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Cardiovascular > Acquired CV Disease Cats > Flashcards

Acquired CV Disease Cats Flashcards

1
Q

What is the cause of the majority of acquired cardiac disease in cats?

A

Cardiomyopathy (can be complex cardiopathy)

  • congenital and primary arrythmias also possible but less common
  • 1* valvular disease VERY RARE
  • pericardial disease much less common than dogs
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2
Q

What are the 4 main types of cardiomyopathy?

A

> hypertrophic (HCM)
dilated (DCM)
restrictive (RCM)
arrythmogenic RV (AVRC)

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3
Q

Potential 2* myocardial diseases in cats?

A
  • hyperthyroid myocardial disease
  • hypertensive myocardial disease
  • cardiomyopathy 2* to hypersomatotropism (acromegaly)
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4
Q

What are the key features of HCM?

A
  • concentric Lv hypertrophy (diastolic septum/free wall thickness >6mm)
  • poor LV relaxation (stiff)
  • primary diastolic dysfunction
  • later stages see poor systolic function due to LV scarring
  • myocyte dissaray
    > narrowed coronary aa. can lead to myocardial infarction
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5
Q

What are the key features of RCM?

A
  • much less common than HCM and DCM
  • marked atrial dilation
  • no LV hypertrophy or dilation
  • stiff LV
  • myocyte dissarray
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6
Q

What are the key features of ARVC?

A
  • left heart normal
  • severe dilation of RA, RV
  • RV wall thinning
  • fibrofatty replacement
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7
Q

What does SAM describe? What predisposes this?

A
  • systolic anterior motion
  • mitral valve leaflets flap over and cause LVOTO
    > valve leaflets may be especially long
    > worse with septal hypertrophy
    > worse with ^ sympathetic tone
    > seen with HCM
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8
Q

What is the cause of HCM?

A

> Idiopathic or genetic

- NOT 2* to hypertension, aortic stenosis or hyperthyroidism

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9
Q

What is seen in advanced HCM?

A
  • left atrial dilation
  • left artrial contractile dysfucntion (-> thrombus formation)
  • left ventricular systolic dysfunction (-> ^ atrial pressure)
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10
Q

What occours with HCM?

A

Dynamic left ventricular outflow tract obstruction (SAM)

- causes mitral regurgitation

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11
Q

Which cats are most commonly seen with HCM?

A
  • young adult males but can be seen in all ages

- maine coons, ragdolls, persians predisposed BUT majority non-pedigree

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12
Q

Presenting signs for HCM?

A
  • asymptomatic
  • respiratory distress (suggests heart failure)
  • hind limb paralysis due to aortic thromboembolism
  • sudden death
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13
Q

PE findings with HCM?

A
  • +- variable intensity murmur (may be present when young but disappear when older due to LV necrosis and fibrosis replacing the hyerptrophied muscle)
    -priminant apical pulse
  • +- gallop sounds
  • +- tachypneoa and crackles
    > physical exam MAY be completely NORMAL
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14
Q

What concurrent clinical signs make prgonsis of HCM worse?

A

Arrythmia

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15
Q

What may be seen on radiograph with HCM?

A

> LV hypertrophy -> long cardiac sillhouette on lateral

> pulmonary oedema or plerual effusion (CHF)

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16
Q

What is the one main indicator of prognosis in cats with myocardial disease?

A

LA enlargement

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17
Q

What is seen on echo with HCM?

A
  • LV enlargement, diastolic wall thickness >6mm

- SAM causing DLVOTO and murmur

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18
Q

Prognosis for HCM?

A
  • good short term if LA normal

- poor if clinical singns, LA enlargement and ATE (aortic thromboembolism)

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19
Q

What is DCM characterised by?

A
  • dilation of all 4 chambers
  • thinning of ventricular walls
  • hypokinesis (systolic dysfunction)
20
Q

What was DCM historically associated with? Is this a common problem now?

A

taurine deficiency - rarely seen now, most diagnosed cats have normal taurine

21
Q

Clinical presentatino of DCM

A
  • middle aged/old cats
  • taurine-deficient cats if fed on dog food
  • output (forward) failure (hypotension, hypothermia, BRADYCARDIA cf. dogs tachycardia)
  • murmur quiet/absent but gallop may be present
  • thromboembolic disease common
22
Q

Echo findings with DCM?

A
  • dilated SPHERICAL LV

- fractional shortening 14mm

23
Q

Prognosis for DCM?

A

Grave

24
Q

What are the 2 forms of restrictive cardiomyopathy?

