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Flashcards in Cardio - DMVD Deck (47)
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What is the most common heart disease in dogs?

Degenerative Mitral Valve Disease (DMVD)


What is DMVD?

Progressive, age-related degeneration of the heart valves that results in valve regurgitation, progressive heart dilation, and ultimately results in CHF.


What valves are most commonly to least commonly affected in DMVD?

Mitral > tricuspid > aortic >> pulmonic (dogs)


What are some other names for DMVD?

Degenerative Valve Disease (DVD)

Myxomatous Mitral Valve Disease (MMVD)

Chronic Valvular Heart Disease (CVHD)



What is the etiology of DVMD?

  1. Myxomatous degenerative valve apparatus changes
  2. Thickening of valve and chordae tendinae
  3. Regurgitation


Valvular regurgitation is a _____ overload disease.



What pathophysiology is caused by DMVD?

  1. Valvular regurgitation is a volume overload disease
  2. Excess volume in the ventricle results in eccentric hypertrophy and dilation
  3. Complications of progressive disease: L-CHF, arrhythmias, atrial rupture


What is the common signalment for DMVD?

Dogs (more common) and horses, middle aged to older, male > female;

Small-medium sized dogs more common

Breeds: CKCS, mini poodle, Schanuzers, Fox terriers, Pomeranian, Yorkie, Chihuahua, Dachshund


What happens in stage A of HF?

At risk breeds and/or signalment with no murmur


What happens in stage B1 of HF?

Degenerative valve changes --> regurgitation and a murmur (L apical systolic regurgitant) with normal heart size or mild L atrial dilation


What happens in stage B2 of HF?

Murmur with moderate or severe LA dilation


What happens in stage C of HF?

Progression to CHF, can have concurrent arrhythmias and/or multiple episodes of CHF

(Heart dilated, fluid starting to back up into lungs)


What happens in stage D of HF?

Episode of CHF that is refractory to tx


What is the presentation of stage A?

Asymptomatic, no murmur


What is the presentation of stage B1?

Asymptomatic, murmur and/or mid-systolic click, normal rads or mild LA dilation


What is the presentation of stage B2?

Asymptomatic or symptoms of cough, exercise intolerance;

Murmur with moderate-severe LA dilation on rads


What is the presentation of stage C?

Signs of CHF - soft cough, increased RR and effort, weakness, exercise intolerance, collapse, restlessness at night, weight loss, reduced appetite;

Murmur, tachycardia, crackles, +/- arrhythmia and/or pulse deficits;

Moderate-severe L cardiomegaly and pulmonary edema on rads



What is the presentation of stage D?

Same as stage C often with cachexia and/or hypotension;

Tx requires hospitalization and more advanced CHF therapies


What diagnostics can be done in GP to assess HF/DMVD?

Thoracic rads, BP, +/- labs (chem, U/A, NT-proBNP), +/- echo, +/- ECG


What stage of DMVD is shown here?

Appears normal due to normal silhouette but is stage B1

(may sometimes have mild LA dilation)


What stage of DMVD is shown here?

B2 - moderate LA enlargement


What stage of DMVD is shown here?


Moderate to severe LA dilation, pulmonary venous dilation, interstitial to alveolar pattern


What is the definitive diagnostic for DMVD?



What echo findings are consistent with stage B1 DMVD?

Thickened valve leaflets with mitral regurgitation

Normal heart size or mild LA dilation


What echo findings are consistent with stage B2 of DMVD?

Eccentric hypertrphy that appears as dilated LA and LV with normal wall thickness

Thickened valve leaflets with regurgitation

+/- valve prolapse or ruptured chordae tendinae


What echo findings are consistent with stage C DMVD?

Same as B2; +/- systolic dysfunction (and end-stage finding in volume overload disease)


What stage of DMVD does this image show? (Would also see "party colors" when the doppler is shown)

Stage B2;

2 leaflets and thickened/nodular/lumpy, open mitral valve, LA dilation, LV dilation


What is relative systemic hypertension?

When a BP is WNL but unacceptably high in the context of a given heart disease


What is the goal in regards to BP in dogs with moderate to severe DMVD?

To maintain it in the low-normal range (~100 mmHg) without signs of hypotension at home (GI upset, weakness, lethargy, collapse)


What stages of DMVD commonly have hypotension? What are the clinical signs? What is the treatment?

Stage C or more commonly stage D;

Cardiogenic shock with low BP;

Tx = positive inotropes (dobutamine)

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