docSystolic murmur ? Diastolic murmur ?
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Systolic murmur ? Diastolic murmur ?
Differential diagnosis of cardiac murmur Systolic murmur ? Diastolic murmur ? Diastolic murmurs Systole Diastolic murmurs Diastole Diastolic Murmurs Rapid ventricular filling (physiological) Presystolic Aortic insufficiency Pulmonary insufficiency Rapid ventricular filling Physiological Protodiastolic (between S2 and S3), short Grade I to III/VI, localized PMI over the mitral or tricuspid area Wheezing to musical, high-pitched, decrescendo ∆ with exercise “whoop” or “2 years squeak” Rapid ventricular filling Differential diagnosis of most common diastolic murmurs Rapid ventricular filling Presystolic Aortic insufficiency Pulmonary insufficiency Timing Grade Proto I-III PMI Irradiati on Character Mitr or Localised Wheezing to musical, highTr pitched, Decrescendo ∆ with exercise “whoop” or “2 years squeak” Diastolic Murmurs Rapid ventricular filling (physiological) Presystolic Presystolic Physiological Telediastolic (between S4 and S1) Grade I to III/VI, localized PMI over the mitral or tricuspid area Roaring, low-pitched Difficult to differentiate from S4 Presystolic Differential diagnosis of most common diastolic murmurs Timing Grade Rapid ventricular filling Proto I-III Mitr or Localised Wheezing to musical, highTr pitched, Decrescendo ∆ with exercise “whoop” or “2 years squeak” Presystolic Tele I-III Mitr or Localised Roaring, lowTr pitched Aortic insufficiency Pulmonary insufficiency PMI Irradiati on Character Diastolic Murmurs Rapid ventricular filling (physiological) Presystolic Aortic insufficiency Aortic insufficiency Epidemiology: - Valvular insufficiency the most υ in older horses - Mainly > 10 years old Murmur: - Characteristic Holo to pandiastolic Decrescendo PMI over aortic area, irradiating towards the l’apex - Grade υ high: III to VI/VI - Roaring to musical Aortic insufficiency Aortic insufficiency Clinical signs: - Rarely ∩ with clinical signs; asymptomatic for a long duration - υ ∩ with non significant arrhythmias (AV block or PVC) - Pulse amplitude= the best clinical indicator of evolution into CHF - If CHF => Cfr clinical signs of mitral insufficiency Aortic insufficiency Signs of favourable prognosis - Clinical signs: • Normal resting HR • No sign of CHF, EI or significant arrhythmias • Normal arterial pulse amplitude - Echo Doppler: • AoV: no nodular lesion, prolapsus • No diastolic vibration of valves/septum • Reflux limited in surface; P1/2 prolonged • No signs of LV volume overload • No mitral insufficiency • No worsening on CTR echo Aortic insufficiency Signs of un favourable prognosis - Clinical signs: • Resting HR > 45/min • Signs of CHF, EI or significant arrhythmias • Bounding arterial pulse - Echo Doppler: • AoV: nodular lesion, valve thickening • Severe reflux (surface); P1/2 short • Signs of LV volume overload • Mitral insufficiency • Dilation Ao/Pu • Rapid worsening on CTR echo Differential diagnosis of most common diastolic murmurs Timing Grade Rapid ventricular filling Proto I-III Mitr or Localised Wheezing to musical, highTr pitched, Decrescendo ∆ with exercise “whoop” or “2 years squeak” Presystolic Tele I-III Mitr or Localised Roaring, lowTr pitched Aortic Holo insufficiency to pan Pulmonary insufficiency I-VI PMI Ao Irradiati on Ventrally Character Roaring to musical Decrescendo Diastolic Murmurs Rapid ventricular filling (physiological) Presystolic Aortic insufficiency Pulmonary insufficiency Differential diagnosis of most common diastolic murmurs Timing Grade Rapid ventricular filling Proto I-III Mitr or Localised Wheezing to musical, highTr pitched, Decrescendo ∆ with exercise “whoop” or “2 years squeak” Presystolic Tele I-III Mitr or Localised Roaring, lowTr pitched Aortic Holo insufficiency to pan Pulmonary Holo insufficiency to pan I-VI PMI Ao Pu Irradiati on Ventrally Character Roaring to musical Decrescendo Difficult to hear Conclusions Clinical signs: → Differential diagnosis - physiological ≠ - pathological Doppler Echocardiography: → Confirmation of the diagnosis → Prognosis Pulmonary insufficiency Epidemiology: - Rarely isolated: Most υ repercussion of a left heart disease Murmur: - Difficult to detect Murmurs: Conclusions Clinical signs: → Differential diagnosis - physiologic ≠ - pathologic Dopppler echocardiography: → To confirm the diagnosis → To give a more accurate pronosis Murmurs in horse Clinical examination Differential diagnosis Clinical cases
