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Cardiac Disease Flashcards

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1
Q

What clinical signs and echo findings would you see in a cause of heart worm?

A

Echo- pulmonary hypertension + pulmonary thromboembolism

End result and signs - right sided congestive heart failure +
pericardial effusion

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2
Q

What is the most common cardiac disease?

A

Degenerative mitral valve disease

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3
Q

What is the aetiology and signalment in mitral valve dysplasia?

A

Mitral valve leaflets are too short
Papillary muscles don’t work

Congenital - seen in young large breed dogs

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4
Q

What is the aetiology and signalment of MDVD?

A

Older small breed dogs
CKCS
Idiopathic nodular thickening of the mitral valve leaflets

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5
Q

What are the haemodynamic effects of MDVD?

A

Reduced afterload
Increased preload
Reduced stroke volume
Volume overload of the left side of the heart
= eccentric hypertrophy and dilation of the heart

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6
Q

What is the clinical presentation in MDVD?

A

Grade 1-6, left apical, pan or holo, early sytolic, plateau murmur
+/- palpable thrill

Coughing at night 
Tachypnoea / dysponea
Tachycardia
Slow CRT 
History of lethargy and exercise intolerance 
Pulmonary crackles

May be a symptomatic

ALWAY REMEMBER TO SIMULTANEOUSLY AUSCULTATE AND PALPATE PULSE

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7
Q

What blood pressure can you expect in MDVD?

A

Normal

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8
Q

What ECG abnormalities might you see with MDVD?

A

Supra ventricular premature complexes
Atrial fibrillation
Ventricular premature complexes

(Not VTach, seen in DCM)

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9
Q

What should you sedate a dog in heart failure with?

A

Butorphanol and alfaxalan top ups

Avoid alpha 2 agonists - cause a reflex bradycardia - massively drop cardiac output

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10
Q

How can you confirm MDVD?

A

Echocardiography

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11
Q

What findings will you see on echo in MDVD?

A 
Enlarged left atrium and ventricle
Mitral valve regurgitation 
Rounded left ventricle
Hyper dynamic systolic function
Poor contractility
Pulmonary hypertension
Tricuspid regurgitation
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12
Q

How can you measure systolic function in MDVD?

A 
Fractional shortening - contractility
Ejection fraction - stroke volume
E point septal separation - contractility
End systolic volume index
Systolic time intervals
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13
Q

How can you differentiate MDVD from DCM?

A

MDVD - left atrium is bigger than the left ventricle, wall is normal thickness

DCM - both the left atrium and ventricle are dilated, thin wall

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14
Q

What clinical pathology results will you see in MDVD?

A

Pre-renal azotaemia

Elevated cardiac troponin, pro-BNP and pro-ANP

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15
Q

How can you diagnose MDVD in the pre-clinical phase?

A

Murmur

Holter monitor - VPCs or atrial fibrillation

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16
Q

What is the prognosis of MDVD in the CKCS compared to large breeds?

A

Better for CKCS - can survive 12m with CHF if well controlled
Poorer for large dogs, deteriorate rapidly

Larger ventricles and atria are poor prognostic indicators, along with ruptured chordae and high pro-BNP

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17
Q

What is the aetiology of endocarditis?

A

Infection of 1 or more of the endocardium surfaces
- mitral and aortic valves most common

Streps, staphs, e.coli, pseudomonas, bartonella

Bacteriaemia occurs (IV catheter, dental disease)
Multiple emboli - concurrent plolyarthrits, glomerulonephritis, neuro
Bacteria adhere to damage enocardium (eg subaortic stenosis)
Aided by a hyper coagulate state

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18
Q

How does endocarditis present?

A

New murmur
Diastolic murmur
PUO - classic presentation

Arrhythmias, myocardial infarction, signs of CHF
Medium to large breeds

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19
Q

How can you diagnose endocarditis?

A

Haematology and biochemistry
Blood culture
Echocardiography - valvular vegetations, regurgitation, systolic dysfunction

Major criteria

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20
Q

What are the major criteria for defining endocarditis?

A

Positive echocardiogram
- vegetative, oscillating lesions, erosive lesions, abscess

New valvular insufficiency / diastolic murmur

Positive blood culture - 2 positive cultures

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21
Q

How should you treat endocarditis?

