Radiology2- Congenital Heart Disease

  1. What are potential causes of a heart murmur when advanced diagnostics are normal? (3)
    • innocent murmur
    • physiologic murmur (fever, dehydration)
    • mild congenital causes
  2. What are congenital differentials for a patient with a systolic murmur and cyanosis? (3)
    • tetralogy of fallot
    • pulmonary hypertension
    • reversed PDA/ VSD/ASD
  3. What are congenital differentials for a left-sided systolic heart murmur with no cyanosis? (4)
    • pulmonary stenosis (heart base PMI)
    • atrial septal defect (heart base PMI)
    • sub-aortic stenosis
    • mitral dysplasia (apex PMI)
  4. What are congenital differentials for a right-sided systolic heart murmur with no cyanosis? (4)
    • ventricular septal defect
    • endocardial cushion defect
    • tricuspid dysplasia
    • sub-aortic stenosis
  5. What are types and congenital causes (3) of systolic+ diastolic heart murmurs?
    • continuous murmur- PDA
    • to and fro murmur- sub-aortic stenosis and aortic insufficiency or ventricular septal defect and aortic insufficiency
  6. Describe eccentric myocardial hypertrophy.
    • dilation of the chamber to accommodate volume
    • usually radiographically identifiable
  7. Describe concentric myocardial hypertrophy.
    • thickening of the myocardium to accommodate pressure
    • may or may not be radiographically identifiable
  8. What are the most common congenital causes of heart murmurs in dogs and cats? (4 each)
    • Dogs: pulmonic stenosis, PDA, aortic stenosis, VSD
    • Cats: VSD, aortic stenosis, pulmonic stenosis, HCM with OLVOT (<--is that really congenital tho?)
  9. What breeds are predisposed to pulmonic stenosis? (7)
    • English bulldog (esp males; correlated with coronary anomalies)
    • Beagle
    • Chihuahua
    • Mastiff
    • Samoyed
    • Keeshond
    • Fox terrier
  10. Describe the specific location and pathophysiology of pulmonic stenosis. (3)
    • valvular stenosis (unlike SAS)
    • concentric myocardial hypertrophy first d/t increased pressure in right heart THEN eccentric hypertrophy
    • post-stenotic dilatation of main pulmonary artery
  11. What are radiographic findings associated with pulmonic stenosis? (3)
    • right atrial and ventricular enlargement- Reverse D on VD projection
    • bulge at pulmonary trunk (post-stenotic dilatation)
    • pulmonary vasculature is normal to under-circulated
  12. What are breed dispositions for sub-aortic stenosis?
    generally large breed dogs
  13. What is the specific location and pathophysiology of sub-aortic stenosis?
    • sub-aortic stenosis (below the valves, within the LV); fibrous ridge in the LV outflow tract
    • concentric myocardial hypertrophy first d/t pressure overload in left heart then eccentric hypertrophy
    • post-stenotic dilatation of the aorta
  14. What are radiographic findings with sub-aortic stenosis? (4)
    • prominent "cranial waist" on lateral projections (enlarged/ dilated aortic arch)
    • widening of the cranial mediastinum on VD
    • LV enlargement +/- LA enlargement
    • normal pulmonary vasculature
  15. What is the specific location of a PDA?
    • normal fetal structure b/w the descending aorta and pulmonary artery
    • becomes a PDA when it fails to close within 72hr of birth (should become ligamentum arteriosus)
  16. What is the pathophysiology of a PDA?
    connection b/w high pressure systemic circulation and low pressure pulmonary circulation--> volume overload
  17. What are radiographic findings with PDA? (4)
    • three notches: aortic arch, main pulmonary artery, and left auricle
    • LA and LV enlargement
    • +/- increased width of cardiac silhouette
    • enlarged pulmonary arteries and veins (over-circulation)
  18. What is Eisenmenger Syndrome?
    • systemic to pulmonary circulation connection and left-to-right shunting of blood
    • --> increased pulmonary blood flow, irreversible pulmonary vasculature injury, irreversible pulmonary vasculature resistance--> REVERSAL OF SHUNT, begins shunting right-to left--> cyanosis, hypoxia, and erythrocytosis
  19. What is the most common congenital heart defect in cats?
    VSD
  20. What is the specific location and pathophysiology of VSDs?
    • most commonly high in the membranous septum
    • small defects make a loud noise but may be non-symptomatic
    • large defects may be quieter but shunt from high-pressure left to low-pressure right--> volume overload
  21. What are radiographic findings associated with VSDs? (7)
    • enlarged pulmonary arteries and veins
    • +/- RV enlargement
    • +/- dilated pulmonary trunk
    • cats: cardiomegaly on lateral rads, dilated/ tortuous pulmonary vessels, enlarged CVC, +/- pulmonary edema
  22. What are some possible locations of atrial septal defects? (2)
    • ostium secundum: foramen ovale (middle)
    • ostium primum: base of atrial septum at endocardial cushion (may be associated with tricuspid or mitral dysplasia)
  23. Describe the pathophysiology of ASD.
    • small defects may be non-symptomatic
    • large defects shunt from high pressure left to low pressure right
  24. What are radiographic findings associated with ASDs? (4)
    • enlarged pulmonary arteries and veins
    • RA enlargement
    • +/- RV enlargement
    • +/- MPA dilation
  25. Great vessel defects are often found as a result of...
    regurgitation or "vomiting" (what the client thinks) after eating d/t extraluminal stricture at heart base
  26. What are the different vascular ring anomalies?
    • persistent right aortic arch (most common) with left ductus arteriosus
    • aberrant right subclavian artery
    • double aortic arch
Author
Mawad
ID
329635
Card Set
Radiology2- Congenital Heart Disease
Description
vetmed radiology2
Updated