Lit Cardiovascular Flashcards

Question

What is native vs contrast T1 mapping? What 2 key determinants cause increased T1 values?

Answer 1

Fries JVIM 2021 T1 mapping measures the longitudinal or spin-lattice relaxation time of tissues. All tissues have inherent T1 relaxation times that are based on a composite of their cellular and interstitial components. 2 impt determinants: 1) Interstitial oedema secondary to infarction with associated cellular destruction 2) Increased interstitial space from fibrosis. Native T1 values are a composite signal of myocytes & cardiac extracellular volume fraction (ECV), whereas contrast-enhanced T1 mapping can specifically calculate the ECV fraction.

Answer 2

Fries JVIM 2021 Diastolic function Decreased Increased? Increased

Answer 3

Freiche JVIM 2021 - Males, longer duration of CSx, polyphagia - US findings – rounded jejunal LN, presence of abdo effusion (small vol) more prevalent in LGAL cats.

Answer 4

Freiche JVIM 2021 Features in LGAL cats: - Monomorphic lymphocytic population (100% cats), in-depth mucosal infiltration (68%) = hallmarks - Much more frequent epithelial patterns (nests & plaques) (50% vs 5% LPE) - More frequent CD3+ lymphocytic apical-to-basal gradient (41% vs 5% LPE) - CD3+ pSTAT3- & pSTAT5 in 100% LGAL cats (LPE cats – high pSTAT3 expression, lower pSTAT5). - Sig increased Ki-67 20%- & 30%-thresholds in LGAL cats within both epithelium (spec >95%) & LP (spec >95%) respectively. - T-cell PARR (gamma chain gene rearrangements) – monoclonality in 86% LGAL cases, but also 70% LPE cats (40% monoclonality, 30% monoclonality on polyclonal background).

Answer 5

Silva JVIM 2020 Colour Doppler shows the direction of the blood flow in red or blue (either towards or away from the transducer). Meanwhile, spectral Doppler not only shows the direction of blood flow, it also shows the phases (pulsatility) and acceleration of the blood flow. Spectral Doppler imaging is routinely performed for cardiac valves, vascular and other pathological lesions to assess blood flow direction and measure velocity. True Hepatic spectral Doppler findings correlates with RV systolic and diastolic indices. - A wave: retrograde. Represents right atrial contraction - S wave: largest anterograde wave. Occurs in ventricular systole, as the walls contract and the tricuspid annulus is directed to the apex, generating negative pressure and pushing blood out of the liver. - V wave: transient; anterograde, retrograde or neutral. Result of atrial filling as systole becomes less intense and the tricuspid valve returns to its normal position. - D wave: anterograde. Occurs during passive filling of the atrium and right ventricle (RV) during diastole.

Answer 6

Liu JVIM 2020 a) SDMA, NT-proBNP b) Leucine-rich alpha-2-glycoprotein 1, SAA & ceruminoplasmin c) a1-acid glycoprotein concentration

Answer 7

Corda JVIM 2020 2 different Ao transverse sections: - Caudal to the left renal artery (K_AoSt) - Cranial to the external iliac arteries (I_AoSt)) K_AoSt and I_AoSt indices can be used to assess systemic hypertension-related Ao stiffness, especially when NIBP measurements are inconsistent or inaccurate.

Answer 8

DeProspero JAVMA 2021 Mini Schnauzers: - Significantly higher MMVD prevalence, much younger at time of diagnosis. - More likely to have MV prolapse & syncope (potentially 2' to SSS or airway disease e.g. tracheal collapse) Yorkies: - More likely to have coughing

Answer 9

Allen JAVMA 2021 Transoesophageal US + echo-guided LA decompression. Involves a minimally invasive creation of an atrial septal defect to significantly & immediately reduce LA pressure. Successful outcome in 100% (17) dogs w/o intra-op deaths. MST 195d (0-478d).

Answer 10

Stepien JAVMA 2020 Vertebral LA score (VLAS) ≥ 3 vertebral body units (VBUs) 96% 60%

Answer 11

Mostafa JAVMA 2020 - L-sided cardiac dz: supportive - combo of high short-, long- & overall-MHS. - R-sided cardiac dz: highest mean CSI. Supportive - high short-MHS WITHOUT high long-MHS & high overall MHSs. *FYI: all dimensions quantified on R lateral TXR. CSI (cardiac sphericity index) = cSAL:cLAL ratio. ML: manubrium length (1st bone along sternum). Short-MHS = cSAL:ML ratio Long-MHS = cLAL:ML ratio Overall-MHS = (cLAL + cSAL)/ML VHS = # of vertebrae (beginning at the cranial end plate of T4) that represented the same length as that of (cLAL + cSAL).*

Answer 12

Meurs JAVMA 2020 PDK4 (pyruvate kinase dehydrogenase 4) gene - involved in mitochondrial energy production. TTN (titin) gene - sarcomeric gene involved in cardiac contraction. TTN variant most common (58%, 28/48), 20% (10/48) both variants, 12.5% (6/48) neither variant, 8% (4/48) only PDK variant.

Answer 13

Yata JVIM 2019 BNP1-32 = synthetic BNP. BNP1-32 was well tolerated. Rapidly absorbed after dosing --> led to increased urinary cyclic guanosine monophosphate (UEcGMP) (mediator of diuresis, natriuresis, vasodilation & RAAS antagonism) 1-2hrs after. But no measurable effects on biological outcomes (UOP, BP, HR, FENa/K, and plasma [aldosterone]) in this study.

Answer 14

Langhorn JVIM 2016 (*Review*) Cardiac-specific protein. Troponin complex controls cardiomyocyte contraction. I, C & T subunits. Actin = thin filament, myosin = thick filament. - T secures to the thin filament (*T for thin*) - I inhibits ATP hydrolysis for actin & myosin interaction (*I for inhibitory*). - C binds Ca2+ when contraction is initiated. *(C for Ca2+ & contraction)* Pimobendan - positive inotrope. Ca-sensitizing effect on the contractile proteins by increasing affinity of the cTnCC for Ca2+ >> promotes increased contractility w/o decreasing free cellular Ca2+ & therefore myocardial O2.

Answer 15

Hunt JVIM 2018 Yes - can exceed upper RI

Answer 16

Beaumier JVIM 2020 MicroRNA bind RNA and prevent signal translation; very stable - potentially useful as biomarkers. Dogs receiving doxo - miR-107 & miR-146A sig downregulated, miR-502 sig upregulated. Biomarker for doxorubicin cardiotoxicity in dogs. Significant changes in miR-502 occurred before 3rd chemo dose. miRNA changes preceded cTnI elevations (latter only occurred after completing chemo course).

