Backwell's 5 Min Veterinary Consult

8/20/2019 Backwell's 5 Min Veterinary Consult

1/120

Cardiology

A John Wiley & Sons, Ltd., Publication

Figure 7. Aortic thromboembolism.

Topic-Ascites

Figure 1. Ascites in a dog—lateral radiography.

Figure 2. A dog with ascites.

Topic-Atrial Fibrillation and Atrial Flutter

Figure 1. Atrial utter with 2:1 conduction at ventricularrate of 330/minute in a dog with an atrial septal defect.

This supraventricular tachycardia was associated witha Wolff-Parkinson-White pattern. (From: Tilley, L.P.Essentials of canine and feline electrocardiography,3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Figure 2. “Coarse” atrial brillation in a dog withpatent ductus arteriosus. The f waves are prominent.(From: Tilley, L.P. Essentials of canine and felineelectrocardiography, 3rd ed. Baltimore: Williams &

Wilkins, 1992, with permission.)

Topic-Aortic Stenosis

Figure 1. Angiogram of aortic stenosis.

Figure 2. Postmortem of a dog with subaortic stenosisdemonstrating left ventricular (LV) hypertrophy, aorticpost-stenotic dilation (Ao), and a subvalvular brousridge (instrument pointer).

Figure 3. Two-dimensional echocardiograph, rightparasternal long axis view, demonstrating a subvalvular

ridge typical of subaortic stenosis. Thickening of theanterior mitral valve leaet (MV) is also apparent. Aorta(Ao), left ventricle (LV), and left atrium (LA).

Figure 4. Similar to 1A with color ow Doppler overlaydemonstrating turbulent ow distal to the obstruction.

Topic-Aortic Thromboembolism

Figure 1.

Figure 2. A cat with thrombus of the left forelimb.

Figure 3. A cat with thrombus and cyanotic pads.

Figure 4. Postmortem thrombus in a cat.




2/120

Cardiology


Topic-Atrial Standstill

Figure 1. Persistent atrial standstill in English springerspaniel. No P waves are present on any of theleads (also including chest leads and intracardiacelectrocardiogram, not shown here). The regularbradycardia is either junctional in origin, with pathologicinvolvement of the left bundle branch block (widepositive QRS complexes), or ventricular. (From: Tilley,L.P. Essentials of canine and feline electrocardiography.

3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Topic-Atrial Wall Tear

Figure 1. Gross specimen—left atrial tear

Figure 2. Right parasternal short axis echocardiographicimage at the level of the aorta and left atrium. The arrowpoints to an intra-atrial thrombus attached to the atrialwall at the junction of the body of the left atrium and the

left auricular appendage. Severe left atrial enlargementand pericardial effusion are present. LAA= Left auricularappendage; LA=Left atrium; PE=Pericardial effusion.

Topic-Atrial Premature Complexes

Figure 1. APC in a dog. P9 represents the prematurecomplex. The premature QRS resembles the basicQRS. The upright P9 wave is superimposed on the Twave of the preceding complex. APC. (From: Tilley,L.P. Essentials of canine and feline. 3rd ed. BlackwellPublishing, 1992, with permission.)

Figure 2. APCs in bigeminy in a cat under generalanesthesia. The second complex of each pair isan APC, where the rst is a sinus complex. Theabnormality in rhythm disappeared after the anestheticwas stopped. (From: Tilley, L.P. Essentials of canine andfeline electrocardiography. 3rd ed. Blackwell Publishing,1992, with permission.)

Topic-Atrial Septal Defect

Figure 1. Atrial septal defect. Defect involves thelowermost part of the atrial septum, known as ostium

primum defect. Note the left dominant left-to-rightshunt. RV = right ventricle, LV = left ventricle, RA =right atrium, Ao = aorta, PT = pulmonary trunk. (FromRoberts W. Adult congenital heart disease. Philadelphia: FA Davis Co., 1987, with permission.)


3/120

Cardiology


Figure 2. Complete heart block in a cat. The P wavesrate is 240/minute, independent of the ventricularrate of 48/minute. QRS conguration is a left bundlebranch block pattern. (From: Tilley, L.P. Essentials ofcanine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Figure 3. Lateral radiograph of a dog with transvenouspacemaker.

Topic-Atrioventricular Block, First DegreeFigure 1. Lead II ECG rhythm strip recorded froma cat with hypertrophic cardiomyopathy. There issinus bradycardia (120 beats/minute) and rst degreeatrioventricular conduction block. The PR interval is0.12 second. (paper speed = 50 mm/s)

Figure 2. Lead II ECG rhythm strip recorded from a dogshowing sinus tachycardia (175 beats/minute) and rstdegree atrioventricular conduction block. Because theheart rate is rapid, P waves are superimposed on thedownslope of the preceding T waves. The PR intervalexceeds 0.16 second. (paper speed = 50 mm/s)

Figure 3. Right parasternal short axis echocardiographicimage at the level of the left ventricle (LV). Pericardialeffusion is noted and a characteristic linear thrombus isseen within the pericardial sac adjacent to the LV. LV=left ventricle; PE=pericardial effusion.

Figure 4. Gross cardiac specimen from a dog withadvanced mitral endocardiosis that died following anacute left atrial tear. The probe is pointing to a 2 cmtear in the left atrial wall at the junction of the body of

the left atrium and left auricular appendage. LAA=leftauricular appendage; LA=left atrium. Photo courtesy ofDr. Richard Jakowski.

Topic-Atrioventricular Block, Complete(Third Degree)

Figure 1. Complete heart block. The P waves occur ata rate of 120, independent of the ventricular rate of 50.The QRS conguration is a right bundle branch blockpattern. The regular rate and stable QRS indicate thatthe rescuing focus is probably near the AV junction.(From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)


4/120

Cardiology


Topic-Atrioventricular Valvular Stenosis

Figure 1. This image of the liver in a dog with tricuspidstenosis and right heart failure shows markedlydistended hepatic veins.

