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Cardiovascular > Acquired Cardiovascular Disease in Dogs > Flashcards

Acquired Cardiovascular Disease in Dogs Flashcards

1
Q

What are the most common heart diseases in dogs?

A
  1. DMVD
  2. DCM
  3. Pericardial effusion
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2
Q

Describe mitral value disease pathophysiology..

A
  1. Distortion of valve leaflets due to degenerative change
  2. Results in development of insufficiency (regurg)
  3. Need an increase in ventricular stroke volume
  4. Leads to ventricular dilation
  5. Worsens leakage of valve
  6. Responds with vasoconstriction, which worsens condition
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3
Q

What do the valves look like in degenerative mitral valve disease?

A

Nodular - myxomatous changes/endocarditis

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4
Q

What is the signalment for mitral valve disease?

A
  1. Typically older dogs
  2. Small dogs (<25kg) e.g. CKCS, terriers, chihuahua
  3. Affects males earlier
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5
Q

What are the 4 steps in the DMVD staging pyramid?

A

B1 - murmur, no cardiomegaly, no signs
B2 - cardiomegaly, no signs
C - Signs of heart failure
D - refractory signs of heart failure

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6
Q

What are the clinical signs of DMVD?

A 
Incidental finding
Signs of LSF
e.g. cough, dyspnoea, exercise intolerance
Signs of collapse
e.g. dysrrhythmias
Sudden death
rare but due to arrhythmia, left atrial treat, ruptured chord
Signs of RHSF
later in disease
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7
Q

What are the clinical findings with mild DVMD disease?

A

Left apical systolic murmur +/- exercise intolerance

Otherwise normal

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8
Q

What are the clinical findings of moderate DVMD disease?

A 
Murmur higher grade
Dyspnoea
Tachycardia
Dysrrhythmias
Crackles/wheezes
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9
Q

What are the clinical findings of severe DVMD disease?

A 
CHF!
Higher grade murmur
Dyspnoea
Tachycardia
Dysrrhythmia
Crackles/wheezes
Progress to RCHF
- Ascites, juglar pulse, hepatomegaly
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10
Q

What are you likely to find on ECG when looking for dilated mitral valve disease?

A

Usually normal

  • May see pattern consistent with hypertrophy
  • Rhythm disturbance (rare)
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11
Q

What may you find on radiography when looking for DVMD?

A 
LA enlargement
LV enlargement
Bronchial compression
Pulmonary venous congestion
Pulmonary oedema
RCHF
- Pleural effusion
- Ascites
- Hepatomegaly
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12
Q

What may you find on echo when looking for DVMD?

A

Valvular changes

  • Rough irregular leaflets
  • Prolapse ruptured chordae
  • Failure of apposition

Chamber enlargement
- both LA and LV

Myocardial function
- altered fractional shortening

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13
Q

What will give you a definitive diagnosis of DMVD?

A

Doppler echocardiography

Demonstrates regurgitant flow

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14
Q

What is the best evidence treatment for DVMD?

a. Prior to onset of CHF signs
b. After onset of CHF signs

A

a. Pimobendan in stage B2

b. Furosemide and pimobendan - also consider ACEi and spironolactone

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15
Q

Why is pimobendan good at treating DMVD?

A

Arteriodilator which increase the diameter of the aorta, making it easier for blood to flow through aorta rather than back into atrium

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16
Q

What are the signs of bacterial endocarditis in dogs? Is it common?

A

Rare

  • Murmur that changes
  • PUO
  • Lameness
  • Sepsis
17
Q

How might you diagnose and treat bacterial endocarditis and what is the prognosis?

A

Diagnosis:
Echocardiography
Blood cultures
Changing murmur

Treatment:
Antibiotic therapy over many weeks

Prognosis is poor

18
Q

Common cardiomyopathies in the dog?

A

Dilated cardiomyopathy

Sometimes arrhythmogenic right ventricular cardiomyopathy

19
Q

What is DCM?

A

Systolic failure of myocardium
Dilation of the ventricle due to increased end diastolic pressures
- May lead to valvular insufficiency secondary

20
Q

What are the clinical signs of DCM?

A 
Incidental finding
Signs of forward failure
\+ Intermittent collapse
\+ Weakness
\+ Sudden death
Signs of backwards failure
\+ Cough
\+ Exercise intolerance
\+ Dyspnoea
\+ Ascites
21
Q

What is the occult phase of DCM?

A

Where there is early myocardial disease but no signs of heart failure.

22
Q

What physical exam findings are suggestive of DCM?

A 
Systolic murmur
Gallop rhythm
Arrhythmias, pulse deficits
Signs of CHF
\+ Dyspnoea, crackles, cough
\+ Ascites, pleural effusion, subcutaneous oedema.
23
Q

What may you find on ECG when looking for DCM?

A 
Variety of rhythm disturbances:
Sinus tachycardia
AF
APC
VPC
Paroxysimal ventricular tachycardia
24
Q

What may you find on radiography when looking for DCM?

A

Cardiomegaly
Generalised
LV hypertrophy
LA enlargement

LCHF
Pulmonary oedema
Pulmonary congestion

RCHF
Ascites
Pleural effusion

25
Q

What may you find on echocardiography suggestive of DCM?

A

Dilation of LV
Fractional shortening <25%
LA enlargement
Mitral insufficiency

26
Q

What is fractional shortening? What % indicates DCM?

A

Degree to which ventricular diameter reduced from diastole to systole

<25%

27
Q

What is the best evidence treatment for DCM?

a. Prior to onset of signs of CHF
b. After onset of signs CHF

A

a. Pimobendan - possibly ACEi
b. Furosemide, ACEi and pimobendan

Consider also giving antirrhythmic drugs because they often have accompanying arrhythmias

28
Q

What are your treatment options for heart failure once best evidence treatment has been exhausted?

A

Optimise cardiac rate and rhythm
Control of rate in atrial fibrillation
Control severity of rhythm disturbance with VTach

Antagonise neurohormonal mechanisms
ACE inhibitors, beta-blockers, spironolactone

Nutritional support

29
Q

What causes pericardial effusions in dogs?

A 
Idiopathic pericarditis
Neoplasia
- RA haemangiosarc
- Mesothelioma
Rarely - trauma, hypoproteinaemia, RCHF, FBs,
30
Q

What is the pathophysiology of pericardial effusions?

A

Increase in pressure within pericardial sac compromises diastolic function

Right side affected more due to thin walled right ventricle

Results in development in RCHF

If acute may see signs of syncope and forward failure

31
Q

What are the clinical signs of pericardial effusion?

A 
Acute onset
Lethargy
RCHF
- Ascites
- Dyspnoea
- Collapse
- History of coughing
32
Q

What on clinical exam is suggestive of pericardial effusion?

A 
Signs of RCHF 
- Jugular distension
- Ascites
- Hepatomegaly
Muffled heart sounds
No murmur
33
Q

What on ECG is suggestive of pericardial effusion?

A

Small QRS complexes

34
Q

What on radiography is suggestive of a pericardial effusion?

A

Generalised enlargement of the cardiac silhouette +/- RCHF signs

35
Q

What are the echocardiography findings suggestive of pericardial effusion?

A

Presence of fluid
Possible indicators e.g. neoplasia
May show cardiac tamponade
- collapse of RA and RV during diastole

36
Q

What is the treatment for pericardial effusion?

A

Pericardiocentesis

37
Q

What is the prognosis for dogs with pericardial effusion?

A

Dependent on underlying causes
Idiopathic disease may be cured by drainage but has tendency to reoccur
Neoplasia poor
FB/infectious manageable by surgery

Cardiovascular (10 decks)

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