Answer 17

Larouche-Lebel JVIM 2020 a) Classic APs mediate vasoconstriction, Na retention, congestion, cardiac remodelling >> promote CHF. E.g. Angiotensin (AT) 2, AT3, AT4, AT2-receptor type 1 Alternative APs mediate vasodilation, natriuresis, diuresis, anti-remodelling > cardioprotective. E.g. Ang1-5, Ang1-7 (best studied), Ang1-9. b) ACE2 enzyme removes a single AA from AT1 or AT2 to form Ang1-9 & Ang1-7 respectively. c) i) ARB + ACE2

Answer 18

Huh JVIM 2020 Combo tx sig increased Ang1-7 & other alternative APs in CM cats --> cardioprotective. (ARB tx alone also sig increased Ang1-7 but to a smaller degree vs combo tx).

Answer 19

Larouche JVIM 2019 1. ACE2 = homologue of ACE, produces angiotensin peptides (APs) e.g. Ang1-9 & Ang1-7 that are vasodilatory and natriuretic --> act to counterbalance AT-II. 2. Yes - plasma ACE-2 & benefical APs (esp Ang1-7) are increased in dogs with CHF (~10x preclinical dogs). 3. rhACE2 increased beneficial APs (e.g. Ang1-9) while simultaneously decreasing maladaptive APs (e.g. AT-II).

Answer 20

Ward JVIM 2021 q12hr dosing & higher K+ at the first revisit were predictive of 2 year survival. q12hr dosing may optimize cardioprotective benefits of ACEI.

Answer 21

Spalla JVIM 2019 Allows quantification of myocardial deformation in the longitudinal, radial, and circumferential planes; and can provide info on regional & global myocardial function. Cats with HCM had increased LV mass, decreased systolic long axis (longitudinal deformation) & radial deformation, but overall preserved circumferential strain & strain rate.

Answer 22

Santiago JVIM 2020 41.6% prevalence. Associated with older age, pleural effusion, lower HCT/Hb, higher neutrophils, higher BUN, lower BCS. Shorter survival time vs non-cachexic cats.

Answer 23

Ward JAVMA 2017 POCUS - positive site defined by > 3 B-lines at site. ≥ 2 positive sites on each hemithorax. Dogs/cats with CPO had higher # of positive LUS sites vs non-cardiac causes. Sn 84%, spec 74% (similar to TXR - Sn 85%, spec 87%). False positives most common with diffuse interstitial or alveolar disease - not useful to differentiate in these cases.

Answer 24

Visser JVIM 2016 1. Tricuspid regurgitation velocity (TR Vmax). Modified Bernoulli equation: PAP = 4 x (TR Vmax)^2 (Also can use pulmonic regurg velocity) 2. Right pulmonary artery distensibility (RPAD) - strong negative correlation to tricuspid regurgitation Cut-off <29.5%, Sn 84%, Sp 95% to predict TRPG >50mmHg Other echo parameters (in order of correlation): Main PA size: aorta size (MPA:Ao) > acceleration time to peak PA flow (AT)> AT: ejection time of PA flow (AT:ET).

Answer 25

Stockdale JAVMA 2018 No. Increased surgical time but without better outcomes (no sig diff in MST).

Answer 26

Hezzell JVIM 2016 - **Quantitative ELISA** was Sn & Sp for both **plasma (95% Sn, 82% Sp)** + pleural effusion (100% Sn, 76.5% Sp), with different cut-offs (higher proBNP concentrations in PLEURAL FLUID vs plasma). Notably highly sensitive but moderately specific. - **POC test** was useful for PLASMA samples (Sn 95%, Sp 87%), but for **pleural fluid had high Sn (100%)** but poor specificity (64%). - Similar diagnostic accuracy with 1st gen ELISA assays.

Answer 27

Zoia JFMS 2016 Pleural fluid to serum lactate dehydrogenase (LDH) & TP ratios. Lactate ratio 0.6+ & TP ratio 0.5+ consistent with exudate. 2. Albumin gradient (ALBg). Some CHF cats will be "exudative" on Lights criteria but clinical criteria = transudate. Gradient will help differentiate. NB: classic exudate cut of: 30+g/L and >7K cells/uL. Transudate <25g/L, < 1500K cells/uL. NB: original paper on Lights Criteria - Zoia JFMS 2009. Pleural fluid lactate dehydrogenase concentration (LDHp) & pleural fluid/serum total protein ratio (TPr)) were most reliable in differentiating transudates & exudates (Sn 100% & 91%, Sp 100%). Also evaluated serum/fluid cholesterol ratio, glucose & TNCC.

Answer 28

Zoia Vet Rec 2020 Pleural effusion lactate dehydrogenase concentration & serum TP. LC had 98% diagnostic accuracy (vs 57% for traditional classification) in discriminating exudates from transudates. Fluid TNCC & TP had poor diagnostic utility.

Answer 29

Ruiz JAVMA 2018 Rectal temperature - lower in CHF cats (36.9 vs 37.9) Age - CHF & neoplasia more likely in older cats (LSA cats significantly younger cf carcinoma).

Answer 30

Martinez JVIM 2016 Altered plasma eicosanoid profiles - consistent with activation of metabolite pathways that promote vascular dysfunction & contribute to higher BP & albuminuria. - Hypertension correlated with higher 11,12EET & 20(S)HETE *Hydroxyeicosatetraenoic acid = HETE, epoxyeicosatrienoic acid = EET* - Albuminuria correlated with total DHET (higher in greyhounds) *Dihydroxyeicosatrienoic acid = DHET*

Answer 31

Malcolm JAVMA 2018 Right lateral thoracic radiograph. 1st line - measure from carina to the caudal aspect of LA where intersects with the CVC dorsal border. 2nd line (equal length to 1st) - measure from cranial edge of T4 caudally - to get no. of vertebrae included in this length. LA = 2.3+ vertebrae - predictive of LA enlargement. Repeatable & reliable correlation with LA:Ao.

Answer 32

Sanders JAVMA 2018 2

Answer 33

Visser JVIM 2018 Class III anti-arrhythmic. K channel blocker + non-selective beta-adrenergic receptor blocker. Rapid absorption, peak plasma [ ] within 2-4hrs post pill, so can be useful to acutely terminate arrhythmias in hemodynamically stable dogs. Main indication is chronic tx of ventricular arrhythmias. **Mild decrease in LV systolic function.** Caused decreases in all systolic function indices except TAPSE; but only % changes in **LVIDs (normalised) & ejection fraction (EF)** were significantly different. *(NB LVIDs INCREASES with systolic dysfunction).* No adverse events, even in dogs with LA enlargement or systolic dysfunction.