Figure 2. This continuous wave Doppler recordingacross the tricuspid valve in a dog with tricuspidstenosis illustrates the prolonged pressure half time(evidenced by the slope of the line between E and Fpoints) and the prominent atrial contribution (A) to lling. This animal also had tricuspid regurgitation.

Topic-Cardiomyopathy, Dilated - Cats

Figure 1. Postmortem of dilated cardiomyopathy (cat).

Figure 2. Echocardiogram of dilated cardiomyopathy(cat).

Topic-Cardiomyopathy, Dilated - Dogs

Figure 1. Gross postmortem of dilated cardiomyopathy

(dog).

Figure 2. Electrocardiographic ndings.

Topic-Cardiomyopathy, Hypertrophic - Cats

Figure 1. Dyspnea in a cat.

Topic-Atrioventricular Block, SecondDegree - Mobitz Type I

Figure 1. Lead II ECG strip recorded from a dogwith Mobitz type I, second degree AV block. The PRintervals become progressively longer with the longestPR intervals preceding nonconducted P waves (typicalWenkebach phenomenon). (paper speed = 50 mm/s)

Topic-Atrioventricular Block, Second

Degree - Mobitz Type IIFigure 1. Lead II ECG rhythm strip recorded from a dogwith both rst- and second-degree atrioventricular block. The second-degree AV block is high grade with both 2:1and 3:1 block resulting in variation in the RR intervals.The PR interval for the conducted beats is prolongedbut constant (0.28 second) (paper speed = 25 mm/s).

Topic-Atrioventricular Valve Dysplasia

Figure 1. Lateral radiographs of mitral valve dysplasia.

Topic-Atrioventricular Valve Endocardiosis

Figure 1. Postmortem of valvular endocardiosis.

Figure 2. Lateral radiograph of mitral valveendocardiosis.


5/120

Cardiology


Figure 3. Jugular distension in a cat with right-sidedcongestive heart failure.

Figure 4. Abdominal venous distension in a dog with right-sided heart failure.

Topic-Digoxin Toxicity

Figure 1. “Sagging” type of S-T segment depression in a dog with digitalis toxicity.

Topic-Endocarditis, InfectiveFigure 1. Gross postmortem of bacterial endocarditis

Figure 2. Echocardiogram of bacterial endocarditis.

Figure 3. Echocardiogram of bacterial endocarditis.

Topic-Heartworm Disease - Cats

Figure 1. Gross postmortem of heartworm disease incat.

Topic-Heartworm Disease - DogsFigure 1a. Microlaria of dirolaria andacanthocheilonema (Justin A. Thomason).

Figure 1b. Microlaria of dirolaria andacanthocheilonema (Justin A. Thomason).

Figure 2. Chest radiograph (lateral) of hypertyrophiccardiomyopathy (cat).

Figure 3. Chest radiography (dorsoventral) ofhypertrophic cardiomyopathy (cat).

Figure 4. Echocardiogram of hypertrophiccardiomyopathy (cat).

Figure 5. Gross postmortem of hypertrophiccardiomyopathy (cat).

Figure 6. Angiocardiogram of hypertrophiccardiomyopathy (cat).

Topic-Cardiomyopathy, Restrictive - Cats

Figure 1. Cardiomyopathy, restrictive–cats.

Topic-Congestive Heart Failure, Left-Sided


Figure 2. Cachexia in a dog.

Topic-Congestive Heart Failure, Right-Sided

Figure 1. Ascites in a dog—lateral radiography.

Figure 2. A dog with ascites.


6/120

Cardiology


Topic-Left Anterior Fascicular Block

Figure 1. Left anterior fascicular block in a cat withhypertrophic cardiomyopathy. Severe left axis deviation(2608) with a qR pattern in leads I and aVL and an rSpattern in leads II, III, and aVF. The QRS complexesare of normal duration. (From: Tilley, L.P. Essentials ofcanine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Figure 2. Left anterior fascicular block in a dog withhyperkalemia (serum potassium, 5.3 mEq/L). There isabnormal left axis deviation (260_) with a qR patternin leads I and aVL and an rS pattern in leads II, III,and aVF. The large T waves are compatible withhyperkalemia. (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Figure 2. Dorsoventral radiograph of heartworm disease in a dog.

Figure 3. Echocardiogram of heartworm disease.

Figure 4. Gross postmortem of heartworm disease in a dog.

Topic-Idioventricular Rhythm

Figure 1. Ventricular escape complexes (arrows) duringvarious phases in the dominant sinus rhythm in a dogduring anesthesia. The sinus rate increased (not shown)after anesthesia was stopped; 1/2 cm1 mv. (From: Tilley,L.P. Essentials of canine and feline electrocardiography.3rd ed. Blackwell Publishing, 1992, with permission.)

Figure 2. Complete heart block. The P waves occur ata rate of 120, independent of the ventricular rate of 50.The QRS conguration is a right bundle branch blockpattern. The regular rate and stable QRS indicate thatthe rescuing focus is probably near the AV junction.

(From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)


7/120

Cardiology


Topic-Murmurs, Heart

Figure 1. Differential diagnosis of cardiac diseasebased on the timing and location of murmurs. (Adaptedfrom Allen, D.G. Murmurs and abnormal heart sounds.By permission of Mosby-Year Book, Inc. In: Allen,D.G., Kruth, S.A., eds. Small animal cardiopulmonarymedicine. Philadelphia: BC Decker, 1988:13.)

