1. Basic Echocardiography Additional Information Wendy Blount, DVM Nacogdoches TX 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