Answer 34

Wright JVIM 2019 Orthodromic AV reciprocating tachycardias (OAVRT). 84% converted with median total dose 2mg/kg (2-5.5). The typical accessory pathway (AP) is composed of myocardial cells spanning the fibrous AV function, and provide electrical continuity between A & V myocardium at distinct sites from SV node & proximal His-Purkinje system. Failure of these pathways to regress forms the substrate for APs. APs can facilitate retrograde conduction, from V to A myocardium, allowing a macroreentrant tachycardia circuit. AP cells share ultrastructural similarities with ventricular myocardial cells. ECG findings - regular, narrow QRS complex tachycardia that terminates in the face of 2nd deg AV block.

Answer 35

Wright JVIM 2018 Labradors 47%, male (67%). CSx: lethargy & GI signs, also tachycardia-induced cardiomyopathy in 46% (see DCM phenotype). Right-sided APs (92%) > L. Radiofrequency catheter ablation eliminated AP conduction long term in 98.8% of dogs, recurrence eliminated with a 2nd procedure in small % of dogs.

Answer 36

Santilli JVIM 2016 14% (7/48) of dogs regressed, typically within 30days after pacemaker implantation. 86% had static or progressive paroxysmal AVBs. Progression occurred at any time, so degree of AVB at the time of PMI should not be considered definitive, requires ongoing monitoring. Most dogs that did not improve had chronic structural (fibrous/fibrous-fatty change to AV bundle. The dogs that improved could have had myocarditis (reported as cause of transient AVB).

Answer 37

Santilli JVIM 2016 14% (7/48) of dogs regressed, typically within 30days after pacemaker implantation. 86% had static or progressive paroxysmal AVBs. Progression occurred at any time, so degree of AVB at the time of PMI should not be considered definitive, requires ongoing monitoring. Most dogs that did not improve had chronic structural (fibrous/fibrous-fatty change to AV bundle. The dogs that improved could have had myocarditis (reported as cause of transient AVB).

Answer 38

Szatmári JVIM 2018 Inhibitor of the inward rectifier K+ current (IK1), which is important for depolarisation & maintaining RMP (at -90mV) + contributes to phase 3 repolarization. In experimental AFib models this K+ channel is upregulated, so this drug was proposed to be effective for AFib. Evaluated in large breed dogs with AFib. Protocol was IV bolus 2.5 mg/kg over 10min then maintenance CRI 0.04 mg/kg/min for max 50mins. None cardioverted to sinus rhythm. Self-limiting SE: VPC, respiratory distress with laryngeal stridor, muscular weakness & twitching.

Answer 39

Pedro JVIM 2018 * For every 10bpm increase, risk of all-cause mortality increased by 35%. * MST longer in dogs with HR <125bpm (1037d vs 105d if HR 125+). * Mean HR was independently associated with all-cause & CVS-related mortality. Jung JVIM 2016 * Simliar findings, AF increased risk of cardiac death. * MST 142d for AF (vs 234d w/o AF) * Inadequately controlled AF associated with increased risk of mortality. * Diltiazem + digoxin combo significantly decreased HR & prolonged MST (130d) cf diltiazem (35d) alone. Borgeat JVIM 2021 14.8% (vs 5.5% controls). Younger age at dx, larger LA, syncope.

Answer 40

Vollmar JVIM 2016 Pimobendan. Reached study endpoint in 1991d (digoxin 1263d, benazepril 997d).

Answer 41

Wesselowski JVIM 2019 PDA phenotypes classified based on angiography. Types I, IIa, IIb, III. IV, V. Type III PDAs (tubular appearance with minimal-no tapering in ductal diameter before insertion into the PA) are not amenable to interventional procedures (e.g. Amplatz canine duct occluder placement; instead surgical ligation is performed to avoid device-related complications due to inadequate device stability). Type II anatomy most common in GSDs (88%). 3/24 dogs had unusual anatomy in this study (types IV & V), with median minimal ductal diameter was larger than in a mixed dog population, hence recommend echo for optimal procedural planning.

Answer 42

Doocy JVIM 2018 3D Transoesophageal echocardiography (TEE-3D). Oval shape.

Answer 43

Wesselowski JVIM 2017 Poor correlation, not recommended to base choice of occluder on BW. in small patients the femoral artery size can limit the size of device used *(see paper on Amplatz plug Type 4).*

Answer 44

Boutet JVIM 2017 No. pulmonary hypertension was not seen in this study but still associated with L-R shunts. Adult dogs in this study and improvement was seen with PDA closure, even when clinical.

Answer 45

Boutet JVIM 2017 Differential cyanosis. (blue/purple caudal MM, pink cranial MM). Polycythemia (renal response to hypoxia) > seizures if severe. No. Pulmonary hypertension is not a contraindication for closure as long as it does not cause complete R-L (reverse) shunting. Yes. Adult dogs presenting with L-R PDA later in life (5+yo) resulting in cardiomegaly & clinical signs can still improve or resolve with PDA closure.

Answer 46

Spalla JVIM 2016 Speckle tracking echo (STE). This showed stable systolic function (normal S & SR values) post PDA closure. *S = strain, SR = strain rate (of LV)* Spalla JVIM 2016 Used STE to assess PDA dogs PRE-OP vs healthy dogs. Conventional parameters (EF & FS) did not differ between groups. STE-derived parameters identified subtle changes in cardiac systolic function and contractility between the 2 groups, so may be more sensitive method.

Answer 47

Baron Toaldo JVIM 2017 2D method using speckle tracking to calculate regional myocardial deformation and therefore function. This study showed that LA speckle tracing echo (STE) analysis highlights progressive decline in atrial function with worsening MMVD. Found to be feasible & reproducible.

Answer 48

Ranganathan JAVMA 2018 10% major complication rate in sx group vs 0% in occluder group. Survival to discharge was comparable (overall 99%).

Answer 49

Corda JVIM 2019 Dogs with SIRS had lower 2D-STE ejection fraction, endocardial global longitudinal strain (ENDO-G-Long-St), LVIDd (normalised) & LVIDs (normalised) vs healthy dogs.

Answer 50

Markovic JVIM 2018 Oesophageal pigtail marker catheter. Radioopaque table ruler underestimated size of structures by 10% - greatest effect when measuring larger structures (e.g. pulmonary valve annulus & larger dogs).

Answer 51

Lake-Bakaar JVIM 2017 Balloon valvuloplasty. Labradors. Presented with syncope, R-CHF, exercise intolerance. Most had clinical improvement & echo parameters improved (decreased RA pressure, TVmax). But CSx recurred in 2/5 dogs; 1 dog was euthanised due to progressive TR & R-CHF (pre-existing moderate-severe TR).