Topic-Myocardial Infarction

Figure 1. Transmural infarction of the left ventricle in adog with arteriosclerosis and hypothyroidism. The rstthree rapid successive complexes represent ventriculartachycardia. The sinus rhythm that follows illustratessmall complexes, marked elevation of the S-T segment,and rst degree AV block (prolonged P-R interval).(From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)

Topic-Patent Ductus ArteriosusFigure 1. Angiocardiogram of patent ductus arteriosus.

Figure 2. Patent ductus arteriosus.

Topic-Left Bundle Branch Block

Figure 1. Left bundle branch block in a cat withhypertrophic cardiomyopathy. The QRS complex isof 0.07-second duration and is positive in leads I, II,III, aVF. Neither a Q wave nor an S wave occurs inthese leads. The QRS complex is inverted in leadsaVR.” (From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)

Figure 2. Intermittent left bundle branch block in aChihuahua. QRS complexes are wider (0.07–0.08second) in the second, third, and fourth complexes andin the last three complexes. Consistent P-R intervalconrms a sinus origin for the abnormal-appearingQRS complexes (lead II, 50 mm/second, 1 cm 5 1mV). (From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)


8/120

Cardiology


Figure 3. Instrumentation used for pericardiocentesis. A 14g 5½“catheter and stylus are shown with a smallsyringe attached, i.e. congured to advance into thepericardial space. The sharp metal stylus is removedafter the catheter is fully positioned, as demonstratedfor the 16g 5½“catheter, and an extension tube attachedto the catheter for aspiration using a larger syringe and3-way stopcock. An 18g 2” catheter is used for cats andsimilarly sized dogs. A #11 blade is ideal for creating asmall stab incision at the site of entry. The author usesa #10 blade to cut side holes in the distal end of thelarger catheters (optional).

Topic-Pleural Effusion


Figure 2. Radiograph of pleural effusion–lateral (dog).

Topic-Pulmonic Stenosis

Figure 1. Ventrodorsal radiograph of a dog with

pulmonic stenosis. There is a marked right ventricularenlargement, with the apex shifted to the left. Aprominent pulmonary artery bulge is visible (arrow)(Virginia Luis Fuentres).

Topic-Pericarditis

Figure 1. The photograph demonstrates catheterpositioning and orientation for pericardiocentesisfrom the right ventral approach. While stabilizing thecatheter near the entry point with one hand, the catheteris advanced in a cranial and dorsal direction withthe other, i.e. towards the opposite scapula. A smalldegree of suction is maintained with the syringe so thatpericardial uid is aspirated at the moment of pericardial

penetration. Subsequently the syringe and stylet areheld stationary while the exible catheter is advancedwell into the pericardium. The sharp metal stylet iswithdrawn after the catheter is fully positioned.

Figure 2. Echocardiograph acquired with transducerat the same location and orientation (direction) as thecatheter shown above. Dotted line indicates structuresencountered by the central ultrasound beam, i.e. inthe path of the catheter. While this patient had arelatively small amount of pericardial effusion (PE),proper catheter positioning, orientation, and linearadvancement minimizes risk. Oblique orientation of thecatheter, relative to the cardiac surface, increases theeffective distance between the pericardium and heart.


9/120


10/120

Cardiology


Topic-Sinus Bradycardia

Figure 1. Sinus bradycardia at a rate of 75 beats/minute in a cat during anesthetic complications duringsurgery. (From: Tilley, L.P. Essentials of canine andfeline electrocardiography. 3rd. ed. Baltimore: Williams& Wilkins, 1992, with permission.

Topic-Sinus Tachycardia

Figure 1. Sinus tachycardia at a rate of 272/minute in a

dog in shock. The rhythm is sinus because the P wavesare normal, the P-R relationship is normal, and therhythm is regular. (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. Baltimore:Williams & Wilkins, 1992, with permission.)

Topic-Supraventricular Tachycardia

Figure 1. Sinus with an atrial premature complexand paroxysmal supraventricular tachycardia. Abruptinitiation and termination of the tachycardia helpdistinguish it from sinus tachycardia (lead II, 50 mm/second, 1 cm = 1 mV). (From: Tilley, L.P. Essentialsof canine and feline electrocardiography. 3rd ed.Baltimore: Williams & Wilkins, 1992, with permission.)

Topic-Sinus Arrest and Sinoatrial Block

Figure 1. Intermittent sinus arrest in a brachycephalicbreed with an upper respiratory disorder and episodesof fainting. The pauses (1 and 1.44 seconds) are greaterthan twice the normal R-R interval (0.46). (From: Tilley,L.P. Essentials of canine and feline electrocardiography.3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Topic-Sinus ArrhythmiaFigure 1. Respiratory sinus arrhythmia with an averagerate of 120/minute (paper speed, 25 mm/second; 6complexes between 1 set of time lines m 20). The rateincreases during inspiration (INSP) and decreasesduring expiration (EXP). The uctuation of the baselinecorrelates with the movement of the electrodes by thethoracic cavity. (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. Baltimore:Williams & Wilkins, 1992, with permission.)


11/120

Cardiology


Figure 4. Example of ventricular arrhythmia seen inseverely affected German shepherds with inheritedarrhythmias and propensity for sudden death. Courtesy of Sydney Moise.

Figure 5. Example of ventricular arrhythmia seen inseverely affected German shepherds with inheritedarrhythmias and propensity for sudden death. Courtesyof Sydney Moise.

Topic-Ventricular Fibrillation

Figure 1. Coarse ventricular brillation. (From: Tilley,L.P. Essentials of canine and feline electrocardiography.3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Figure 2. Ventricular utter-brillation in a cat withsevere myocardial damage from an 11-story fall. Thecomplexes are very wide, bizarre, tall, and rapid.(From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Baltimore: Williams &Wilkins, 1992, with permission.)

