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Assessment of Cardiac Murmurs
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Introduction
Cardiac murmurs are extremely common, occurring in 65- 80% of athletic horse breeds. While cardiac murmurs can be associated with poor performance or even occasionally heart failure, most cardiac murmurs are detected when the heart is examined as part of a general physical examination, for example in a pre-purchase setting or prior to anaesthesia. In this situation, the clinician must decide whether the cardiac murmur is indicative of serious cardiac disease, mild sub-clinical cardiac disease or due to physiological processes. In addition, if cardiac disease is detected, it is necessary to decide whether this is likely to be progressive or non- progressive. With careful examination it is possible to characterize murmurs, determine the list of differential diagnoses and identify those horses that require further investigation before a prognosis can be offered. Echocardiography is extremely useful is assessing the structure of the heart and in identifying changes to the chamber dimensions and function that may provide an insight on the impact of the heart disease. Electrocardiography allows concurrent cardiac rhythm disturbances to be documented but, in horses, provides little information on cardiac chamber size.
Characterizing Murmurs
Cardiac murmurs are prolonged sounds occurring during periods of the cardiac cycle that are usually silent. Murmurs arise when normal laminar flow is disrupted. The criteria used to describe murmurs are its timing, location (point of maximal intensity and direction of radiation) and quality (intensity and shape). If all five characteristics of a murmur are considered carefully, the clinician is usually able to formulate a differential diagnosis and differentiate murmurs which are physiological (functional) from those which indicate that there is cardiac pathology and justify further diagnostic evaluation. [...]
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