Answer 52

König JVIM 2019 Ang-2 produced by endothelial cells & released into circulation when activated. Together with VEGF; regulate vascular endothelial activation, promote inflammation, adhesions & vascular dysfunction. In this study Ang-2 was higher in SIRS/sepsis vs healthy dogs; also higher in non-survivors, so could be another biomarker. VEGF was higher in sepsis > SIRS > healthy dogs, but had poor ability to predict outcome.

Answer 53

Bijsmans JVIM 2017 No. * VEGF was higher in HT+ocular TOD cats vs all other groups (HT-TOD, CKD + normotensive, geriatric cats). Independently predictive of hypertension. * CTnI was also independently predictive of hypertension (lower in healthy cats vs other groups), but not specifically ocular TOD. * NT-proBNP was higher in HT + ocular TOD vs healthy cats. Based on ROCs, none were useful diagnostically though. Preferred diagnostic methods still SBP measurement + fundoscopy. Enache JFMS 2021 Retinal vascular (arteriole + venule) diameter decreases with age. Vessel diameters also decreased at 3 & 6mths post tx in hypertensive cats. Study did not conclude if RVD is a risk indicator for hypertension due to short FU; longitudinal studies required.

Answer 54

Bijsmans JVIM 2017 NT-proBNP decreased with anti-hypertensive tx. cTnI & VEGF did not.

Answer 55

Bijsmans JVIM 2016 Pre-treatment BP. (Plasma amlodipine concentrations were directly dose-dependent).

Answer 56

Glaus JVIM 2018 Evaluated telmisartan 2mg/kg PO SID in cats with SBP 160-200mmHg. Effective at reducing BP by 19.2mmHg at 2 weeks & 24.6mmHg at 4 weeks. **52% of cats had SBP < 150mmHg at 4 weeks.** Coleman JVIM 2018 Telmisartan dose protocol: 1.5mg/kg PO BID x14d then 2mg/kg PO SID q12h. Reduced SBP by 23.9mmHg at 4 weeks, with effect persisting over 6 months.

Answer 57

Tjostheim JVIM 2016 37% (also proteinuric) Note: prevalence of SHT (37%) & proteinuria (21%) in dogs with neoplasia at BASELINE - so need to closely monitor these parameters after starting TKI.

Answer 58

Whittemore JAVMA 2017 Coccygeal BP not affected by age or muscle condition. Radial BP affected by muscle condition (older + sarcopenia increases BP readings). Mean systolic coccygeal BP higher than radial (+19mmHg) though this was inconsistent.** Paper recommended coccygeal measurement & MCS monitoring during serial systolic BP measurements.** Zeugswetter JFMS 2017 Noted large discrepancy between coccygeal & radial ABP measurements, which did not correlate with age or BW. Coccygeal was 18.7mmHg higher, possibly due to cone-shaped tails esp in obese cats. 56% cats deemed moderately hypertensive (SBP 170+mmHg) on coccygeal were normo/mildy hypertensive on radial measurements. JAVMA 2017 paper? saying cannot preference coccygeal over radial, as precision of radial is still high and no studies to support difference being pathological Cernia JFMS 2021 No. Oscillometric BP under-read MAP cf SAP (osc mode A better than B, but still difference of 15mmHg).

Answer 59

Bourazak JAVMA 2018 Doppler BP compared to invasive BP monitoring method, Doppler BP unreliable for hypotension, Sn 66-69% & Sp 82-86%. Limb conformation, IVC gauge, recumbency didn't affect invasive BP measurements.

Answer 60

Kim JVIM 2016 Lepin high & adiponectin low cf healthy dogs. ISACHC Class 3 (severe HF) dogs had high leptin + adiponectin concentrations cf Class 1 dogs. *(ISACHC = international Small Animal Cardiac Health Council)*

Answer 61

Reimann JVIM 2017 Oxidized low-density lipoprotein (oxLDL), Vit E, gamma-tocopherol are affected by sex, BCS, neuter status; all also positively correlated with **serum cholesterol.** Could not be used for clinical stage of MMVD in this study.

Answer 62

Karlin JVIM 2018 Trimethylamine N-oxide (TMAO). Precursors - choline, L-carnitine. An oxidised product of trimethylamine, which is produced by GI bacteria when they metabolise choline. TMAO is increased in dogs with CHF secondary to DMVD cf subclinical dogs & healthy controls.

Answer 63

Toaldo JVIM 2017 Several in an univariate analysis. In multivariate, **MV E wave velocity & LA maximal volume (LAVmax) were significant**. - An increase in MV E vel is an indirect measure of MR severity - reflects worsening pressure differences between LA & LV with increasing regurgitant volumes. - LAVmax = strongest predictor of cardiac death (superior to LA:Ao & STE variables) Nakamura JVIM 2016 **Right ventricular Tei-index (RVTX)** Significant independent predictor of death. LA:Ao was also predictive. Index of global myocardial function, including systolic & diastolic performance. Calculated by dual PWD.

Answer 64

Baron Toaldo JVIM 2016 No association between variables of RV systolic/diastolic function & different MMVD stages & severity of PH detected from study. Chapel JVIM 2018 RV systolic function (measured based on TAPSE & RV strain) increased in B2 but then decreased in stage C MMVD. TAPSE = tricuspid annular plane systolic excursion.

Answer 65

Reimann JVIM 2017 Moderate to severe MR (even if intermittent) & increased LVIDs(N) in dogs <3yo were associated with cardiac death later in life in CKCS. Males had higher all-cause mortality with MR.

Answer 66

Menciotti JVIM 2018 MV of CKCS have a smaller annulus height, resulting in a flatter MV with reduced tenting - may confer a mechanical disadvantage & predispose to early MMVD development.

Answer 67

Boswood JVIM 2016 **Pimo significantly prolongs preclinical MMVD period by ~15mths.** * Significantly longer median time to primary endpoint + reduced risk (~2/3) of reaching endpoint for PIMO group (1228d) vs placebo group (766d). * Primary endpoint: time to onset of CHF, cardiac-related death, or euthanasia. **Longer survival in PIMO dogs** (MST 1059d) vs placebo (902d).

Answer 68

Boswood JVIM 2018 **Pimobendan reduced heart size in dogs with B2 MMVD & this was associated with increased time to CHF & cardiac related death**. Therapeutic benefit associated with reduction LV end systolic dimension. At the onset of CHF, groups were similar.

Answer 69

Boswood JVIM 2019 Most extreme values & rate of change occurred in variables immediately before onset of CHF (especially RR & resting RR). VHS increased earliest. Rectal temp & BW decreased.

Answer 70

Chetboul JVIM 2017 Study demonstrated that **torasemide q24h is noninferior to furosemide q12h** when considering a composite clinical score endpoint (% treatment success; clinical & TXR pulmonary oedema). Torasemide was associated with a** 2-fold reduction in the risk of reaching the secondary composite cardiac endpoint** (spontaneous cardiac death, euthanasia for HF, or worsening CHF class) over a 3-month period cf frusemide.

