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Cardiology > Acquired cardiovascular disease in cats > Flashcards

Acquired cardiovascular disease in cats Flashcards

1
Q

Primary cardiomyopathies

A 
hypertrophic (HCM)
dilated (DCM)
restrictive (RCM)
arrythmogenic RV (ARVC)
unclassified (FUCM)
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2
Q

hypertrophic cardiomyopathy (HCM)

A

idiopathic left ventricular hypertrophy

most common feline myocardial disease

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3
Q

HCM - pathophysiology

A

impaired ventricular relaxation - incr atrial pressures
incr ventricular stiffness - congestive failure
dynamic left ventricular outflow tract obstruction - abnormal movement of anterior mitral leaflet in systole

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4
Q

HCM - pathological findings

A

LV hypertrophy affects septum + free wall
LA may be dilatedwhen filling pressures incr
myocardial infarction may occur - appears as localized wall thinning + scarring

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5
Q

HCM - signalment

A

most common in young adult males

most cats with HCM are moggies

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6
Q

HCM - clinical signs

A

asymptomatic mostly
congestive heart failure
aortic thromboembolism - worst
sudden death

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7
Q

HCM - physical exam

A 
\+/- variable intensity systolic murmur
prominent apical impulse
± gallop sounds
± tachpnoea, crackles
physical exam may be completely normal
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8
Q

HCM - radiography

A

LV hypertrophy → ‘long’ cardiac silhouette on the lateral

pulmonary oedema and/or pleural effusion usually indicates congestive heart failure

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9
Q

HCM - echocardiography

A

LV hypertrophy - diastolic septal or free wall thickness ≥6mm (focal or generalised)
Systolic anterior motion (SAM) of the mitral valve causes DLVOTO and a murmur

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10
Q

HCM - prognosis

A

poor if clinical signs, LA enlargement, ATE

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11
Q

Dilated cardiomyopathy (DCM)

A

dilation of all 4 chambers
thinning of ventricular walls + hypokinesis
taurine deficiency
uncommon

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12
Q

DCM - clinical signs

A

Middle-aged and older cats
Taurine-deficiency DCM in cats fed on dog food.
output failure - Hypotension, Hypothermia, Bradycardia
Murmur quiet/ absent - gallop may be present
Thromboembolic disease is common.

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13
Q

DCM - echocardiography

A

Dilated, spherical LV
fractional shortening < 30%,
LV end-systolic diameter >12mm

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14
Q

DCM - prognosis

A

grave

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15
Q

restrictive cardiomyopathy (RCM)

A 
Severely impaired diastolic filling 
Stiff LV
relatively normal left ventricular dimensions + systolic function.
Endomyocardial +Myocardial form 
Severe atrial enlargement in both forms
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16
Q

RCM - clinical signs

A 
Older cats
Dyspnoea from pleural effusion common
± low output signs
± aortic thromboembolism
Arrhythmias common
17
Q

RCM - echocardiography

A

Severe biatrial enlargement
Endomyocardial form of RCM is distinctive - endomyocardial scarring is readily imaged
Myocardial form is more challenging- LV may appear relatively normal

18
Q

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

A

fibrofatty infiltration of right ventricle
right heart enlargement
May be asymptomatic
May be syncopal in association with arrhythmias
May have right-sided heart failure

19
Q

ARVC - echocardiography

A

Severe right ventricular and right atrial dilation

Tricuspid regurgitation usually present.

20
Q

cats at risk of HCM

A

Maine coons, Ragdolls etc may be at incr genetic risk of HCM, but MBPC mutation testing only valid for maine coons
ANY cat could be at risk of HCM
Echocardiography provides definitive diagnosis
Can consider NT-proBNP as initial step?

21
Q

asymptomatic cats (HCM) - treatment

A

some affected cats at low risk + need no treatments
ACE inhibitors - consider if LA dilated?
Diltiazem - licensed, but no good evidence of benefit
Beta-blocker (atenolol) good for control of LVOTO- but is there long term benefit?

22
Q

Acute, life-threatening heart failure - treament

A

Echo less stressful than radiographs, and if LA dilation is identified, can support aggressive management of congestive failure
administer O2 - oxygen cages
Sedation - more important to sedate cats than dogs, as dyspnoeic cats often become very distressed (butorphanol)
IV furosemide to effect - to decr resp rate
Thoracocentesis: Significant pleural effusions are more common than in dogs with congestive heart failure - should be drained while causing minimal stress
Increase cardiac output? -Difficult, If BP normal, just treat congestive signs, avoid IV fluids (Will not increase output, & will worsen CHF)

23
Q

mild-moderate heart failure - treatment

A 
can usually be treated as out-patients
eliminate abnormal fluid retention
modulate neurohormonal activation 
optimize haemodynamic function
prevention of thromboembolism
24
Q

eliminate fluid retention - drugs

A

Furosemide - use to effect

ACE inhibitor - benazepril

25
Q

modulate neurohormonal activation - drugs

A

ACE inhibitor: benazepril preferred as licensed in cats
No evidence that abnormal hypertrophy is reversed in cats. Imidapril can be considered in cats difficult to pill (it is a tasteless liquid)

26
Q

optimize haemodynamic function

A

v.difficult to improve diastolic function

27
Q

chronic refractory heart failure

A

If CHF persists despite therapy with furosemide + an ACE inhibitor, the dose of furosemide should be incr
If CHF continues despite this, consider adding other diuretics:
Spironolactone: not licensed in cats,Facial lesions have been reported.
Thiazides: Moduret® (a combination of hydrochlorothiazide and amiloride) is used most commonly
For cats with systolic dysfunction, pimobendan can be added, not licensed, and should NOT be used in cats with dynamic LVOT obstruction.

28
Q

arterial thromboembolism (ATE)

A

may occur in any cardiomyopathy - esp with LA dilated + poorly contractile
thrombus usually forms in left auricle
commonest lodging site is distal aorta

29
Q

arterial thromboembolism (ATE) - clinical signs

A

peracute and severe

hindlimb paresis + pain associated with obstruction of the terminal aorta

30
Q

arterial thromboembolism (ATE) - prognosis

A

Rate of survival to discharge <45%.

Underlying myocardial disease predisposing to thromboembolism cannot usually be resolved

31
Q

management of acute ATE

A

Analgesia (methadone, fentanyl CRI)
management of electrolyte and acid-base abnormalities
Prevention of thrombus extension -heparin
Pulses often return within 72 hours - use of the limb usually takes longer -physiotherapy.
thrombolysis, can be associated with incr risk of reperfusion syndrome, therefore not usually attempted

32
Q

preventing systemic thromboembolism

A

aspirin
warfarin - not recommended
low molecular weight heparins – costly, subcutaneous injection
Clopidogrel –studies underway

Cardiology (9 decks)

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