Degenerative Valve Disease

Question 1

what is the most common acquired heart disease in dogs?

Answer 1

degenerative valve disease (usually mitral)

Question 2

chronic valvular disease, myxomatous valve disease, and endocardiosis are common names for what disease?

Answer 2

degenerative valve disease

Question 3

what valve is most commonly affected by degenerative valve disease?

Answer 3

mitral

Question 4

T/F: 70% DMVD will be symptomatic and could result in sudden death

Answer 4

FALSE, asymptomatic

Question 5

what breed has a genetic tendency of DMVD?

Answer 5

cavalier King Charles spaniel

Question 6

what is commonly affected in addition to the leaflets in DMVD?

Answer 6

chordae tendineae >ACUTE (no time for compensatory hypertrophy)

Question 7

in patients with DMVD what accumulates in affected valves and makes them thicker?

Answer 7

glycosaminoglycans

Question 8

T/F: dogs with CHF due to DMVD have arteriosclerosis of intramural coronary arteries and myocardial fibrosis

Answer 8

TRUE

Question 9

malformed leaflets lead to what?

Answer 9

valvular regurgitation > +/- reduced CO

Question 10

is DMVD progression acute or chronic in most dogs?

Answer 10

chronic, occurs over several years

Question 11

name this stage: high risk developing heart dz with no identifiable structural disorder

Answer 11

stage A

Question 12

name this stage: structural heart dz but no clinical signs caused by HF

Answer 12

stage B

Question 13

name this stage: asymptomatic patients with no evidence of cardiac remodeling

Answer 13

stage B1

Question 14

name this stage: asymptomatic patients with hemodynamically significant valve regurg, evidence of left-sided heart enlargement

Answer 14

stage B2

Question 15

name this stage: patients with past or current clinical signs of HF assoc. with structural heart dz

Answer 15

stage C

Question 16

name this stage: end-stage dz, clinical signs of HF caused by DVD, refractory to “standard therapy”

Answer 16

stage D

Question 17

T/F: DMVD is more common in LBD

Answer 17

FALSE, small-medium breeds

Question 18

T/F: middle-aged to older dogs are more affected by DMVD

Answer 18

TRUE, EXCEPT: cavalier King Charles

Question 19

what is your first clue in a patient who might have DMVD?

Answer 19

left apical systolic murmur (often correlated with severity of valve regurg)

Question 20

sometimes dogs with DMVD have a mid-systolic click…what is the cause of this?

Answer 20

result of the valve prolapsing

Question 21

what tests are considered the gold standard in diagnosing DMVD?

Answer 21

CBC, chem, UA, echocardiogram

Question 22

your client can’t afford the gold standard testing to diagnose DMVD…what is the minimum lab work you could do instead?

Answer 22

PCV or HCT & TS, serum creatinine, UA

Question 23

in what patients should echocardiography be prioritized to rule out DCM?

Answer 23

LBD

Question 24

patients that are “diuretic dependent” and have L-CHF are considered to be in what stage?

Answer 24

stage C

Question 25

the signs below are criteria for the diagnosis of what on thoracic radiographs? 1. left-sided cardiomegaly (mod-severe LA enlargement) 2. interstitial +/- alveolar pulmonary infiltrates 3. enlargement of cranial and/or caudal pulmonary veins

Answer 25

L-CHF

Question 26

where in the lungs does edema tend to start and then spread in a dog with L-CHF?

Answer 26

begins in peri-hilar region/caudodorsal lung field > cranially and ventrallly

Question 27

what can be a clue in helping differentiate primary respiratory dz vs patient with stage C DMVD?

Answer 27

primary respiratory dz tends to have normal HR whereas DMVD will have high-normal to tachycardia due to compensation involving increase SNS tone

Question 28

what cardiac biomarker is most commonly measured in the diagnosis of DMVD?

Answer 28

B-type natriuretic peptide (BNP) also can measure atrial natrietic peptide (ANP) and cardiac troponin I (cTnl)

Question 29

what cardiac biomarker reflects myocyte damage and death?

Answer 29

cardiac troponin I

Question 30

what two drugs are used in dogs with stage B2 DMVD?

Answer 30

ACE inhibitors and pimobendan

Question 31

what drugs are used in the acute treatment of dogs with stage C DMVD?

Answer 31

furosemide (IV/IM), pimobendan (PO), +/- butorphanol for sedation of anxious patients, +/- topical nitroglycerin

Question 32

what drugs are used in the acute ICU treatment of dogs with stage C DMVD and severe pulmonary edema?

Answer 32

nitroprusside CRI, dobutamine CRI if relevant systolic dysfunction

Question 33

what drugs are used in the chronic treatment of dogs with stage C DMVD?

Answer 33

furosemide, pimobendan, +/- ACE inhibitor (benazepril or enalapril), spironolactone 1-2 weeks after starting ACE inhibitor

Question 34

what two drugs used in the treatment of chronic stage C DMVD would be contraindicated with GI upset (i.e. V/D)?

Answer 34

ACE inhibitors (benazepril or enalapril) and spironolactone

Question 35

in addition to the four standard drugs used to treat chronic stage C DMVD, what other drugs might you consider in treatment of stage D DMVD?

Answer 35

HCTZ, torsemide, SC furosemide, vasodilators, synthetic ADH or BNP

Question 36

what can clients do at home to monitor their dogs with DMVD that is a reliable indicator of L-CHF?

Answer 36

at-home sleeping/resting respiratory rate subclinical or well-controlled CHF: <30 breaths per minute at home stage C: monitor daily stage B2: monitor weekly

Question 37

what is the second most common degenerative valve disease in dogs?

Answer 37

degenerative tricuspid valve disease

Question 38

what clinical signs would you see in a patient with DTVD?

Answer 38

R-CHF: abdominal distension (hepatic congestion and ascites), tachypnea/dyspnea/cough (large volume of pleural effusion> uncommon), exercise intolerance right +/- left apical systolic murmur high-normal HR or tachycardia +/- tachypnea/dyspnea/cyanosis

Question 39

T/F: isolated DMVD is uncommon

Answer 39

FALSE, DTVD

Question 40

in addition to treatment as described in dogs for DVD, what additional treatment is indicated in cats?

Answer 40

anticoagulant and thoracocentesis (can have pleural effusion in both L & R-CHF)

Question 41

T/F: DVD in cats is much less common than dogs and is slower to progress

Answer 41

TRUE