ISSN 2398-2977      

Heart: failure - acute

pequis
Contributor(s):

Synonym(s): Acute heart failure


Introduction

  • Cause: multiple, often a sequel to/progression of other diseases.
  • Signs: acute, cool extremities, altered CRT, cough, dyspnea at rest and collapse.
  • Diagnosis: cardiac auscultation, ECG, echocardiography.
  • Treatment: symptomatic.
  • Prognosis: poor depends on early recognition of the problem and treatment of the underlying pathology if possible.

Pathogenesis

Etiology

  • Aortic rupture   Aorta: rupture  :
    • May be no obvious underlying cause to explain acute vessel rupture.
    • Often, but not exclusively, older stallions during breeding.
    • Death occurs rapidly due to severe hypovolemia.
    • Occasionally rupture of the sinus of Valsalva into the intraventricular septum results in acute/or subacute arrhythmogenic death due to damage to the cardiac conduction system.
    • Rupture of the aortic sinus can occasionally form an aortic-right ventricular fistula resulting in acute onset right heart failure depending on the size of the shunt.
    • Rupture of aneurysm due to vascular damage from migration ofStrongylus vulgarislarvae.
  • Pulmonary vessel rupture:
    • Due to severe EIPH   Lung: EIPH (exercise-induced pulmonary hemorrhage)  .
    • Often occurs acutely during fast exercise.
    • Caliber of vessel damaged will determine time to death or duration and severity of clinical signs.
    • Death results from hypovolemia and hypotension.
  • Chordae tendineae rupture   Chordae tendineae: rupture  :
    • More significant, if major cord of the mitral valve is ruptured.
    • Can occur with acute decompensation of previously stable cardiac disease.
    • Sudden onset pulmonary edema and left heart failure.
  • Acute arrhythmogenic death during exercise: occurs in approximately 1 in 6000 race-starts in Thoroughbred racehorses, etiology is unknown, but affected horses have signs of acute heart failure (pulmonary edema) and no significant cardiac pathology at PM.
  • Ventricular premature beats   Heart: ventricular premature complex      →    ventricular tachycardia   Heart: ventricular tachycardia   and ventricular fibrillation   Heart: ventricular fibrillation  . Often secondary to other systemic disease or metabolic disturbance:
    • Hypoxia.
    • Acidemia.
    • Endotoxemia.
  • Drug induced:
  • The onset of atrial fibrillation   Heart: atrial fibrillation   in otherwise stable cardiac disease.
  • The additional insult to cardiac efficiency that occurs when atrial fibrillation develops is often sufficient to precipitate signs of scute cardiac failure in an otherwise asymptomatic horse.
  • Electrolyte imbalance, eg hyperkalemia in foals with ruptured bladder   Bladder: rupture  .
  • Profound bradycardia:
  • Pericarditis (rare)   Heart: pericarditis  : only when there is a high volume of pericardial fluid or severe restriction to cardiac filling due to fibrin deposition.
  • Viral or immune-mediated myocarditis (very rare)   Heart: myocarditis  .
  • Ionophore antibiotics, eg monensin, used as growth promoters in cattle feed: leads to acute cellular necrosis and myocarditis   Heart: myocarditis  .

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

Other sources of information

  • Patteson M (1995) Equine Cardiology. Blackwell Science. ISBN: 0632032995.

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