Canine Top Cardiac Diseases - Part 3

Question 1

what breeds are predisposed to HCM?

Answer 1

maine coons & ragdolls - males may be predisposed

Question 2

what is the classic case presentation of HCM?

Answer 2

usually no murmur/arrhythmia, tachypnea, dyspnea, paraplegia, or monoplegia due to thromboembolism

Question 3

what is seen on rads of a cat with HCM?

Answer 3

cardiomegaly, dilated left atrium, pulmonary edema, & pleural effusion

Question 4

what is seen on echo of a cat with HCM?

Answer 4

atrial dilation, left ventricular wall thickening, papillary muscle hypertrophy, systolic anterior motion of the mitral valve, & echo contrast (smoke) in dilated left atrium due to swirling of RBCs

Question 5

what screening can be done for HCM?

Answer 5

NT-proBNP for occult HCM that is then confirmed with an echo & genetic testing of myosin binding protein C3 for the A31P/A74T mutation in maine coons or the C820T mutation in ragdolls

Question 6

what treatment is used for HCM?

Answer 6

for CHF, O2 therapy, loop diuretics, pimobendan, ace inhibitors, b-blockers if left ventricular outflow obstruction on echo

Question 7

what in hospital treatment is used for prevention of thromboembolism in cats with HCM?

Answer 7

anticoagulant heparin, analgesia, & CHF treatment

Question 8

what at home treatment can be used for preventing thromboembolisms in cats with HCM?

Answer 8

clopidogrel to prevent thromboembolism & enoxaparin to treat thromboembolism

Question 9

what does the prognosis of HCM depend on?

Answer 9

the presentation, severity of disease, & response to treatment

Question 10

what seen on an echo puts a cat with HCM at rick of a thromboembolism?

Answer 10

evidence of echo contrast in dilated left atrium

Question 11

what genetic testing is done for HCM?

Answer 11

maine coon & ragdoll cats - don’t breed homozygous cats

Question 12

T/F: decompensated cats with CHF are often hypothermic on presentation

Answer 12

TRUE

Question 13

what are the top 3 heart block patterns seen?

Answer 13

2nd degree, 3rd degree, & sick sinus syndrome

Question 14

what clinical signs are seen with 2nd degree av block?

Answer 14

only seen with high grade - exercise intolerance & syncope

Question 15

what clinical signs are seen with 3rd degree av block?

Answer 15

dogs - syncope cats - rarely have clinical signs

Question 16

what clinical signs are seen with sick sinus syndrome?

Answer 16

clinical signs are due to severe bradycardia, sinoatrial arrest, or tachycardia - exercise intolerance & syncope

Question 17

what is the breed predilection for sick sinus syndrome?

Answer 17

mini schnauzers, westies, & cockers

Question 18

what are the 3 main types of 2nd degree block?

Answer 18

mobitz type I, mobitz type II, & high grade

Question 19

what is seen on ecg for 2nd degree mobitz type I block?

Answer 19

successive prolongation of P-R interval until a QRS is absent

Question 20

what is seen on ecg for 2nd degree mobitz type II block?

Answer 20

fixed p-r interval

Question 21

what is seen on high grade 2nd degree av block?

Answer 21

many p waves are not conducted

Question 22

how is 2nd degree block diagnosed?

Answer 22

ecg - look for an occasional unconducted atrial beat, one or more p waves not followed by a QRS complex, but otherwise normal p waves & QRS complexes

Question 23

what is seen on ecg/holter monitor of 3rd degree block?

Answer 23

complete dissociation of atrial/ventricular activity & no relationship between the p wave & QRS complex

Question 24

what is seen on ecg/holter monitor of sick sinus syndrome

Answer 24

sinus bradycardia alone, sinus rhythm with long inappropriate pauses (sinoatrial arrest) between p-qrs complexes, +/- varying tachycardia (brady-tachy syndrome)

Question 25

what may be seen on echo for 2nd degree block, 3rd degree block, & sick sinus syndrome?

Answer 25

look for any structural disease to explain arrhythmias & assess heart changes secondary to bradycardia including chamber enlargement or valvular insufficiency

Question 26

what is the purpose of using an atropine response test on a dog with sick sinus syndrome?

Answer 26

to determine whether it is physiologic (positive response) or pathologic (no change)

Question 27

what treatment is indicated for 2nd degree block?