Topic-SyncopeFigure 1

Topic-Tetralogy of Fallot

Figure 1. Classic Tetralogy of Fallot.

Topic-Ventricular Arrhythmias and SuddenDeath in German Shepherds


Figure 2. Example of ventricular arrhythmia seen inseverely affected German shepherds with inheritedarrhythmias and propensity for sudden death.Courtesyof Sydney Moise.



12/120

Cardiology


Topic-Ventricular Septal DefectFigure 1 Ventricular septal defect. The defect isan unobstructed communication. Right ventricularhypertrophy and pulmonary hypertension areassociated. Left-to-right shunting is shown. RA =right atrium, LA = left atrium, RV = right ventricle,LV = left ventricle, AO = aorta, PT = pulmonary trunk.(From: Roberts, W. Adult Congenital Heart Disease.Philadelphia: F.A. Davis, 1987, with permission.)

Figure 2. Angiocardiogram of ventricular septal defect.

Figure 3. Necropsy specimen of ventricular septaldefect.

Topic-Ventricular Standstill (Asystole)

Figure 1. Ventricular asystole in a dog with severecomplete AV block. Only P wages (atrial activity) arepresent; there is no ventricular activity. (Lead II, 50 mm/second, 1 cm = 1 mV) (From: Tilley, L.P. Essentials of

canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Topic-Ventricular Premature ComplexesFigure 1. VPC and a fusion complex (fth complex)in a dog with myocarditis from a pancreatitis. Afusion complex is the simultaneous activation of theventricle by impulses coming from the SA node andthe ventricular ectopic foci. The QRS complex isintermediate in form. (From: Tilley, L.P. Essentialsof canine and feline electrocardiography. 3rd ed.Baltimore: Williams & Wilkins, 1992, with permission.)

Figure 2. Ventricular bigeminy. Every other complex is aVPC from the same focus. Each is coupled (interval thesame between it and the adjacent sinus complex) to thepreceding normal complex. (From: Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed.Baltimore: Williams & Wilkins, 1992, with permission.)


13/120

Cardiology


Topic-Wolff-Parkinson-White SyndromeFigure 1. Wolff-Parkinson-White syndrome (canine).Ventricular pre-excitation represented by the shortP-R interval, wide QRS complex, and delta wave(arrow) in CV6LU. Paroxysms of supraventriculartachycardia are represented in the long lead II rhythmstrip. (From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)

Figure 2. Ventricular pre-excitation in a cat withepisodes of fainting. The P waves are normal, the P-Rinterval is short, and the QRS complex is wide; deltawaves (arrow) are present. (From: Tilley, L.P. Essentialsof canine and feline electrocardiography. 3rd ed.Blackwell Publishing, 1992, with permission.)

Figure 2. Ventricular asystole in a cat with severehyperkalemia (11 mEq/L) from urethral obstruction. NoP waves or QRS complexes are seen after four wideand nozaree QRS complexes (atrial standstill withdelayed ventricular conduction). (lead II, 50 mm/sec, 1cm = 1 mV) (From: Tilley LP: Essentials of canine andfeline electrocardiography. 3rd ed. Blackwell Publishing, 1992, with permission.)

Topic-Ventricular Tachycardia

Figure 1. Ventricular tachycardia. The wide and bizarreQRS complexes occur at a rate of 160 beats/minute,with no relationship to the P waves. There are moreQRS complexes than P waves. Ventricular tachycardiashould be treated as soon as possible. Acid-base andelectrolyte abnormalities should always be corrected.(From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Baltimore: Williams &Wilkins, 1992, with permission.)


14/120

Cardiology


Topic-Aortic Stenosis Figure 1. Angiogram of aortic stenosis.


15/120

Cardiology


Topic-Aortic Stenosis Figure 2. Postmortem of a dog with subaortic stenosis demonstratingleft ventricular (LV) hypertrophy, aortic post-stenotic dilation (Ao), and asubvalvular brous ridge (instrument pointer).


16/120

Cardiology


Topic-Aortic Stenosis Figure 3. Two-dimensional echocardiograph, right parasternal long axisview, demonstrating a subvalvular ridge typical of subaortic stenosis.Thickening of the anterior mitral valve leaet (MV) is also apparent. Aorta(Ao), left ventricle (LV), and left atrium (LA).


17/120

Cardiology


Topic-Aortic Stenosis Figure 4. Similar to 1A with color ow Doppler overlay demonstratingturbulent ow distal to the obstruction.


18/120

Cardiology


Topic-Aortic Thromboembolism Figure 1.


19/120

Cardiology


Topic-Aortic Thromboembolism Figure 2. A cat with thrombus of the left forelimb.


20/120

Cardiology


Topic-Aortic Thromboembolism Figure 3. A cat with thrombus and cyanotic pads.


21/120

Cardiology


Topic-Aortic Thromboembolism Figure 4. Postmortem thrombus in a cat.


22/120

Cardiology


Topic-Aortic Thromboembolism Figure 5. Aortic thromboembolism.


23/120

Cardiology




24/120

Cardiology




25/120

Cardiology


Topic-Ascites Figure 1. Ascites in a dog—lateral radiography.


26/120

Cardiology


Topic-Ascites Figure 2. A dog with ascites.


27/120

Cardiology


Topic-Atrial Fibrillation and Atrial Flutter Figure 1. Atrial utter with 2:1 conduction at ventricular rate of 330/minutein a dog with an atrial septal defect. This supraventricular tachycardiawas associated with a Wolff-Parkinson-White pattern. (From: Tilley, L.P.Essentials of canine and feline electrocardiography, 3rd ed. Baltimore:Williams & Wilkins, 1992, with permission.)