Answer 71

Hezzell JVIM 2018 A pre-defined treatment escalation algorithm in response to proBNP measurements was able to reduce proBNP in stable MMVD dogs with CHF (proBNP did not significantly decrease for dogs with no tx adjustment).

Answer 72

Paper? A cut off of >2,447 discriminated CHF from non-cardiac respiratory distress with a Sn of 81% & Sp 73%

Answer 73

Harris JVIM 2017 Sn 65%, Sp 100%. Moderate-poor Sn so a negative result cannot exclude cardiac disease. Ward JVIM 2018 a) Presence of >1 site strongly positive for B-lines (>3 B-lines per site) on LUS had Sn 78.8%, Sp 83.3% & accuracy 83%. b) Cardiac US - subjective LA enlargement was 97% Sn & 100% Sp for CHF, accuracy 98%. Presence of pericardial effusion was 100% Sp but only 60% Sn for CHF, accuracy 80%. d) Positive NT-proBNP (blood) was 94% Sn & 72% Sp for CHF, accuracy 83% (so positive test doesn't mean CHF is definitely the cause). Pierce JVIM 2017 Cats with a larger % decrease in NT-proBNP from admission to discharge + without CHF at revisit had longer survival times. MST 109d (1-709d). CHF at re-evaluation & difficulty administering medications were associated with poorer prognosis.

Answer 74

Newhard JVIM 2018 ARB/NEP inhibitor. NEP (Neprilysin) = enzyme that cleaves natriuretic peptides protective against RAAS activation. In people, drug was found to decrease RAAS activation, inhibit RAAS hormones, decrease breakdown of endogenous NPs & decrease the occurrence of aldosterone breakthrough (documented in 32% of MMVD dogs with CHF). **S/V tx decreased urinary aldosterone/creatinine ratios by D30.** Drug did not sig change NT-proBNP, echo, TXR, SBP or biochemical parameters. No SE noted in this study.

Answer 75

Rhinehart JVIM 2017 Yes, 78% of dogs had a significant INCREASE after sedation with butorphanol 0.25mg/kg IM. TRV increased by >0.4m/s in 42% dogs. Authors caution that sedation may affect assessment of estimate PAP at diagnosis of PH & interpretation of tx response.

Answer 76

Cichocki JAVMA 2019 CHF or pulmonary to systemic flow ratio of >3. Palliative PA band reduced ratio to 1.5 in this study & resolved CHF within 2 weeks.

Answer 77

Nucci JAVMA 2016 No difference in sx length, post-op complications, duration of indwelling thoracostomy tube. Median hospitalisation 1 day for thorascopy & 2 days for thoracotomy. Conclusion was thoracoscopy is an acceptable alternative to thoracotomy in dogs with PRAA, similar M&M rates.

Answer 78

Darnis JVIM 2018 CVC to Ao ratio. Measured at the transverse 11th-13th R hepatic intercostal view (HV) & longitudinal R paralumbar view (PV). Good interobserver agreement in healthy dogs; needs validation in hypovolaemic dogs.

Answer 79

Chetboul JAVMA 2016 Echo findings - VSD, override of the IVS by the aortic root, pulmonic stenosis (RVOT obstruction), secondary RV hypertrophy. Keeshonds. Terrier breeds (7/15 dogs). No differences between dogs & cats. MST 23.4mths. Shorter survival associated with no/low-grade heart murmur (MST 3.4mths) vs higher-grade heart murmur (MST 16.4mths). *Remember softer murmur - larger VSD & shunting. *

Answer 80

Garofalo JVIM 2016 **Transpulmonary thermodilution (TPTDCO) and pulmonary artery thermodilution (PATDCO)**: changes in blood temperature noted either in a peripheral artery (femoral) or pulmonary artery (right cardiac catheterisation) after injection of a cold indicator are used to estimate CO. Comparable methods. **Calibrated pulse contour analysis** uses analysis of the systolic portion of the arterial pressure waveform. **Method is affected by systemic vascular resistance which limits clinical utility.**

Answer 81

Keene JVIM 2019 Ideally fulfill all criteria before starting tx. Murmur 3/6+ La/Ao 1.6 + LVIDdn 1.7+ VHS 10.5+ (breed adjusted) OR if not doing echo: * VHS 11.5+ * VLAS (radiographic measurement of LA size) 3+ vertebra

Answer 82

Keene JVIM 2019 Dobutamine (2.5-10 μg/kg/min CRI, start low end & titrate dose up as needed). Reduce dose if tachycardia or ectopic beats occur.

Answer 83

Klüser JVIM 2016 **Volume overload of the LV (increased LV end diastolic volume >91.3ml.m2) = single best variable.** Probability of SCD increases 8.5x per every 50 mL/m²-unit increment in LVEDV/BSA. **Increased cTnI, VTach & rate of VPCs >260bpm** were also predictive.

Answer 84

Klüser JVIM 2019 Conventional cTnI assay: cutoff cTnI of >0.22 ng/mL has Sn 79.5% & Sp 84.4% to detect all DCM disease stages. For Dobermans without CHF & using a cut-off cTnI of >0.113ng/ml: - hs-cTnI assay had Sn 81% & Sp 73% - Conventional Sn 78 & Sp 72% - Similar performance, but hs-cTnI assay detected more dogs (72%) than conventional (62%) for dogs that were normal at exam but subsequently diagnosed with DCM within 1.5yrs. So hs-cTnI has good potential to identify early DCM.

Answer 85

Hanson JAVMA 2018 Phenylpropalamine. Caused severe LV hypertrophy & V arrhythmias post IVDD sx, which resolved when drug was stopped. Note this dog was on CHRONIC PPA therapy (8.5yrs) so not an acute SE. MOA - adrenergic receptor agonist.

Answer 86

Santilli JAVMA 2019 The most common pathogens in dogs with UMRD were **canine distemper virus, canine coronavirus, canine parvovirus 2, and Bartonella spp.** 57% of dogs tested positive to 1+ pathogen. Positive association but causation not found - no pathogens detected on paired blood samples. **Canine coronavirus detected in 10% of CHD biopsies.**

Answer 87

Hori JVIM 2018 Cut-off cTnI of 0.163ng/mL = Sn 62% & Sp 100% for differentiating normal vs asymptomatic HCM (no LA dilation). Cut-off cTnI of 0.234ng/mL = Sn 95% & Sp 77.8% for assessing CHF. **cTnI significantly higher in CHF > asymptomatic HCM > healthy cats --> increased cTnI concentrations reflect the severity of HCM.** Hertzsch JVIM 2019 **Cutoff >0.06ng/mL** provided good discrimination between healthy vs HCM cats (Sn 91.7%, Sp 95.4%, AUC 95%). Overall good screening test - as even for asymptomatic cats with HCM, had high Sn 87.8% & Sp 95.4%.