Answer 27

theophylline (sympathomimetic), terbutaline (sympathomimetic), or propantheline (parasympatholytic) - pacemaker if high grade

Question 28

what treatment is indicated for 3rd degree block?

Answer 28

pacemaker

Question 29

what treatment is indicated for sick sinus syndrome?

Answer 29

bradyarrhythmias - sympathomimetic or parasympatholytic, pacemaker, for brady-tachy syndrome address bradyarrhythmia as meds to control tachycardia can worsen the bradycardia

Question 30

T/F: for sick sinus syndrome & 2nd degree heart block, medication is only indicated if bradycardia is causing clinical signs

Answer 30

TRUE

Question 31

why should 3rd degree heart block always be treated?

Answer 31

there is a risk of sudden death

Question 32

what are the top 5 congenital cardiac conditions?

Answer 32

PDA, subaortic stenosis, pulmonic stenosis, atrial or ventricular septal defects, & teralogy of fallot

Question 33

what are the breed predilections for PDA?

Answer 33

poodles, chi chi, maltese, bichon, poms, GSD, labs, & newfoundlands

Question 34

what is the classical clinical presentation of PDA?

Answer 34

continuous left base washing machine murmur - females usually affected more than males

Question 35

what is the classical clinical presentation of reverse PDA?

Answer 35

cyanotic mucus membranes in caudal body (vulva/prepuce) with pink gingiva & absence of the washing machine murmur

Question 36

what is the breed predilection for pulmonic stenosis?

Answer 36

frenchies, english bulldogs, labs, beagles, samoyeds, & cocker spaniels

Question 37

what is the classic case presentation of pulmonic stenosis?

Answer 37

systolic left base murmur

Question 38

what is the breed predilection for subaortic stenosis?

Answer 38

goldens, rotties, mastiffs, newfoundlands, boxers, german shepherds

Question 39

what is the classic case presentation of subaortic stenosis?

Answer 39

systolic left base murmur that may be auscultable at the thoracic inlet

Question 40

what is the breed predilection of ASD/VSD?

Answer 40

for ASD - english springer spaniel

Question 41

what is the cliassic case presentation of ASD/VSD?

Answer 41

ASD - typically no murmur VSD - possible right thoracic systolic murmur

Question 42

what is the breed predilection for tetralogy of fallot?

Answer 42

english bulldogs, samoyeds, keeshonds, & terriers

Question 43

what is the classic case presentation of tetralogy of fallot?

Answer 43

exercise intolerance, syncope, left systolic murmur, differential cyanosis (mucus membranes in caudal half of body more cyanotic)

Question 44

what is the etiology of reverse PDA?

Answer 44

severe pulmonary hypertension exceeds the systemic pressure causing blood to flow from right to left through the ductus, the caudal body becomes hypoxic, & renal perfusion with hypoxemic blood causes the release of erythropoietin resulting in polycythemia

Question 45

what is the etiology of PDA?

Answer 45

persistent patenty of fetal ductus arteriosus after birth

Question 46

what is seen on radiographs of a dog with a PDA? what about echo?

Answer 46

rads - left atrial/ventricular enlargement, distinct pulmonary artery & descending aorta, ductus bulge echo - variable left atrial/ventricular dilation, continuous turbulent blood flow in pulmonary artery, & visible ductus emptying into the pulmonary artery

Question 47

what is seen on radiographs of a dog with SAS? what about echo?

Answer 47

rads - prominent ascending aortic bulge & left ventricular enlargement echo - turbulent high velocity doppler flow through the aortic valve, subvalvular narrowing of the left outflow tract due to a band of tissue, & varying left ventricular hypertrophy

Question 48

what is seen on rads of a dog with PS? what about echo?

Answer 48

rads - right cardiomegaly & main pulmonary artery bulge echo - high velocity outflow past pulmonary valve, irregular/stenotic pulmonic valves, post-stenotic dilation of the pulmonary artery, pulmonic insufficiency, varying right ventricular hypertrophy/dilation - english bulldogs may have concurrent pulmonary artery abnormalities

Question 49

what is seen on rads of a dog with ASD/VSD? what about echo?

