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Small Animal Medicine II > Feline Heart Disease > Flashcards

Feline Heart Disease Flashcards

1
Q

What aged cats primarily present with congenital and acquired heart disease?

A

CONGENITAL - younger patients

ACQUIRED - 3 months to 19 years

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2
Q

What are the 5 most common types of primary feline heart diseases?

A

heart based:

  1. HCM/HOCM (~58%!)
  2. restrictive cardiomyopathy - RCM
  3. DCM
  4. ARVC
  5. unclassified cardiomyopathy
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3
Q

What are the 7 most common causes of secondary feline heart disease?

A
  1. hyperthyroidism
  2. acromegaly - increased GH causes the myocardium to thicken
  3. HW disease
  4. systemic hypertension
  5. dietary
  6. anemia - increased oxygen demand and heart must work harder (remodeling!)
  7. dehydration (pseudo-hypertrophy)
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4
Q

What are the 2 most common congenital causes of feline heart disease?

A
  1. VSD
  2. valve malformations
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5
Q

DCM vs. HCM vs. RCM:

A

RCM = muscle replaced by fibrous CT and cannot relax properly to allow for complete filling of the ventricles

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6
Q

What breeds are most commonly affected by HCM? How do they most commonly present?

A
  • Maine Coon
  • Ragdoll
  • Sphynx
  • British Shorthair
  • Bengal
  • Persian
  • several with known genetic mutations, males > females

14-34% are overtly healthy!

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7
Q

What 3 cardiac pathologies are associated with HCM?

A
  1. myofiber disarray
  2. intramural arteriosclerosis
  3. fibrosis/CT abnormalities
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8
Q

What is the ultimate result in hearts with HCM? What are 3 signs of this?

A

left ventricular hypertrophy

  1. systolic murmur at sternum - regurgitation not common, caused by the anterior movement of the mitral valve, which increases the velocity of blood entering the LV
  2. gallop rhythm
  3. left/biventricular CHF —> pulmonary edema, pleural effusion
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9
Q

What results from severe cases of HCM? What causes this? What 3 things can this lead to?

A

diastolic failure —> unable to completely relax to allow for ventricular filling

systolic anterior movement of the mitral valve (HOCM) causes outflow obstruction (thickened septum, and mitral/papillary muscles)

  1. arterial thromboembolism - enlarged LA and auricle causes turbulent blood flow
  2. atrial fibrillation
  3. sudden death
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10
Q

What are the 4 morphological characteristics of primary muscle disease causing HCM?

A
  1. ventricular (concentric) hypertrophy
  2. no dilation
  3. decreased compliance = diastolic failure
  4. LV outflow obstruction
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11
Q

What are 3 possible variations of hypertrophy seen in HCM? What does this contribute to?

A
  1. diffuse septal thickening
  2. localized basal thickening
  3. focal outflow thickening

obstructs aortic outflow

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12
Q

What is the pathophysiology od HCM?

A

diastolic failure due to concentrically thickened LV —> poor ventricular filling causes poor myocardial oxygenation

+ HR must increase to maintain CO

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13
Q

HCM pathophysiology:

A
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14
Q

What are 3 signs of HCM on echocardiography?

A
  1. higher LA and PV pressures = LA dilation
  2. smoke in LA due to increased turbulence (thrombus formation!)
  3. SAM/dynamic outflow obstruction
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15
Q

HCM, LA dilation:

A
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16
Q

What are the 4 causes of thromboembolism as a result of HCM?

A
  1. dilated LA and left auricular appendage = turbulent flow
  2. endocardial injury
  3. stasis in LAA
  4. hypercoagulability

(saddle thrombus if it leaves the left side of the heart!!)

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17
Q

What are clinical signs of thromboembolism in cats with HCM?

A
  • extreme pain
  • paralysis/paresis
  • respiratory distress from pain and CHF
  • no femoral pulse
  • hypothermia
  • purple and cold pads/nails
  • gastrocnemius spasm
  • anorexia, vomiting
  • hyperkalemia, increased CK and NT-proBNP
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18
Q

What is the most common cause of heart murmurs heard in cats with HCM?

A

systolic anterior motion of the mitral valve (SAM)

  • septal mitral valve leaflet or chordal structures are pulled into LV outflow tract during systole
  • leaflet is caught in flow, producing a dynamic subaortic stenosis that increases the velocity of blood
  • when the leaflet is pulled toward the interventricular septum, a gap in the mitral valve is produced = mitral regurgittion
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19
Q

HCM, echo:

A
  • large LA
  • mitral valve pulled toward septum
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20
Q

What is the clinical significance of SAM?