28/120

Cardiology


Topic-Atrial Fibrillation and Atrial Flutter Figure 2. “Coarse” atrial brillation in a dog with patent ductus arteriosus.The f waves are prominent. (From: Tilley, L.P. Essentials of canine andfeline electrocardiography, 3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)


29/120

Cardiology


Topic-Atrial Premature Complexes Figure 1. APC in a dog. P9 represents the premature complex. The

premature QRS resembles the basic QRS. The upright P9 wave issuperimposed on the T wave of the preceding complex. APC. (From: Tilley,L.P. Essentials of canine and feline. 3rd ed. Blackwell Publishing, 1992,with permission.)


30/120

Cardiology


Topic-Atrial Premature Complexes Figure 2. APCs in bigeminy in a cat under general anesthesia. The second

complex of each pair is an APC, where the rst is a sinus complex. Theabnormality in rhythm disappeared after the anesthetic was stopped.(From: Tilley, L.P. Essentials of canine and feline electrocardiography. 3rded. Blackwell Publishing, 1992, with permission.)


31/120

Cardiology


Topic-Atrial Septal Defect Figure 1. Atrial septal defect. Defect involves the lowermost part of theatrial septum, known as ostium primum defect. Note the left dominant left-to-right shunt. RV = right ventricle, LV = left ventricle, RA = right atrium, Ao = aorta, PT = pulmonary trunk. (From Roberts W. Adult congenital heartdisease. Philadelphia: FA Davis Co., 1987, with permission.)


32/120

Cardiology


Topic-Atrial Standstill Figure 1. Persistent atrial standstill in English springer spaniel. No Pwaves are present on any of the leads (also including chest leads andintracardiac electrocardiogram, not shown here). The regular bradycardia

is either junctional in origin, with pathologic involvement of the left bundlebranch block (wide positive QRS complexes), or ventricular. (From: Tilley,L.P. Essentials of canine and feline electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, with permission.)


33/120

Cardiology


Topic-Atrial Wall Tear Figure 1. Gross specimen—left atrial tear


34/120


35/120

Cardiology


Topic-Atrial Wall Tear Figure 3. Right parasternal short axis echocardiographic image at the level of the left ventricle (LV). Pericardial effusion is noted and a characteristiclinear thrombus is seen within the pericardial sac adjacent to the LV. LV=left ventricle; PE=pericardial effusion.


36/120

Cardiology


Topic-Atrial Wall Tear Figure 4. Gross cardiac specimen from a dog with advanced mitralendocardiosis that died following an acute left atrial tear. The probe ispointing to a 2 cm tear in the left atrial wall at the junction of the body ofthe left atrium and left auricular appendage. LAA=left auricular appendage;LA=left atrium. Photo courtesy of Dr. Richard Jakowski.


37/120

Cardiology


Topic-Atrioventricular Block, Complete (Third Degree) Figure 1. Complete heart block. The P waves occur at a rate of 120,independent of the ventricular rate of 50. The QRS conguration is a right

bundle branch block pattern. The regular rate and stable QRS indicatethat the rescuing focus is probably near the AV junction. (From: Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)


38/120

Cardiology


Topic-Atrioventricular Block, Complete (Third Degree) Figure 2. Complete heart block in a cat. The P waves rate is 240/minute,independent of the ventricular rate of 48/minute. QRS conguration is aleft bundle branch block pattern. (From: Tilley, L.P. Essentials of canine

and feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, withpermission.)


39/120

Cardiology


Topic-Atrioventricular Block, Complete (Third Degree) Figure 3. Lateral radiograph of a dog with transvenous pacemaker.


40/120

Cardiology


Topic-Atrioventricular Block, First Degree Figure 1. Lead II ECG rhythm strip recorded from a cat with hypertrophiccardiomyopathy. There is sinus bradycardia (120 beats/minute) and rst

degree atrioventricular conduction block. The PR interval is 0.12 second.(paper speed = 50 mm/s)


41/120

Cardiology


Topic-Atrioventricular Block, First Degree Figure 2. Lead II ECG rhythm strip recorded from a dog showing sinustachycardia (175 beats/minute) and rst degree atrioventricular conduction

block. Because the heart rate is rapid, P waves are superimposed onthe downslope of the preceding T waves. The PR interval exceeds 0.16second. (paper speed = 50 mm/s)


42/120

Cardiology


Topic-Atrioventricular Block, Second Degree - MobitzType I Figure 1. Lead II ECG strip recorded from a dog with Mobitz type I, seconddegree AV block. The PR intervals become progressively longer with the

longest PR intervals preceding nonconducted P waves (typical Wenkebachphenomenon). (paper speed = 50 mm/s)


43/120

Cardiology


Topic-Atrioventricular Block, Second Degree - MobitzType II Figure 1. Lead II ECG rhythm strip recorded from a dog with both rst-and second-degree atrioventricular block. The second-degree AV blockis high grade with both 2:1 and 3:1 block resulting in variation in the RRintervals. The PR interval for the conducted beats is prolonged but constant(0.28 second) (paper speed = 25 mm/s).


44/120

Cardiology


Topic-Atrioventricular Valve Dysplasia Figure 1. Lateral radiographs of mitral valve dysplasia.


45/120

Cardiology


Topic-Atrioventricular Valve Endocardiosis Figure 1. Postmortem of valvular endocardiosis.


46/120

Cardiology


Topic-Atrioventricular Valve Endocardiosis Figure 2. Lateral radiograph of mitral valve endocardiosis.


47/120

Cardiology


Topic-Atrioventricular Valvular Stenosis Figure 1. This image of the liver in a dog with tricuspid stenosis and rightheart failure shows markedly distended hepatic veins.