A
  • endomyocardial (severe endomyocardial scarring, bridging scars etc.) seen commonly in oriental breeds
  • myocardial (normal LV dimensions)
    > both forms have severe atrial enlargement
25
Q

clinical presentation of RCM

A
  • older cats
  • dyspnoea and pleural effusion
    +- low output signs (forward failure)
    +- ATE
  • arrythmias common
26
Q

echo findings of RCM?

A
  • severe biatrial enlargement
  • endomyocardial form is distinctive (scarring seen)
  • myocardial form more challenging, LV may appear normal
27
Q

What constititues RCM?

A
  • severely imparied diastolic fillin
  • still LV
  • relatively normal left ventricular dimensions and systolic function
28
Q

prognosis for RCM?

A

poor

29
Q

What is arrythmogenic right ventricular cardiomyopathy (ARVC) characterised by?

A
  • fibrofatty infiltration of RV
  • marked right heart enlargement
  • may be asymptomatic
  • may be syncopal in association with arrythmias
  • may have RCHF: ascites etc. (rare in cats)
30
Q

echo findings with ARVC?

A
  • severe right ventricular and right atrial dilation

- tricuspid regurgitation usually

31
Q

What is Tx of feline heart disease based upon?

A

Stage of disease more than type of cardiomyopathy

32
Q

What are the stages of cardiac disease in cats?

A 
A: predisposed (all cats!)
B1: Preclinical: HCM, no CHF, normal LA
B2: HCM, no CHF, big LA
C: HCM + CHF (past or present)
D: HCM + CHF refractory to Tx
33
Q

Which cats has a genetic screening test for HCM been developed for?

A

Maine coons and ragdolls

34
Q

What is the first step in deciding severity of cardiac disease? How may a definitive diagnosis be made?

A

NT pro-BNP

35
Q

Which cats is tx of heart disease NOT indicated for?

A

> asymptomatic B1 grade with low risk of complications

  • no gallop
  • no arrythmia
  • normal LA size
  • low BNP/ANP
36
Q

What drug may be indicated for cats with LVOTO?

A

Atenolol (B blocker)

  • no evidence for ^ survival
  • but in humans chest pain reported so may help with this
  • trial and then stop if no improvement reported
37
Q

Which cats is prophylactic Tx indicated for? What tx?

A 
> Asymptomatic B2 grade High risk cats
- LA dilation
- systolic dysfunction
- extreme hypertrophy 
> Anti-thrombotic to v risk of ATE eg. Clopidogrel or aspirin (clopidogrel better but tastes gross)
38
Q

How should C grade HCM be diagnosed?

A
  • suspect CHF from clinical exam
  • Echo less stressful than radiographs
  • LA dilation identified then start aggressive management of congestive failure
39
Q

Can any drugs reduce the risk of heart failure?

A

No

40
Q

How can acute, life threatening congestive failure be treated?

A

> improve oxygenation

  • administer O2
  • sedation (dyspnoeic cats get v stressed) Butorphanol
  • IV furosemide to effect (initial dose lower than dogs)
  • thoracocentesis (significant pleural effusion more common than in dogs)
  • ^ CO (difficult! if BP normal just treat congestion, DO NOT USE FLUIDS! Will ^ congestion and not ^ CO)
41
Q

What are the aims of home therapy for mild-moderate heart failure?

A

> mild-moderate no need to be hospitalised

  • eliminate abnormal fluid retention (furosemide, benazepril ACEI)
  • modulate neurohormonal activation (benaxepril/imidapril ACEI)
  • optimise haemodynamic function (pimobendan for systolic function)
  • prevent thromboembolism (aspirin or clopidigrel)
42
Q

How was diastolic heart fialure treated in the past? How has this changed?

A

HR slowed and negative inortrope using atenolol (B blocker)

- no longer indicated as caused death faster

43
Q

Which drugs can be aded if cats become refractory to furosemide and ACEI?

A

> Spironolactone (not licensed in cats, dose similar to dogs. Skin reaction reported)
Thiazides
Pimobendan for systolic dysfunction (NOT FOR DLVOTO)

44
Q

When is ATE risk high?

A

Poor contractility and dilation of LA

45
Q

Management of acute ATE?

A
  • analgesia (methadone, fentanyl CRI)
  • manage electrolyte/acid base abnomalities
  • prevent thrombus extension (early use clopidogrel)
  • pulses return withing 72hrs, use of limbs may take longer - physio needed
    x thrombolysis usually associated with ^ risk of reperfusion syndrome so NOT attempted
46
Q

How may systemic thromboembolism be prevented?

A
  • Clopidogrel
  • Aspirin (less effective)
    x warfarin not recomedned
    x low molecular weight heparins not recommended

Cardiovascular (11 decks)

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