Answer 88

Gunther-Harrington JVIM 2016 Timolol = non-selective beta blocker. Causes transient significant reduction in HR (25bpm), allows assessment of diastolic function w/o clinically significant AE. Caused separation of the E and A waves that were fused before application in 62% of cats. No bradyarrythmias but 2 developed 1st degree AV block. Caused resolution of a dynamic outflow obstruction in 6 cats.

Answer 89

Gunther-Harrington JVIM 2016 Timolol = non-selective beta blocker. Causes transient significant reduction in HR (-25bpm) when assessed 20mins after application. Allows assessment of diastolic function w/o clinically significant AE. Caused separation of E & A waves that were fused before application in 62% cats. No bradyarrythmias but 2 developed 1st degree AV block. Caused resolution of a dynamic outflow obstruction in 6/20 cats.

Answer 90

Freeman JAVMA 2018 Whole blood taurine level ideal (> plasma). Cut-off taurine [ ] <250nmol/L esp for GRs. Note this is low end RI but within RI).

Answer 91

Freeman JAVMA 2018 Boutique, exotic-ingredient & grain free (BEG) diets. Fibre types & amounts, protein types (e.g. lamb vs chicken) - may affect taurine bioavailability. Fibre content may also affect enterohepatic recycling of bile acids (taurine conjugates BAs > bile salts). Many other factors - but still undergoing investigation. Taurine is important in the** modulation of calcium flux,** thereby reducing platelet aggregation, stabilizing neuronal membranes, and affecting cardiac function. Taurine's effects on cardiac function include **positive inotropic** activity without affecting resting potential and modulating ionic currents across the cell membrane + **anti-oxidant effects.** Levocarnitine is an endogenous substance; it is required for **normal fat utilization and energy metabolism**. It serves to ** facilitate entry of long-chain fatty acids into cellular mitochondria,** where they can be used during oxidation for energy production. Cardiac and skeletal muscle are significant sites for levocarnitine storage and activity.

Answer 92

King JVIM 2019 Benazepril 0.5-1mg/kg PO SID for 2yrs. Was well tolerated but no benefit found (no differences in time to treatment fx failure, LA diameter & LV wall thickness, or QOL scores vs placebo). However, study limitations included heterogenous group of cats, multiple diseases and included asymptomatic cats.

Answer 93

King JVIM 2019 Benazepril 0.5-1mg/kg PO SID for 2yrs. Was well tolerated but no benefit found (no differences in time to treatment fx failure, LA diameter & LV wall thickness, or QOL scores vs placebo). However, study limitations included heterogenous group of cats, multiple diseases and included asymptomatic cats.

Answer 94

Guillaumin JFMS 2019 Most common TPA dose = 1mg/kg over 1hr. No statistically significant difference in short term survival, clinical improvement between groups. Complications - reperfusion injury (50% in both) & AKI (30% vs 27%). Similar rate between groups. TPA group presented within 3hrs of onset of FATE (vs 6hrs). Study may have been underpowered.

Answer 95

Pouzot-Nevroret JFMS 2018 A minimum difference of 2.4°C between ipsilateral affected & non-affected limbs has an excellent Sp & Sn for the diagnosis of FATE. Sn 80-90%, Sp 100%, PPV 100%, NPV 75-80%.

Answer 96

Kittleson JFMS 2021 (Review) Both CMs involve LV diastolic dysfunction (stiff non-compliant LV). But HCM has myocardial thickening (concentric hypertrophy) while RCM does not. Fibrosis is the PRIMARY lesion in RCM, but occurs SECONDARY to LV wall thickening in HCM. Locatelli JFMS 2018 MST 69 days overall. If clinical (96% cats - respiratory distress most common), MST 64 days. If asymptomatic (rare), MST 466d. Spalla JFMS 2016 Study looked at survival in different feline CM types. RCM group MST 273d. Chetboul JVIM 2019 Longer MST reported vs JFMS 2018 paper. Median MST from dx = 436d (2-3710d). LA enlargement was associated with decreased survival. Risk of cardiac death increased by 2.5x for every 0.5 LA: Ao increase.

Answer 97

Spalla JFMS 2016 Cats with secondary CM had longer survival (<50% cardiac death rate) vs primary CM cats (MST for HCM 865d, RCM 273d). Increased LA:Ao ratio, presence of CSx, hypercoagulable state.

Answer 98

Kittleson JFMS 2021 (review) Tricuspid dysplasia (TVD), ARVCM. Can be challenging to differentiate however tx is simlar.

Answer 99

HyperT likely increases LV wall thickness by ⩽2 mm in many cats. Dx - if a hyperT cat has severe LV hypertrophy (diastolic LV wall thickness 7mm+), more likely that cat has severe primary HCM or mild-moderate HCM worsened by hyperT. Tx - many but not all cats will have thinner LV after achieving euthyroidism. HyperT exacerbates heart failure by increasing the BMR - so HF is easier to managed when hyperT is controlled - IMPT.

Answer 100

Kittleson JFMS 2021 The noncompacted myocardium appears as recesses/ trabeculae that communicate with the LV cavity (on long-axis view) & appears spongiform (like Swiss cheese) in short-axis view. Px unknown, but tx indicated if atrial enlargement present.

Answer 101

Kittleson JFMS 2021 Cavitary effusions - pleural effusion (esp if large volume), ascites. These cats tend to require periodic thoraco/abdominocenteses on top of diuretic tx, don't usually respond well to diuretic alone.

Answer 102

MST without PH =758d, with PH 456d. PH presence wasn't an independent predictor of survival, but TRPG >55mmHg was an independent negative predictor of survival.

Answer 103

Ineson JVIM 2018 Shorter survival assocaited with: - Cachexia - Obesity & being underweight at diagnosis (NB: some obese dogs were sarcopenic). - Azotemia & clinically significant tachyarrythmias

Answer 104

Martinez JVIM 2017 Greyhounds had higher sCr, Na+ & SDMA; also higher BP & albuminuria. Basal RAAS activation (renin & ACE activity) similar between groups, but Greyhounds had lower aldosterone concentrations. *Lower aldosterone is in response to high Na & BP, suggesting AT-II effects predominate over aldosterone in Greyhounds*.

Answer 105

Martinez JVIM 2017 Greyhounds had higher sCr, Na+ & SDMA; also higher BP & albuminuria. Basal RAAS activation (renin & ACE activity) similar between groups, but Greyhounds had lower aldosterone concentrations. *Lower aldosterone is in response to high Na & BP, suggesting AT-II effects predominate over aldosterone in Greyhounds*.