A

IV antibiotics for 1-6w
Fluoroquinolones + metronidazole + potentiated amoxicillin

C-reactive proteins
Anticoagulants

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22
Q

What is the prognosis for endocarditis?

A

Guarded - recurrent problems and CHF possible

Irreversible valvular damage

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23
Q

What types of primary cardiomyopathy are there?

A

Dilated cardiomyopathy
Arrthymogenic right ventricular cardiomyopathy
Hypertrophic cardiomyopathy - rare in dogs, terriers, pointer
- 2ndry to left ventricular outflow tract obstruction
Atrial cardiomyopathy - springers, Labrador
- atrial walls thin leading to atrial standstill

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24
Q

What secondary cardiomyopathies occur?

A

Myocarditis - viral, automimmnue, infectious, traumatic
Tachycardiomyopathy - most common
- seen with AF, VTach and SVTach

Other causes 
Nutritional - taurine or l-carnitine deficiency
Systemic hypertension 
Drugs and toxins 
Metabolic and endocrine
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25
What is the aetiology and signalment of DCM?
= impaired systolic function + dilated cardiac chambers Seen in middle aged medium to large breed dogs Idiopathic but likely to be genetic Dilation of all 4 chambers and increased heart to body weight ratio
26
What is the most common cardiomyopathy in dogs?
DCM
27
What is the cardiac decompensation in DCM?
Dilation of the AV value annulus = mitral regurgitation Fibrosis and arrhythmias due to cardiac remodelling Increased hydrostatic pressure = congestion Toxicity to myocyte a due to sympathetic drive
28
How does DCM present in the Doberman?
Slowly progressive Inherited Ventricular arrhythmias and sudden death Cardiomegaly Screening recommended every 4 months - short survival after development of CHF
29
What is the aetiology and signalment seen with arrhythmogenic right ventricular cardiomyopathy?
= loss of cardiac myocytes, replaced with fibro-fatty tissue | Boxers
30
What is the clinical presentation of ARVC?
Asymptomatic with VPCs Symptomatic with VPCs Ventricular dilatation, myocardial dysfunction and dysrrthymias May present as sudden death May also present as syncope and exercise intolerance Cough, tachypnoea, dysponea, abdominal distension, increased water intake, heart murmur
31
What presentation would you expect in a dog with DCM?
Large breed or cocker spaniel Grade 1-3 systolic heart murmur, some dogs have none Gallop sound Adult dog with a history of collapse
32
What would you find on the rest of your clinical exam in a case of DCM?
``` Cardiac cachexia Pale mm and slow CRT Tahcyponea, dysponea Weak femoral pulses Chest percussion - pleural effusion Jugular distension Abdominal effusion Respiratory crackles ```
33
What are the two presentations of DCM?
Preclinical - sudden death and ventricular arrhythmias | Clinical - forwards and backwards heart failure
34
What arrhythmias are seen with DCM?
AF SVTach VTach VPCs
35
What is the definitive diagnosis of DCM?
Echocardiography Left and right sided chamber enlargement Thin walls Reduced contractility and systolic function Mild to moderate mitral valve regurgitation
36
How many VPC on a holster monitor in 24h would make you suspicious of cardiomyopathy?
Doberman - more than 50 VPCs Boxer - 100-300 VPCs Likely affected 300-1000 Affected greater than 1000
37
What drug is indicated in pre-clinical DCM?
Pimobendan | +/- Benazepril - used in people
38
What conditions should you consider treating in DCM?
``` Supraventricular tachycardia Ventricular tachycardia Pulmonary hypertension Preclinical disease Congestive heart failure ```
39
What is the prognosis for DCM?
Better with cocker spaniels with taurine deficiency, especially if over two - contractility improves after taurine supplementation Dobermanns can live 2-4y with preclinical DCM Survival only around 4m after development of CHF
40
What are common causes of a secondary myopathies in cats?
Hypertension | Hyperthyroidism
41
How should you investigate hypertension in a cat?
Haematology and biochemistry Total T4 Urinalysis
42
What complications can hypertension cause?
Retinal detachment Neurological problems Renal damage
43
What is the pathology and presentation in feline HCM?
Marked concentric hypertrophy of the left ventricle = reduced diastolic function & reduced compliance Present as sudden death, sleeping more or dysponeic Persians, Maine coons, ragdoll, Norwegian forest cat
44