Answer 49

rads for asd - dilated pulmonary artery & right ventricular dilation rads for vsd - dilated pulmonary artery & left atrial/ventricular dilation echo - visualization of the septal defect

Question 50

what is seen on a CBC from a dog with tetralogy of fallot?

Answer 50

polycythemia secondary to chronic hypoxia!!

Question 51

what are the 4 cardinal signs of tetralogy of fallot on echo?

Answer 51

interventricular septal defect, pulmonic stenosis, right ventricular hypertrophy, & over-riding aorta

Question 52

what treatment is indicated for a reverse PDA?

Answer 52

no occlusion!!!!! phlebotomy to treat polycythemia

Question 53

what treatment is indicated for a PDA?

Answer 53

surgical ligation (thoracotomy), minimaly invasive transarterial occlusion, transarterial coil, & manage CHF is present

Question 54

what is the treatment used for SAS?

Answer 54

atenolol to decrease the risks of arrhythmias - intervention/surgery isn't successful

Question 55

what is the treatment used for PS?

Answer 55

percutaneous balloon valvuloplasty if severe & in english bulldogs, concurrent pulmonary artery anomalies/aberrant carotid artery bands make intervention tricky

Question 56

what is the treatment used for ASD/VSD?

Answer 56

small defect - no treatment large defect - patch graft repair (not commonly done for ASD), & for vsd - amlodipine for aterial vasodilation to reduce afterload

Question 57

what is the treatment used for teralogy of fallot?

Answer 57

b-blockers, therapeutic phlebotomy if erythrocytosis, & no good surgical/intervention available

Question 58

what is an innocent murmur?

Answer 58

soft murmur before 16 weeks of age in an asymptomatic puppy that should be reassessed after 16 weeks

Question 59

what is the prognosis for PDA?

Answer 59

with repair, good, without repair, guarged to poor prognosis as it will progress to CHF

Question 60

what is the prognosis of SAS?

Answer 60

mild to moderate - dogs can live a normal life & severe - poor long term, average life span of 3 years

Question 61

what is the prognosis of PS?

Answer 61

mild to moderate, normal lives, severe - if successful balloon valvuloplasty can be normal, but if unsuccessful/not possible, guarded to poor long term

Question 62

what is the prognosis of ASD/VSD?

Answer 62

small defects is good & large defect is guarded

Question 63

what is the prognosis of teralogy of fallot?

Answer 63

death at a young age is common in animals that are hemodynamically affected by the defects

Question 64

what is the breed predilection of endocarditis?

Answer 64

dogs over 4 years - GSD, labs, boxers, dobermans - may have concurrent congenital heart disease (SAS/mitral dysplasia)

Question 65

what is the classic case presentation of endocarditis?

Answer 65

signs of systemic illness (lethargy, anorexia, weakness), intermittent lameness, fever, & signs of CHF (cough, tachypnea, dyspnea) - approximately 26% don't have a murmur

Question 66

what are the bacterias that can cause endocarditis?

Answer 66

strep, staph, klebsiella, e coli, & bartonella

Question 67

what is seen on echo of a dog with endocarditis?

Answer 67

thickened hyperechoic valve, pedunculated mass on valve leaflet, +/- secondary chamber dilation

Question 68

what is seen on cbc, chem, urinalysis, & blood/urine cultures in a dog with endocarditis?

Answer 68

CBC - leukocytosis, anemia, thrombocytopenia, chem - azotemia urinalysis - proteinuria & cultures for listed bacterias

Question 69

what treatment is used for endocarditis?

Answer 69

antibiotics for 2-3 months ideally based on culture/testing, broad spectrum (ampicillin/amoxicillin, cephalosporin combined with fluorinated quinolone - cidal drugs are best), for bartonella - combo of fluorinated quinolone & doxycycline, & treat for CHF (oxygen, furosemide, pimobendan)

Question 70

how is bartonellosis causing endocarditis prevented?

Answer 70

flea control

Question 71

what is the prognosis of endocarditis involving the mitral valve? what about the aortic?

Answer 71

mitral valve is more favorable than aortic valve

Question 72

T/F: a new murmur, especially a diastolic one, in a systemically ill dog should prompt evaluation for endocarditis

Answer 72

TRUE

Question 73

T/F: there is no specific treatment for valve damage & secondary valvular insufficiency from endocarditis

Answer 73

TRUE