Answer 106

Birkegård JVIM 2016 Yes, breeding scheme over 8-10 year period reduced risk by 73% (of having a MR murmur).

Answer 107

Beaumier JVIM 2018 Advanced HF defined as recurrent CHF signs despite initially prescribed pimobendan dose, ACEI & furosemide >4 mg/kg/d. Median duration between the diagnosis of stage C & AHF = 163d. MST after dx of AHF = 281d (considered reasonably long). Higher frusemide dose (>6.7mg/kg/d) & non-hospitalisation were associated with longer survival. 81% dogs had increased BUN & 76% dogs with hypoCl at some point during tx.

Answer 108

Mattin JVIM 2018 Plasma NT-proBNP, HR, heart murmur intensity, presence of a cough, being a CKCS & being prescribed pimobendan were associated with clinical progression to initiation of tx with a potent diuretic or cardiac-related death. Mattin JVIM 2019 * Higher NT-proBNP & cTnI, higher HR, older dogs, females, CSx (exercise intolerant, dyspnea) & selected co-morbidities - associated with increased hazard of all-cause morbidity. * Higher plasma biomarker [ ] , higher HR & murmur intensity, exercise intolerance, dogs receiving potent diuretics - associated with increased hazard of cardiac-related death.

Answer 109

Spalla JVIM 2017 Mitral annular plane systolic excursion (MAPSE) & its right-sided counterpart - tricuspid annular plane systolic excursion (TAPSE) - are M-mode-derived indices of **systolic** longitudinal displacement of the AV annular plane. MAPSE and TAPSE can therefore be considered as markers of ventricular long-axis function. L-sided heart disease can also influence TAPSE. Study found that HCM cats have LOWER MAPSE & TAPSE values vs healthy controls, with lowest values in HCM+CHF cats.

Answer 110

Marinus JVIM 2017 Systolic, left heart base, up to 2/6 intensity. Plasma NT-proBNP [ ] was higher in pups with pathologic vs innocent murmur, however normal proBNP [ ] does not rule out a congenital cardiac anomaly. Murmurs longer than 80% of the systole are most likely abnormal, whereas murmurs shorter than that could be either innocent or pathologic.

Answer 111

Martinelli JVIM 2016 Presence of cardiovascular-renal disorder (CvRD) reduces survival time. Significant correlation between ACVIM class and IRIS stage found. Treatment for medical management of heart failure may play a role in inducing CKD. Anaemia was not associated with worsening of heart function.

Answer 112

Martinelli JVIM 2016 Presence of cardiovascular-renal disorder (CvRD) reduces survival time. Significant correlation between ACVIM class and IRIS stage found. Treatment for medical management of heart failure may play a role in inducing CKD. Anaemia was not associated with worsening of heart function.

Answer 113

Häggström JVIM 2016 Ao, LVED, LVFW thickness, LA dimensions

Answer 114

Roderick JFMS 2017 RDW = measurement of variability in circulating RBC size. Single RDW values did not predict mortality in cats with acquired heart disease. **But RDW increased in CHF cf those without**. Median RDW was higher in cats with UCM cf other CMs.

Answer 115

Hanås JFMS 2017 No difference in HR or no. of VPC/APCs. Intermittent sinus arrhythmia observed in 60% cats with HCM.

Answer 116

Fox JVIM 2018 CHF or ATE in 30.5%, cardiovascular death 27.9%. No difference in M&M between HCM and HOCM. 10% of preclinical HCM/HOCM cats reached 9-15 years.

Answer 117

Van Hoek JVIM 2020 Significant decreases in echo parameters (IVSd, max LVWd), IGF-1 after 12mths; and in ultrasensitive cTnI after 6mths.

Answer 118

Van Hoek JVIM 2020 Significant decreases in echo parameters (IVSd, max LVWd), IGF-1 after 12mths; and in ultrasensitive cTnI after 6mths.

Answer 119

Abbott JVIM 2017 V(TR) = peak velocity of tricuspid valve regurgitation - to measure estimated systolic PAP. If TR is absent, alternative measures = acceleration time of pulmonary ejection & acceleration-to-ejection time ratio. Change >0.3m/s

Answer 120

Mazzotta JVIM 2016 RBC distribution width (RDW) = quantitative measurement of anisocytosis. Significantly increased in dogs with SEVERE pre or post-capillary PH vs healthy dogs. Associated with peak TR pressure gradient, urea, Hct, WBCC, age Diseases associated with PH rather than PH severity likely responsible for increased RDW.

Answer 121

Vezzosi JVIM 2018 R atrial index - Evaluates RA size, may be more effective than TRPG in predicting R-CHF. Cut-off RAA of >12.3mc2/m2 had 100% Sn & 89% Sp to predict R-CHF. TR severity = main determinant of RAA. RVEDA index - Evaluates RV dimension - Similarly TR severity = main determinant - RVEDA higher in R-CHF dogs. RV systolic function - Measured using TAPSEn & FSCn (fractional area change) - no association with PH severity & presence/absence of R-CHF.

Answer 122

Vezzosi JVIM 2017 Lung US had good diagnostic accuracy to identify CPO (90% Sn, 93% Sp, PPV 85%, NPV 95%). Also potentially useful in staging CVHD. Rare-absent B lines in 98% B1 dogs, 88% B2 dogs & 100% stage C dogs w/o radiographic signs of CPO. 90% of stage C dogs with XR signs of CPO had numerous/confluent B lines.

Answer 123

Conroy JVIM 2017 19.5%. Cats diagnosed as a result of monitoring pre-existing disease (vs diagnosis after CSx) & cats with amlodipine dose change (repeat BP monitoring) had improved survival.

Answer 124

Tidholm JVIM 2019 Simpson's modified method of discs (SMOD) - using formula, area-length method (ALM). SMOD underestimated LA volume whereas ALM overestimated. SMOD preferred as only 7% systematic difference with RT3DE.

Answer 125

Tidholm JVIM 2017 2 chamber - highest agreement with 3D method. Underestimates.

Answer 126

Fox JVIM 2018 No sig diff in % of non-CVS death (most common - cancer, CKD, GI-related) between groups. CVS mortality contributed to greater % all-cause mortality in pHCM cats vs healthy (65% vs 40%). Also no diff in MST, but HCM that developed clinical disease had shorter all-cause survival.

Answer 127

Kittleson JVIM 2017 Excessive, prominent trabeculae confined to the inner LV or RV walls and separated from each other by deep, intertrabecular sinusoids (recesses) that communicate with the ventricular cavity.

Answer 128

Kilkenny JVIM 2021 >0.625ng/mL (RI <0.1). Not associated with survival in this study.