48/120

Cardiology


Topic-Atrioventricular Valvular Stenosis Figure 2. This continuous wave Doppler recording across the tricuspidvalve in a dog with tricuspid stenosis illustrates the prolonged pressure halftime (evidenced by the slope of the line between E and F points) and theprominent atrial contribution (A) to lling. This animal also had tricuspidregurgitation.


49/120


50/120

Cardiology


Topic-Cardiomyopathy, Dilated - Cats Figure 2. Echocardiogram of dilated cardiomyopathy (cat).


51/120

Cardiology


Topic-Cardiomyopathy, Dilated - Dogs Figure 1. Gross postmortem of dilated cardiomyopathy (dog).


52/120

Cardiology


Topic-Cardiomyopathy, Dilated - Dogs Figure 2. Electrocardiographic ndings.


53/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 1. Dyspnea in a cat.


54/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 2. Chest radiograph (lateral) of hypertyrophic cardiomyopathy (cat).


55/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 3. Chest radiography (dorsoventral) of hypertrophic cardiomyopathy(cat).


56/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 4. Echocardiogram of hypertrophic cardiomyopathy (cat).


57/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 5. Gross postmortem of hypertrophic cardiomyopathy (cat).


58/120

Cardiology


Topic-Cardiomyopathy, Hypertrophic - Cats Figure 6. Angiocardiogram of hypertrophic cardiomyopathy (cat).


59/120

Cardiology


Topic-Cardiomyopathy, Restrictive - Cats Figure 1. Cardiomyopathy, restrictive–cats.


60/120

Cardiology


Topic-Congestive Heart Failure, Left-Sided Figure 1. Dyspnea in a cat.


61/120

Cardiology


Topic-Congestive Heart Failure, Left-Sided Figure 2. Cachexia in a dog.


62/120

Cardiology


Topic-Congestive Heart Failure, Right-Sided Figure 1. Ascites in a dog—lateral radiography.


63/120

Cardiology


Topic-Congestive Heart Failure, Right-Sided Figure 2. A dog with ascites.


64/120

Cardiology


Topic-Congestive Heart Failure, Right-Sided Figure 3. Jugular distension in a cat with right-sided congestive heartfailure.

C


65/120

Cardiology


Topic-Congestive Heart Failure, Right-Sided Figure 4. Abdominal venous distension in a dog with right-sided heartfailure.

C di l


66/120

Cardiology


Topic-Digoxin Toxicity Figure 1. “Sagging” type of S-T segment depression in a dog with digitalistoxicity.

C di l


67/120

Cardiology


Topic-Endocarditis, Infective Figure 1. Gross postmortem of bacterial endocarditis

C di l


68/120

Cardiology


Topic-Endocarditis, Infective Figure 2. Echocardiogram of bacterial endocarditis.

C di l


69/120

Cardiology


Topic-Endocarditis, Infective Figure 3. Echocardiogram of bacterial endocarditis.

C di l


70/120

Cardiology


Topic-Heartworm Disease - Cats Figure 1. Gross postmortem of heartworm disease in cat.

C di l


71/120

Cardiology


Topic-Heartworm Disease - Dogs Figure 1a. Microlaria of dirolaria and acanthocheilonema (Justin A. Thomason).

C di l


72/120

Cardiology


Topic-Heartworm Disease - Dogs Figure 1b. Microlaria of dirolaria and acanthocheilonema (Justin A.Thomason).

Cardiolog


73/120

Cardiology


Topic-Heartworm Disease - Dogs Figure 2. Dorsoventral radiograph of heartworm disease in a dog.

Cardiology


74/120

Cardiology


Topic-Heartworm Disease - Dogs Figure 3. Echocardiogram of heartworm disease.

Cardiology


75/120

Cardiology


Topic-Heartworm Disease - Dogs Figure 4. Gross postmortem of heartworm disease in a dog.

Cardiology


76/120

Cardiology


Topic-Idioventricular Rhythm Figure 1. Ventricular escape complexes (arrows) during various phasesin the dominant sinus rhythm in a dog during anesthesia. The sinus rateincreased (not shown) after anesthesia was stopped; 1/2 cm1 mv. (From:

Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed.Blackwell Publishing, 1992, with permission.)

Cardiology


77/120

Cardiology


Topic-Idioventricular Rhythm Figure 2. Complete heart block. The P waves occur at a rate of 120,independent of the ventricular rate of 50. The QRS conguration is a rightbundle branch block pattern. The regular rate and stable QRS indicate

that the rescuing focus is probably near the AV junction. (From: Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Cardiology


78/120

Cardiology


Topic-Left Anterior Fascicular Block Figure 1. Left anterior fascicular block in a cat with hypertrophiccardiomyopathy. Severe left axis deviation (2608) with a qR pattern inleads I and aVL and an rS pattern in leads II, III, and aVF. The QRS

complexes are of normal duration. (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, withpermission.)

Cardiology


79/120

Cardiology


Topic-Left Anterior Fascicular Block Figure 2. Left anterior fascicular block in a dog with hyperkalemia (serum

potassium, 5.3 mEq/L). There is abnormal left axis deviation (260_) witha qR pattern in leads I and aVL and an rS pattern in leads II, III, and aVF. The large T waves are compatible with hyperkalemia. (From: Tilley, L.P.Essentials of canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)


80/120

Cardiology


81/120

Cardiology


Topic-Left Bundle Branch Block Figure 2. Intermittent left bundle branch block in a Chihuahua. QRScomplexes are wider (0.07–0.08 second) in the second, third, and fourthcomplexes and in the last three complexes. Consistent P-R interval

conrms a sinus origin for the abnormal-appearing QRS complexes (leadII, 50 mm/second, 1 cm 5 1 mV). (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, withpermission.)