A
  • can cause intermittent murmurs - mitral regurgitation and LA dilation
  • may affect therapeutic recommendations
  • causes aubaortic stenosis
  • initiates/progresses hypertrophy
  • possibly higher risk for sudden death or progression to clinical signs
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21
Q

How do most cats auscultate with HCM?

A
  • 50% have murmurs +/- gallop S3
  • crackles/edema with edema, may have quiet lungs with high RR and effort
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22
Q

How is respiratory effort affected by HCM?

A

> 30 bpm at rest at home and >36 bpm in exam room —> respiratory distress due to pleural effusion/edema

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23
Q

HCM, ECG:

A
  • VPCs
  • ventricular tachycardia
  • increased R wave amplitude
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24
Q

How does HCM appear on radiographs?

A

DV —> Valentine heart due to LA dilation and cardiomegaly

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25
Q

HCM, radiographs:

A

enlarged LA and pulmonary veins

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26
Q

HCM, radiographs:

A

pleural effusion progression following a tap

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27
Q

How is HCM definitively diagnosed?

A

echocardiograph —> thick left ventricle, loss of normal “mushroom sign”

28
Q

HCM, echo:

A

heart suspended in pleural fluid

29
Q

HCM, echo:

A

LA enlargemennt

  • should be close to the size of the aorta
30
Q

HCM thrombus, echo:

A

smoke in LA!

31
Q

What does the normal size of the heart in cats depend on?

A

expected values based on weight

32
Q

How do NT-proBNP tests compare for diagnosing HCM?

A
  • in-house/point of care SNAP = way to rule out distress caused by cardiac vs respiratory, cats showing clinical signs!
  • send out = screening, determines risk
33
Q

What are the 5 stages of HCM?

A
  • A = normal echo, predisposed breed
  • B1 = subclinical, low risk
  • B2 = subclinical, higher risk
  • C = clinical with current/previous CHF or ATE
  • D = clinical with refractory CHF
34
Q

How are owners educated about stage A HCM? Is treatment indicated?

A

cat is seemingly healthy, but will need some form of yearly follow-up

NO

35
Q

WHat are some diagnostics used to screen cats in Stage A HCM?

A
  • auscultation
  • RR at rest and at home
  • chest rfads
  • echo
  • NT-proBNP
36
Q

What is stage B1 HCM? What is required for diagnosis? What screening is recommended?

A

evidence of LV hypertrophy, but no significant LA enlargement —> subclinical, low-risk

ECHO

screen annually with auscultation, RR at rest at home, chest rads, echo, and NT-proBNP —> no treatment needed

37
Q

What is stage B2 HCM? Is treatment recommended? What if there is HOCM?

A

moderate to severe LV hypertrophy with LA enlargement —> subclinical, high risk for developing failure, ATE, or SAM

YES —> Clopidogrel (+/- Aspirin) and arrhytmia treatments

Atenolol —> still has good systolic function, can increase CO and afterload to decrease SAM

38
Q

What new drug may be available for better treatment of stage B2 and above HCM?

A

Rapamycin —> may be able to reverse hypertrophy

39
Q

What monitoring is recommended for stage B2 HCM?

A
  • RR at rest as home
  • minimize stress from exams with medication
  • monitor for development of CHF and ATE
  • q 6-12 months - chest rads, ECG, echo, NT-proBNP
40
Q

What 4 effects do beta-blockers have in the treatment of HOCM?

A
  1. decreases LV outflow tract obstruction
  2. decreases HR to improve filling
  3. decreases wall tress and myocardial oxygen demand
  4. anti-arrhythmic
41
Q

What is stage C HCM? How do patients present?

A

moderate to severe LA enlargement and LVH, but patients are now clinical and at HIGH RISK for developing ATE and recurrent CHF

  • lethargy, hyporexia/anorexia
  • tachypnea, dyspnea
  • syncope
  • paralysis/paresis
  • hypothermia
  • murmur
42
Q

What 7 aspects of stage C HCM are treatable? How?

A
  1. DECREASE PRELOAD - diuretics to resolve edema/effusion
  2. INCREASE INOTROPY - Pimobendan
  3. DECREASE AFTERLOAD - Benazepril, Spironolactone
  4. OPTIMIZE HR - control arrhythmias
  5. BLUNT RAAS - Benazepril, Spironolactone
  6. THROMBOSIS - Clopidogrel +/- Aspirin, factor Xa inhibitor, LMWH
  7. ANXIETY - Gabapentin, Buprenorphine

(no evidence that any therapy beyond diuretics imrpove survival)

43
Q

What 7 treatments/diagnostics are recommended in cats with acute CHF with HCM? What is avoided?