Answer 129

Ferasin JVIM 2020 No, can be iatrogenic (increasing transducer probe pressure on right thoracic wall). HyperT, anemia, inflammatory disease, CKD +/- systemic hypertension

Answer 130

Langhorn JVIM 2016 review Boxers & Greyhounds False increase: haemolysis, lipemia, fibrin, increased ALKP, rheumatoid factor, heterophilic antibodies, immune complexes False neg: circulating troponin autoantibodies

Answer 131

Langhorn JFMS 2018 Increased serum cTnI (higher than controls, but lower vs cardiac cats). Measurable urine cTnI in renal cats.

Answer 132

Dutton JSAP 2017 Generalised seizures sig increased SERUM cTnI [ ] in dogs. Higher [ ] in dogs experiencing more seizures.

Answer 133

Larouche-Lebel JVIM 2019 1) Mitral regurgitant fraction (RF) 2) Effective regurgitant orifice area (EROA) 3) Ratio of MR to aortic flow (QMR:QAo) 1) 50%+, 2) EROA 0.347+ & 3) 0.79+ correlated to LA:Ao 1.6+ & LVIDdN 1.7+.

Answer 134

Suzuki JVIM 2019 Found differences in myocardial function of HOCM cats vs healthy controls cf conventional echo > reflects compensation for occult systolic dysfunction.

Answer 135

Rohrbaugh JVIM 2020 Doppler echo variables of LV filling derived from diastolic transmitral flow, pulmonary vein flow, and tissue Doppler. Also LA size

Answer 136

Nakamura JVIM 2017 Yes. LA longitudinal strain during atrial contraction (eA) = best predictor for presence or history of CHF. eA (indicator of booster pump function) & LA strain during ventricular systole (indicator of reservoir function) (eS) were significantly LOWER in stages C/D than B1/B2.

Answer 137

Nishimura JVIM 2018 No to both, but atenolol reduces PG (pulmonary valve maximum pressure gradient). Flow-dependent methods included pulmonary valve velocity ratio, VTI ratio (velocity time integral), iPVA (pulmonic valve area indexed to BSA), mean & max PG.

Answer 138

Meurs JAVMA 2016 Holter monitoring to detect ventricular tachyarrhythmias (90-8700 VPCs/24hr). Suspect autosomal recessive dz.

Answer 139

Morgan JAVMA 2019 85% purebred. 23% GSD, 15% Labs, 8% Greyhounds.

Answer 140

Ames JVIM 2019 RAAS review Chymase is primarily found in mast cells (MCs), fibroblasts, and vascular endothelial cells > released into the extracellular interstitium in response to inflammatory signals, tissue injury, and cellular stress. Also an **impt enzyme for ATII formation **(e.g. in myocardium). Not yet evaluated in vet med, but chymase inhibitors are being trialled in people (RAAS suppression).

Answer 141

Pariaut VCNA 2017 review **Amiodarone: ** K+ channel blocker. Mild rate control. - Acute setting – CRI; common AE – facial oedema, diffuse erythema, urticaria, pruritus, hypersalivation, extreme weakness, agitation with apparent pain. - Chronic use – achieved NSR in 1-25d of tx, reduced V response rate. Well tolerated even by HF dogs. NB: long term use: LE increases (mainly ALT), reduce dose if 2-3x incr, discontinue if continued ALT elevation or CSx develop. Also thyroid dysfunction, anemia, neutropenia, thrombocytopenia, ocular signs. **Lidocaine ** fast Na channel blocker. - For vagally mediated paroxysmal AF in large breed dogs - Usually 1-2 IV doses enough to restore NSR in 30-90secs) **Clinical features **- recent onset AFib, normal cardiac function, check/correct electrolyte abnormalities.

Answer 142

Pariaut VCNA 2017 review Presence of accessory AV pathway with concurrent AFib. Lacks filtering function of AV node (slow/control ) --> so slowing V rate with meds could favour activation of ventricles by accessory pathway, leading to very rapid V response rates (VPCs) that could become VFib. Use mexiletine to prevent conduction pathway.

Answer 143

ACVIM 2020 consensus MYBPC gene mutation (myosin binding protein C) Ragdoll - MYBPC-R820W Main Coon - MYBPC-A31P Autosomal dominant with incompelte penetrance

Answer 144

ACVIM 2020 consensus 1. LVFWd 6mm+ (<5mm WNL, 5-6mm equivocal) - note LVFWd increases with body size, hydration & HR also influences. 2. No (opp in people)

Answer 145

ACVIM 2020 consensus 1. NT-proBNP: reasonable diagnostic accuracy. Main utility is to differentiate cats with severe CM from normal/mildly diseased cats when echo not available. NOT recommended to differentiate healthy cats from cats with mild-moderate HCM. 3. Serum cTnI - prognostic value; increased cTnI associated with increased risk of CVS death regardless of LA size.

Answer 146

ACVIM 2020 consensus Pimobendan & taurine - if global LV systolic dysfunction is identified. Also consider pimobendan (dobutamine if refractory) if signs of low C.O. (hypotensive and/or bradycardia).

Answer 147

LA(ES) >1.7cm, LA:Ao >2.0

Answer 148

Geddes VCNA 2020 40-60%, concurrent CKD. 57% regained vision (based on menace response) with amlodipine monotherapy in 94% cats. Some were visual within 3 wks, some took up to 2 months with persistence of vision.

Answer 149

Geddes VCNA 2020 40-60%, concurrent CKD. 57% regained vision (based on menace response) with amlodipine monotherapy in 94% cats. Some were visual within 3 wks, some took up to 2 months with persistence of vision.

Answer 150

Geddes VCNA 2020 1. Ratio of proximal ascending aorta to aortic annulus 2. Vasa vasorum arteriopathy (latter = delicate network of arterioles supplying blood to walls of great vessels)

Answer 151

Amlodipine & telmisartan (Not ACEI as only reduces SBP by 10mmHg in cats)

Answer 152

Guglielmini JAVMA 2016 High Sp (92-99%), but poor Sn (large range; 40-80% between 2 observers) Based on mass-like opacity cranial to heart and/or tracheal deviation.

Answer 153

Excessive, prominent trabeculae confined to the inner LV or RV walls and separated from each other by deep, intertrabecular sinusoids (recesses) that communicate with the ventricular cavity.

Answer 154

Mazzotta JVIM 2016 RBC distribution width (RDW) = quantitative measurement of anisocytosis. Significantly increased in dogs with SEVERE pre or post-capillary PH vs healthy dogs. Associated with peak TR pressure gradient, urea, Hct, WBCC, age Diseases associated with PH rather than PH severity likely responsible for increased RDW.

Lit Cardiovascular Flashcards

(180 cards)