Consensus Statements

Question 1

What is the appropriate width of a blood pressure cuff?

Answer 1

30-40% the circumference of the limb / location in question

Question 2

True or false: most of the time, treatment of the underlying cause for a pet with secondary hypertension will resolve the hypertension, and no additional treatment is needed

Answer 2

False. Most dogs/cats will continue to be hypertensive even after treating the primary cause, so anti-hypertensives should be started if appropriate (ie evidence of TOD, or SBP > 160)

Question 3

Why shouldn’t CCB be used as a sole means of anti-hypertensive therapy?

Answer 3

CCBs (ie amlodipine) cause preferential dilation of the afferent renal arteriole. This could result in higher glomerular hydrostatic pressure due to increased volume going into the glomerular capillaries. CCBs should always be administered with a RAAS inhibitor, which will cause dilation of the efferent renal arteriole, negating the effects of the CCB.

Question 4

What is the first line anti-hypertensive agent in dogs, and in cats?

Answer 4

Dogs: ACE-inhibitors

Cats: Amlodipine (CCB)

Question 5

What can be given orally to help with copper storage disease in dogs following discontinuation of d-penicillamine?

Answer 5

Zinc

If you give zinc concurrently with d-penicillamine, they will cancel each other out.

Question 6

What are the two mainstays of copper storage disease treatment?

Answer 6

Low copper diet
D-penicillamine

Question 7

What triad of clinical signs / lab findings are suggestive of a portal vein thrombus?

Answer 7

Ascites
Abdominal pain
Thrombocytopenia

Question 8

What GI disease process can cause an acute exacerbation of hepatic encephalopathy?

Answer 8

GI bleeding (increased protein absorption)

Question 9

Which major side effect of azathioprine occurs within weeks of starting the drug, and which occurs after a few months?

Answer 9

Hepatotoxicity (ie ALT elevation) can occur within a few weeks.

Myelosuppression can occur after a few months.

Question 10

What common immunosuppressive agent is metabolized primarily through the hepatic cytochrome P-450 system?

Answer 10

Cyclosporine

Beware when administering this medication concurrently with phenobarbital as the phenobarbital may accelerate the metabolism of the cyclosporine, making it less effective.

Question 11

What is the grading scheme for feline cardiomyopathy?

Answer 11

Essentially the same as dogs

A - at risk, but no actual evidence of cardiomyopathy

B1 - mild changes associated with cardiomyopathy, low risk of CHF /ATE

B2 - severe changes associated with cardiomyopathy, imminent risk of CHF / ATE

C - current or historic CHF / ATE

D - refractory version of C

Question 12

What are 6 causes of an HCM phenotype (aside from HCM itself)?

Answer 12

1. Hypertension
2. Reduced preload
3. Neoplastic infiltration
4. Transient myocardial thickening
5. Acromegaly
6. Hyperthyroidism

Question 13

Changes in this gene have been associated with HCM. What does this gene control? In what two breeds of cats has this defect been found in?

Answer 13

Myosin binding protein C (MyBPC3)

Sarcomere integrity

Maine Coons, Ragdolls

Question 14

What percentage of healthy cats can have a heart murmur? Gallop rhythm?

What percentage of cats with HCM have a heart murmur? Gallop rhythm?

Answer 14

30-45% / rare

80% / 3-20%

Question 15

In an adult cat of normal size, what should the thickness of the left ventricle be at the end of diastole?

Answer 15

Less than 5 mm

Question 16

What is the goal of performing an NT-proBNP in cats?

Answer 16

To screen for advanced heart disease; a normal result does not completely rule out heart disease, but it makes it much less clinically significant.

Question 17

What percent of dogs experience persistent back pain following hemilaminectomy for TL IVDE? What is the proposed reason for this?

Answer 17

• 15%
• neuropathic pain secondary to damage of the somatosensory system

Question 18

Why is PH associated with a split heart sound? Which heart sound is split?

Answer 18

S2 is split due to asynchronous closure of the pulmonic and aortic valves. The high pressure in the lungs results in slightly premature closure of the pulmonic valve compared to the aortic valve.

Question 19

What are the 6 categories of pulmonary hypertension?

Answer 19

1. Pulmonary arterial hypertension (ie idiopathic, over circulation from L to R shunts)
2. Secondary to left sided heart disease
3. Secondary to primary lung disease / hypoxia
4. Pulmonary thromboembolism
5. Parasitic (heart worm, angiostrongylus)
6. Combination / unknown

Question 20

What is the most common cause of pulmonary hypertension (at least historically)?

Answer 20

Left sided heart disease

Question 21

Most common cause of mortality in IMHA; what does this do to VQ mismatch?

Answer 21

PTE - causes dramatic increase due to sudden lack of perfusion (Q) to a potentially large area of the lungs.

Question 22

What drug class is sildenafil / tadalafil?

Dosing scheme for both?

Answer 22

Phosphdiesterase V inhibitors, promoting NO formation

Sildenafil - q8h
Tadalafil - q24h

Question 23

What is a possible consequence of starting a PDEVi in a dog with left sided heart disease?

Answer 23

Acute pulmonary edema

Question 24

In which category of PH is it recommended to treat dogs with PH-specific (ie PDEVi) medications, but not in people?

Answer 24

Type 3 - primary respiratory disease / hypoxia

Question 25

This amino acid, in conjunction with oxygen, is essential for the formation of NO, and has thus been explored for treatment of pulmonary hypertension.

Answer 25

L - arginine

Question 26

What are the infectious rule outs for a facial / nasal deformity? What is the most common cause of this sign?

Answer 26

Aspergillosis, sporothrocosis, cryptococcosis Sinonasal cancer