Cardiology


82/120

Cardiology


Topic-Murmurs, Heart Figure 1. Differential diagnosis of cardiac disease based on the timing and

location of murmurs. (Adapted from Allen, D.G. Murmurs and abnormalheart sounds. By permission of Mosby-Year Book, Inc. In: Allen, D.G.,Kruth, S.A., eds. Small animal cardiopulmonary medicine. Philadelphia: BC Decker, 1988:13.)

Cardiology


83/120

Cardiology


Topic-Myocardial Infarction Figure 1. Transmural infarction of the left ventricle in a dog witharteriosclerosis and hypothyroidism. The rst three rapid successivecomplexes represent ventricular tachycardia. The sinus rhythm that followsillustrates small complexes, marked elevation of the S-T segment, and rstdegree AV block (prolonged P-R interval). (From: Tilley, L.P. Essentials ofcanine and feline electrocardiography. 3rd ed. Blackwell Publishing, 1992,with permission.)

Cardiology


84/120

Cardiology


Topic-Patent Ductus Arteriosus Figure 1. Angiocardiogram of patent ductus arteriosus.

Cardiology


85/120

Cardiology


Topic-Patent Ductus Arteriosus

Figure 2. Patent ductus arteriosus.

Cardiology


86/120

Cardiology


Topic-Pericarditis Figure 1. The photograph demonstrates catheter positioning and

orientation for pericardiocentesis from the right ventral approach. Whilestabilizing the catheter near the entry point with one hand, the catheteris advanced in a cranial and dorsal direction with the other, i.e. towardsthe opposite scapula. A small degree of suction is maintained with thesyringe so that pericardial uid is aspirated at the moment of pericardialpenetration. Subsequently the syringe and stylet are held stationary whilethe exible catheter is advanced well into the pericardium. The sharpmetal stylet is withdrawn after the catheter is fully positioned.

Cardiology


87/120

Cardiology


Topic-Pericarditis Figure 2. Echocardiograph acquired with transducer at the same locationand orientation (direction) as the catheter shown above. Dotted lineindicates structures encountered by the central ultrasound beam, i.e. inthe path of the catheter. While this patient had a relatively small amountof pericardial effusion (PE), proper catheter positioning, orientation, andlinear advancement minimizes risk. Oblique orientation of the catheter,relative to the cardiac surface, increases the effective distance between thepericardium and heart.

Cardiology


88/120

Cardiology


Topic-Pericarditis Figure 3. Instrumentation used for pericardiocentesis. A 14g 5½“catheterand stylus are shown with a small syringe attached, i.e. congured to

advance into the pericardial space. The sharp metal stylus is removedafter the catheter is fully positioned, as demonstrated for the 16g5½“catheter, and an extension tube attached to the catheter for aspirationusing a larger syringe and 3-way stopcock. An 18g 2” catheter is used forcats and similarly sized dogs. A #11 blade is ideal for creating a small stab incision at the site of entry. The author uses a #10 blade to cut side holesin the distal end of the larger catheters (optional).

Cardiology


89/120

Cardiology


Topic-Pleural Effusion Figure 1. Dyspnea in a cat.

Cardiology


90/120

Cardiology


Topic-Pleural Effusion Figure 2. Radiograph of pleural effusion–lateral (dog).

Cardiology


91/120

Cardiology


Topic-Pulmonic Stenosis Figure 1. Ventrodorsal radiograph of a dog with pulmonic stenosis. There isa marked right ventricular enlargement, with the apex shifted to the left. Aprominent pulmonary artery bulge is visible (arrow) (Virginia Luis Fuentres).


92/120

Cardiology


93/120

Cardiology


Topic-Pulmonic Stenosis Figure 3. Continuous wave spectral Doppler recording of pulmonaryartery ow from a left cranial view in a dog with severe pulmonic stenosis. Pulmonary artery velocities are greatly increased (approximately 5 m/s).


94/120

Cardiology


95/120

gy


Topic-Right Bundle Branch Block Figure 2. Right bundle branch block in a cat with the dilated form ofcardiomyopathy. The QRS duration is 0.08 second (4 boxes). Large and

wide S waves are present in leads I, II, III, aVF, and CV6LU. The QRS inCV5RL has a wide R wave (M-shaped). There is a marked axis deviation(approximately − 90° ). (From: Tilley, L.P. Essentials of canine and felineelectrocardiography. 3rd ed. Blackwell Publishing, 1992, with permission.)

Cardiology


96/120

gy


Topic-Sick Sinus Syndrome

Figure 1. A continuous lead II ECG rhythm strip recorded from a dog withsick sinus syndrome. The dog’s rhythm is initially an ectopic atrial rhythm(negative P waves; heart rate 187 beats/minute) followed by asystole ofmore than 10 seconds duration which is terminated by a junctional escapecomplex. Four sinus complexes precede a brief sinus pause that is againterminated by a junctional escape complex. The ectopic atrial rhythm thenresumes. (paper speed = 50 mm/s)

Cardiology


97/120

gy


Topic-Sinus Arrest and Sinoatrial Block Figure 1. Intermittent sinus arrest in a brachycephalic breed with an upperrespiratory disorder and episodes of fainting. The pauses (1 and 1.44seconds) are greater than twice the normal R-R interval (0.46). (From:Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed.

Baltimore: Williams & Wilkins, 1992, with permission.)

Cardiology


98/120

gy


Topic-Sinus Arrhythmia Figure 1. Respiratory sinus arrhythmia with an average rate of 120/minute (paper speed, 25 mm/second; 6 complexes between 1 set of timelines m 20). The rate increases during inspiration (INSP) and decreasesduring expiration (EXP). The uctuation of the baseline correlates with

the movement of the electrodes by the thoracic cavity. (From: Tilley, L.P.Essentials of canine and feline electrocardiography. 3rd ed. Baltimore:Williams & Wilkins, 1992, with permission.)

