wave, RBBB, +/- increased P wave (if RA enlargement)
    • [only occur with moderate to severe disease!!! not consistent]
  12. What are radiographic findings that may be present with pulmonic stenosis? (2)
    RV enlargement, dilatation of main PA (post-stenotic)
  13. What echo abnormalities may be noted with pulmonic stenosis? (7)
    • thick dysplastic valve leaflets or leaflet fusion
    • post-stenotic dilatation of PA
    • RV hypertrophy +/- RA enlargement
    • dynamic RVOT obstruction 
    • flow turbulence in RVOT and MPA
    • increased velocity of flow on Doppler
    • +/- pulmonary and TV regurg
  14. Why might there be RVOT obstruction with pulmonic stenosis?
    d/t muscle hypertrophy and "squeezing"
  15. Where is the MPA normally seen on radiography?
    MPA is at 1 o'clock on VD
  16. Why might S waves be prominent with pulmonic stenosis?
  17. RV and RA enlargement with pulmonic stenosis is suggestive of concurrent ____________.
    patent foramen ovale
  18. What is the PW Doppler flow pattern of the RVOT with pulmonic stenosis? (3)
    • severely increased peak flow velocity (estimate pressure gradient with Bernoulli)
    • turbulent blood flow (not laminar)
    • often pulmonary regurg
  19. How is mild to moderate pulmonic stenosis managed?
    often no treatment, mild exercise restriction, do very well
  20. What are management options for high moderate to severe pulmonic stenosis? (6)
    exercise restriction, balloon catheter dilation (vavuloplasty), beta-blockers (atenolol), medical therapy of CHF, stenting of hypoplastic valve, DON'T BREED THESE DOGS
  21. In contrast to aortic stenosis, dogs with pulmonic stenosis DO NOT develop ____________.
  22. Why do we give beta-blockers to dogs with high moderate to severe pulmonic stenosis? (2)
    decreases dynamic RVOT obstruction, cardioprotective
  23. What breeds often have coronary anomalies concurrently with pulmonic stenosis, and what are the clinical implications of this?
    • Bulldogs, Frenchies, Boxers
    • cannot balloon dilate the stenotic PV
  24. What coronary anomaly can sometimes be present (in certain breeds) concurrently with pulmonic stenosis?
    only 1 single right coronary ostium and the left coronary artery comes off the right and wraps around the pulmonary valve [this is why we can't balloon dilate pulmonic stenosis in these cases--> would cut off the left coronary artery]
  25. With atrial septal defect, __________ may develop.
    cyanotic heart disease
  26. What gross lesions are associated with congenital aortic stenosis? (5)
    • fibrous/ fibromuscular or fibrocartilagenous tissue below the aortic valve [i.e. subaortic stenosis]
    • concentric LV hypertrophy (chronic pressure overload)
    • LV fibrosis (chronic)
    • dilatation of ascending aorta (d/t to turbulent blood flow and dissemination of kinetic energy)
    • intramural coronary arteries often sclerotic (wall thickening, luminal narrowing)
  27. What causes the post-stenotic dilatations?
    turbulent blood flow through the stenotic lesion and dissemination of kinetic energy (blood flowing at high velocity)
  28. Why might a dog with aortic stenosis die suddenly?
    intramural coronary arteries--> arteriosclerosis with wall thickening and luminal narrowing--> ischemia--> arrhythmias--> death
  29. ECG indicator of myocardial ischemia.
    ST segment depression
  30. With aortic stenosis, the _____________ is proportional to the _____________ (which is why we can use Bernoulli to estimate severity).
    velocity of flow across the stenosis; pressure gradient b/w the 2 chambers
  31. What pressure gradient, as calculated by Bernoulli's, is considered severe aortic stenosis?
  32. Describe the murmur associated with aortic stenosis. (4)
    • [indistinguishable from pulmonic stenosis- differentiate based on pulse quality]
    • left hear base area
    • ejection murmur/ systolic
    • diamond-shaped/ crescendo-decrescendo
  33. What are PE findings with aortic stenosis? (2)
    left heart base ejection murmur with hypokinetic pulses
  34. What ECG findings are common with aortic stenosis? (3)
    increased R amplitude(LVH), ST segment depression, ventricular ectopy (VPCs)+/- bigeminal distribution
  35. Where is the aorta located on radiographs?
    11-1 o'clock is aortic valve/aorta on VD
  36. What are radiographic findings common with aortic stenosis? (2)
    LV enlargement, post-stenotic dilatation
  37. What are echo findings common with aortic stenosis? (7)
    subaortic obstruction, LV hypertrophy, aortic dilatation, progressive LV systolic dysfunction (if severe), aortic regurgitation, turbulent flow (not laminar) in LVOT, aortic insufficiency, may be normal with mild disease
  38. What historical findings may be present with canine subaortic stenosis? (3)
    no signs, +/- exercise intolerance, +/- syncope
  39. When does aortic stenosis develop?
    it is heritable and they are born with it, but it is not detectable at birth; subaortic stenosis is NOT detectable at birth or within the first 3 weeks of life; you might not find it until a few months old
  40. What are outcomes of aortic stenosis? (5)
    exercise intolerance, syncope, sudden cardiac death, L-CHF (rarely), bacterial endocarditis
  41. What is the management for mild to moderate aortic stenosis?
    none, maybe exercise intolerance
  42. What is the management for high moderate to severe aortic stenosis? (5)
    exercise restriction, beta-blockade (atenolol), medical management of CHF, prophylactic antibiotics (to avoid bacterial endocarditis), +/- cutting balloon
  43. Aortic valve degeneration is most common in __________.
    older horses
  44. Describe the murmur associated with aortic valve degeneration. (3)
    • left mid-thoracic
    • holodiastolic heart murmur 
    • musical/ decrescendo
  45. What gross lesions are associated with aortic degeneration? (3)
    • severe aortic valve thickening and degeneration
    • valve prolapse
    • linear beads/bands
  46. Describe the pathophysiology of aortic regurgitation.
    insufficiency of aortic valve leading to LV volume overload
  47. Describe the diagnosis of aortic valve degeneration in horses. (3)
    • arterial pulses often hyperkinetic
    • holodiastolic heart murmur over aortic valve area
    • confirm with echo
  48. Describe the management of aortic degeneration in a horse.
    • rarely a clinical problem (only if severe)
    • exercise restriction
  49. What is the Bernoulli Equation? (actual values)
    pressure gradient = 4(peak velocity)²
  50. What is the main difference in arterial pulse quality between SAS and PS?
    • with PS, femoral pulses are normal
    • with SAS, femoral pulses are weak/ hypokinetic
Card Set
Cardio3- Semilunar Valve Dz
vetmed cardio3