What other diseases must you rule out to make a diagnosis or hypertrophic cardiomyopathy?
``` Aortic stenosis Systemic hypertension Hyperthyroidism Chronic renal failure Acromegaly Diabetes mellitus ```
45
What diagnostic signs will you see on echo in a cat with HCM?
Thickened left ventricular wall and septum = more than 1/3 of chamber diameter Enlarged papillary muscles Bulging left atrium Smoke in the the left atrial appendage SAM of MV Mild mitral valve regurgitation (exacerbates hypertrophy)
46
What are the radiographic signs of HCM?
Cardiomegaly Enlarged left atrium DV - typical valentines heart - left side of the heart is pushing the atrial septum over to the right Signs of CHF - patchy alveolar pattern seen in cats with CHF (Less predictable distribution) Congested pulmonary veins
47
What signs might you see on electrocardiography in HCM?
Left fasicular bundle branch block Atrial fibrillation Left ventricular enlargement - tall T waves
48
What produces the murmur in HCM?
Atrial septum bulge obstructs the LVOT = high ventricular outflow tract velocity and biphasic acceleration SAM of the mitral valve
49
What kind of murmur is produced in HCM?
Diastolic, Gallop murmur - hear S3 and S4 | Harsh murmur
50
What are the two presentations of HCM?
Asymptomatic but have a murmur Left sided congestive heart fairlure
51
How does a cat with FATE present?
Extreme pain - methadone ASAP!! Paraplegic Hypothermia of the limbs Blue nail beds - due to thrombus at the aortic bifurcation -- external iliac arteries
52
How should you treat clinical HCM and CHF?
Furosemide IV - venodilator and reduces blood volume (preload) Benazepril - ace inhibitor (licensed for renal disease) Per untold - venodilators Prevent thromboembolism - clopidogrel Furosemide and enalapril have been proven to reduce the risk of an adverse outcome in cats with CHF due to HCM
53
How can you treat preclinical HCM?
Beta blockers - Propanolol, emsomolol - reduce LVOT and SAM - slows heart rate and improves diastolic function - CI in CHF Pimobendan - Ca channel blocker Benazepril - ace inhibitor Diltiazem - positive lusiotrope = improves diastolic filling There is no evidence that any drug slows down the progression to CHF
54
How does DCM usually present in cats and what must you rule out?
Usually collapse and in cardiogenic shock Must rule out taurine deficiency as a cause - supplement
55
How should you manage DCM due to taurine deficiency in cats?
``` Taurine Pimobendan Benazepril Furosemide Digoxin ``` O2 therapy Warmth Drain the pleural effusion
56
What are the two forms of restrictive myopathy seen in cats?
Endomyocardial - large atrium and bridging scars Unclassified - has features of different types of cardiomyopathy Usually have normal ventricular wall measurements, chamber size and function However the left atrium is dilated and diastolic is reduced due to restrictive pathology
57
How does ARVC usually present in cats?
Ventricular arrhythmias and right sided congestive heart failure
58
What are the consequences of HCM?
Left sided congestive heart failure FATE Hypertension Arrhythmias
59
What does increased pro BNP suggest?
Ventricular stretch
60
What does increased cardiac troponin I suggest?
Ischaemic episode, neoplasia, myocarditis | = damage to myocardium
61
When should you recommend a cardiology work up to an owner?
Grade 3+ mitral valve regurgitation | Grade 4+ mitral valve regurgitation
62
How should you work up a dysponeic patient with a history of MDVD?
Auscultate - determine progression of murmur Palpate pulses, CRT mm colour Give oxygen Sedate with butorphanol for thoracic radiographs T fast scan to check for pericardial effusion Give IV furosemide after ruling out pericardial effusion Take baseline bloods
63
How should you work up a MDVD with a chaotic heart rhythm no is collapsed?
ECG Oxygen T fast to rule out pleural / pericardial effusion IV furosemide
64
What underlying conditions lead to VPCs and ventricular tachycardia, therefore must be treated first?
``` CHF - myocardial hypoxia and ischaemia Catecholamines - stress and pain Hypokalaemia Acidosis Abdominal disease - GDV - pancreatitis - splenic lesions - pyometra - sepsis - perforated GI ulcer ```
65
What underlying factors do you need to identify and exclude before treating a bradyarrhythmia?
High vagal tone Hyperkalaemia - addisons, urinary obstruction, anuric RF Hypothyroidism Drug side effects

Small Animal Cardiology (9 decks)

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