A
  1. OXYGEN
  2. anxiolytic
  3. tap chest
  4. FUROSEMIDE IV
  5. baseline bloods (PCV/TS, renal values, Na, K, BUN, CREA)
  6. Pimobendan
  7. Clopidogrel (consider Rivaroxaban with LA dilation or present clot)

FLUIDS

44
Q

Cat, CHF:

A
  • pulmonary edema
  • pleural effusion
45
Q

Cat, CHF:

A

pleural effusion

46
Q

What should be monitored in cats with acute CHF and HCM? What is the goal?

A
  • temp
  • RR
  • BW
  • BP
  • urine output
  • renal values and electrolytes

get stabilizes and home ASAP —> return in 3-7 days for re-evaluation (log at home resting RR and ensure its consistently <30 BPM at rest) + recheck q 2-4 months

47
Q

What 3 medications are recommended to go home after acute cases of CHF from HCM? What is added once cat is stabilized?

A
  1. Furosemide
  2. Pimobendan
  3. Clopidogrel

Benazepril + Spironolactone

48
Q

What 5 treatments are recommended in cats with stage C HCM? What monitoring is recommended?

A
  1. Furosemide - taper to lowest dose possible to maintain RR < 30
  2. Pimobendan
  3. Clopidogrel
  4. low salt diet
  5. Benazepril and Spironolactone once renal values are normalized

rechecks q 2-4 months - renal values, electrolytes, RR and effort, weight

49
Q

What is stage D HCM? What 5btreatments are recommended?

A

refractory CHF in cats with HCM

  1. Furosemide - taper to lowest dose possible to maintain RR < 30
  2. Pimobendan - increase to TID and higher doses
  3. Clopidogrel
  4. low salt diet
  5. Benazepril and Spironolactone once renal values are normalized
50
Q

What monitoring is recommended for stage D HCM?

A

rechecks q 2-4 months - renal values, electrolytes, RR and effort, weight

51
Q

When is thromboembolytic treatment in cases of HCM contraindicated?

A
  • early stages A and B1
  • ATE has already developed
52
Q

What 2 cardiac changes do restrictive cardiomyopathy result in? What does this cause?

A
  1. diffuse LV endocardial fibrosis (scarring)
  2. myocardial fibrosis

normal sized LV, larger LA +/- RA = diastolic dysfunction

53
Q

What are 3 causes of restrictive cardiomyopathy?

A
  1. amyloidosis
  2. storage disease
  3. inflammatory disease with severe reparative fibrosis
54
Q

What are 5 signs of restrictive cardiomyopathy?

A
  1. systolic or gallop rhythm
  2. left/biventricular CHF
  3. ventricular arrhythmias
  4. ATE
  5. sudden death
55
Q

RCM, echo:

A
  • biatrial enlargement
  • normal LV wall thickness
56
Q

Why is feline DCM much less common now?

A

cat foods supplement the necessary levels of taurine

57
Q

What is the normal morphological characteristics of feline DCM? What does this cause?

A

dilation of 2 or 4 chambers —> ventricles/left side > atria/right side —> eccentricl hypertrophy

systolic dysfunction of one or both ventricles (poor fractional shortening)

58
Q

What breeds are predisposed to developing feline DCM? What are the primary causes of resulting systolic dysfunction?

A

Burmese, Siamese, Abyssinian

  • chronic volume overload
  • ischemic heart disease
  • myocarditis
59
Q

What 2 laboratory tests should be performed in cases of cats with systolic dysfunction?

A
  1. whole blood taurine levels
  2. troponin I - detects ischemic myocardial disease nad myocarditis
60
Q

DCM, echo:

A
  • eccentric hypertrophy
  • increased end-diastolic LV diameter and end-systolic LV diameter = poor fractional shortening
61
Q

What are the 4 morphologic characteristics of feline arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A
  1. RA and RV dilation
  2. RV systolic dysfunction
  3. normal to mildly reduced LV systolic function
  4. arrhythmias - ventricular > supraventricular
62
Q

What gross changes are seen in the heart with feline ARVC?

A

severe loss of RA and RV muscle, causing thinning and dilation of the walls

63
Q

Echo HCM vs. DCM vs. HOCM vs. RCM:

A
  • HCM = small lumen, concentric hypertrophy
  • DCM = large lumen, eccentric hypertrophy, poor contractility
  • HOCM = thickened septum or valve leaflets blocks aortic outflow
  • RCM = enlarged RA and LA, normal ventricles
64
Q

HCM/HOCM vs. DCM vs. RCM vs. ARVC:

A
65
Q

What history is especially important to get in cats with heart failure?

A

FULL dietary history

  • taurine deficiency associated with “boutique” or grain-free diets
  • peas, lentils
  • toxins
  • tell owners to only purchase WSAVA approved diets

Small Animal Medicine II (57 decks)

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