Cardiology


99/120

gy


Topic-Sinus Bradycardia Figure 1. Sinus bradycardia at a rate of 75 beats/minute in a cat duringanesthetic complications during surgery. (From: Tilley, L.P. Essentialsof canine and feline electrocardiography. 3rd. ed. Baltimore: Williams &

Wilkins, 1992, with permission.


100/120

Cardiology


101/120

gy


Topic-Supraventricular Tachycardia Figure 1. Sinus with an atrial premature complex and paroxysmalsupraventricular tachycardia. Abrupt initiation and termination of thetachycardia help distinguish it from sinus tachycardia (lead II, 50 mm/second, 1 cm = 1 mV). (From: Tilley, L.P. Essentials of canine and feline

electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Cardiology


102/120

gy


Topic-Syncope Figure 1


103/120

Cardiology


104/120


Topic-Ventricular Arrhythmias and Sudden Death inGerman Shepherds Figure 1. Example of ventricular arrhythmia seen in severely affectedGerman shepherds with inherited arrhythmias and propensity for suddendeath. Courtesy of Sydney Moise.

Cardiology


105/120


Topic-Ventricular Arrhythmias and Sudden Death inGerman Shepherds Figure 2. Example of ventricular arrhythmia seen in severely affectedGerman shepherds with inherited arrhythmias and propensity for suddendeath.Courtesy of Sydney Moise.

Cardiology


106/120



Cardiology


107/120



Cardiology


108/120




109/120

Cardiology


110/120


Topic-Ventricular Fibrillation Figure 2. Ventricular utter-brillation in a cat with severe myocardialdamage from an 11-story fall. The complexes are very wide, bizarre,tall, and rapid. (From: Tilley, L.P. Essentials of canine and feline

electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, withpermission.)

Cardiology


111/120


Topic-Ventricular Premature Complexes

Figure 1. VPC and a fusion complex (fth complex) in a dog withmyocarditis from a pancreatitis. A fusion complex is the simultaneousactivation of the ventricle by impulses coming from the SA node and theventricular ectopic foci. The QRS complex is intermediate in form. (From:Tilley, L.P. Essentials of canine and feline electrocardiography. 3rd ed.Baltimore: Williams & Wilkins, 1992, with permission.)

Cardiology


112/120


Topic-Ventricular Premature Complexes

Figure 2. Ventricular bigeminy. Every other complex is a VPC from thesame focus. Each is coupled (interval the same between it and theadjacent sinus complex) to the preceding normal complex. (From: Tilley,L.P. Essentials of canine and feline electrocardiography. 3rd ed. Baltimore: Williams & Wilkins, 1992, with permission.)

Cardiology


113/120


Topic-Ventricular Septal Defect Figure 1 Ventricular septal defect. The defect is an unobstructedcommunication. Right ventricular hypertrophy and pulmonary hypertension

are associated. Left-to-right shunting is shown. RA = right atrium, LA = leftatrium, RV = right ventricle, LV = left ventricle, AO = aorta, PT = pulmonarytrunk. (From: Roberts, W. Adult Congenital Heart Disease. Philadelphia:F.A. Davis, 1987, with permission.)

Cardiology


114/120


Topic-Ventricular Septal Defect Figure 2. Angiocardiogram of ventricular septal defect.

Cardiology


115/120


Topic-Ventricular Septal Defect Figure 3. Necropsy specimen of ventricular septal defect.

Cardiology


116/120


Topic-Ventricular Standstill (Asystole) Figure 1. Ventricular asystole in a dog with severe complete AV block. OnlyP wages (atrial activity) are present; there is no ventricular activity. (LeadII, 50 mm/second, 1 cm = 1 mV) (From: Tilley, L.P. Essentials of canine

and feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, withpermission.)

Cardiology


117/120


Topic-Ventricular Standstill (Asystole) Figure 2. Ventricular asystole in a cat with severe hyperkalemia (11 mEq/L)from urethral obstruction. No P waves or QRS complexes are seen afterfour wide and nozaree QRS complexes (atrial standstill with delayed

ventricular conduction). (lead II, 50 mm/sec, 1 cm = 1 mV) (From: TilleyLP: Essentials of canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Cardiology


118/120


Topic-Ventricular Tachycardia Figure 1. Ventricular tachycardia. The wide and bizarre QRS complexesoccur at a rate of 160 beats/minute, with no relationship to the P waves.There are more QRS complexes than P waves. Ventricular tachycardiashould be treated as soon as possible. Acid-base and electrolyte

abnormalities should always be corrected. (From: Tilley, L.P. Essentialsof canine and feline electrocardiography. 3rd ed. Baltimore: Williams &Wilkins, 1992, with permission.)

Cardiology


119/120


Topic-Wolff-Parkinson-White Syndrome Figure 1. Wolff-Parkinson-White syndrome (canine). Ventricular pre-excitation represented by the short P-R interval, wide QRS complex, and

delta wave (arrow) in CV6LU. Paroxysms of supraventricular tachycardiaare represented in the long lead II rhythm strip. (From: Tilley, L.P.Essentials of canine and feline electrocardiography. 3rd ed. BlackwellPublishing, 1992, with permission.)

Cardiology


120/120

Topic-Wolff-Parkinson-White Syndrome Figure 2. Ventricular pre-excitation in a cat with episodes of fainting. The Pwaves are normal, the P-R interval is short, and the QRS complex is wide;delta waves (arrow) are present. (From: Tilley, L.P. Essentials of canineand feline electrocardiography. 3rd ed. Blackwell Publishing, 1992, withpermission.)

Backwell's 5 Min Veterinary Consult

Documents

Transcript of Backwell's 5 Min Veterinary Consult