Test 1: lecture 17 feline Flashcards by jillian Bastidas

primary myocardial disease of cats

hypertrophic (HCM)
Restrictive (RCM)
dilated (DCM)

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secondary myocardial diseases in cats

systemic hypertension
hyperthyroid
transient myocardial thickening
nutritional (taurine)

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myocardial disease in cats can lead to — cardiac dysfuction, — and atrial dilation leading to —

diastolic
arrhythmias, sudden death
thromboembolic event

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diastolic dysfunction is caused by

impaired relaxation
increase LV stiffness, decreased LV compliance
fibrosis

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diastolic dysfunction will lead to increased — pressure and increased — size

↑LV diastolic pressure
↑LA pressure

↑LA size

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HCM causes — hypertrophy and — dysfunction

concentric LV

diastolic

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what cause HCM

we dont know
but it is inherited

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histo of cat with HCM

disarray
increased size of cell
increased cells in interstitial space

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prevalence of HCM in cats

15% of cats
29% of older cats

most subclinical

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what kind of cats get HCM

middle aged males

maine coon, ragdoll, sphinx

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genetics of HCM in cats

Autosomal dominant

Genetic mutations
Myosin binding protein C (MYBPC) – sarcomeric protein
* Maine Coon: Missense mutation (A31P)
* Ragdoll: Missense mutation (R820W)

ALMS1 – Protein involved in cell cycle control
* Sphinx: Glycine to arginine variant in exon 12

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PE of cat with HCM

systolic murmur
gallop heart sound (S4)
arrhythmias

dyspnea, tachpnea
abnormal lung sounds
clots

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what valves close at S1

AV valves

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what valves close at S2

semilunar valves (end of sytolic- aorta and pulmonary)

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what happens at S4

atria contract, fill noncompliant LV

happens with HCM in cats

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EKG of HCM in cats

LV and/or LA enlargement pattern
Ventricular arrhythmia
Conduction disturbance
* Left anterior fascicular block (partial LBBB)

Supraventricular arrhythmia
* Atrial fibrillation rare

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left anterior fascicular block will have mean toward

-30

will have negative QRS in lead 2, 3, aVF

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xray of cat with HCM

heart could be normal: does not rule it out

cardiomegaly
CHF: pulmonary venous distension
pulmonary edema

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echo of HCM in cats

LV hypertrophy
* Symmetric
* Asymmetric
* Focal/regional

+/- LA dilation
+/- Spontaneous echocontrast (“smoke”)
+/- Intracardiac thrombi
+/- Dynamic LV outflow tract obstruction (HOCM)

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what causes HOCM in cats

HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM)

Dynamic left ventricular outflow tract obstruction
* Systolic anterior motion (SAM) of the mitral valve

mitral valve gets in the way during systolic (ventricle contracting)

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what can worsen HOCM

Decreased diastolic filling (increased HR, diuretics)

Increased myocardial contractility (increased SNS, positive inotropes)

Reduced afterload (exercise, vasodilators)

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differential diagnosis for thick LV in cat

HCM
hyperthyroid
systemic hypertension

treatment of HCM in cats

no drugs can prevent LV thickening

minimize LV outflow tract obstruction (atenolol)
control CHF
treat arrhythmias
prevent/treat clots

how to treat severe LV outflow tract obstuction in cats with HCM

give atenolol- slow HR= decrease LV pressure

only for severe or LVOTO with clinical signs

cats with Left sided CHF can form

pleural effusions and pulmonary edema

what anti-arrhythmic for ventricular and/or supraventricular arrhythmias caused by HCM

atenolol sotalol

--- is an AA to stop supreventricular arrhythmias

diltiazem used for treatment in HCM in cats

what is ATE

aterial thromboemoblism

what causes ATE

aterial thromboembolism **virchow's triangle**: hypercoagulability, vessel wall injury, stasis LA dilation cause clot to form, can travel to hindlimbs **(saddle)**, forelimbs, kidney or brain

what is smoke in echo

micro thrombi

clinical signs of ATE

acute paralysis pain weakness pale pink/cyanotic paw pads cold +/- dyspnea

5 Ps of ATE

pain paresis/paralysis pallor pulselessness poikilothermy (cold limbs)

what are bad signs for cat with ATE

hypothermia bradycardia absent motor functions more than one limb affected ## Footnote arterial thromboembolism

how to diagnose ATE

echo and xrays low glucose in affected limbs high lactase in affected limbs serial bloodwork * kidney function * reperfusion injury = ↑K

how to treat ATE

**prophylaxis** platelet inhibitor: clopidogrel**(plavix)**, ASA anti-coagulants: heparin **Thrombolysis (rare)** urokinase, TPA **Thromboectomy (surgery)**

clopidogrel

plavix platelet inhibitor: prevents platelet aggregation and fibrin cross linking effect after 3 days, and lasts 7 days can cause GI upset bitter taste

how does rivarozaban work

xarelto inhibits factor Xa: prevents clot formation super cat study still ongoing

how does TPA work

tissue plasminogen activator activated plasminogen which will break up clots

cat at risk for ATE is treated with

clopidogrel

cat with current ATE is treated with

clopidogrel +/- other prophylaxis pain meds supportive care +/-CHF therapy

heart with restrictive cardiomyopathy will look

normal LV thickness with diastolic dysfunction unknown origin

Physical of cat with RCM

gallop heart sound murmur arrhythmia Dyspnea, tachypnea Abnormal lung sounds Thromboembolism

what type of cats get RCM

older, male cats no specific breeds

echo of RCM with show

* Normal LV thickness * Left atrial dilation +/- right atrial dilation * +/- Systolic dysfunction * +/- Spontaneous echocontrast (“smoke”) * +/- Intracardiac thrombi

cats with systolic dysfunction can be treated with

pimobendan

DCM in cats will have --- dilation and --- dysfunction

cardiac chamber systolic can be idiopathic or secondary to taurine deficiency

--- is an amino acid important for cardiovascular function. Cats cannot synthesize this

taurine deficiency can lead to DCM in cats

taurine deficiency in cats can lead to

central retinal degeneration DCM

how to treat DCM in cats

**treat for CHF:** furosemide ACE inhibtor: enalapril or benazepril spironolactone **treat arrhythmias**: atenolol and sotalol (ventricular and/or supraventricular) diltiazem (supraventricular) **treat poor pumping (positive inotropes)** dobutamine (seizures) pimobendan **Taurine supplements**

how to treat HCM in cats

**treat for CHF:** furosemide ACE inhibtor: enalapril or benazepril spironolactone **treat arrhythmias**: atenolol and sotalol (ventricular and/or supraventricular) diltiazem (supraventricular)

what is TMT

TRANSIENT MYOCARDIAL THICKENING * Form of secondary cardiomyopathy * Can **mimic HCM** * Occurs more commonly in **younger cats** * **Antecedent events** (general anesthesia, stress, other illness) * Increased cardiac troponin I (CTnI) may strengthen suspicion * Hypertrophy **resolves over time** * Good prognosis

cats with --- have a higher likely of having TMT

previous stressful event (general anesthesia, stress, other illness) increased troponin younger cats

TMT will look like ---

HCM but hypertrophy will resolve over time ## Footnote transient myocardial thickening (TMT)