Acquired Heart Disease: Valvular

Question 1

Chr. degenerative valvular disease (endocardiosis)

Answer 1

Most common acquired cardiac dz in dogs
Non-inflammatory myxomatous degeneration (collagen disorder, fibroelastic tissue replacement)

Question 2

Which valve is endocardiosis most common?

Answer 2

Mitral valve
Then tricuspid, aortic then pulmonic (+ chordae tendineae)

Question 3

___________ breeds are at an increased risk for endocardiosis

Answer 3

Chondrodystrophic (short-legged dogs)

Question 4

Other names for mitral valve dz

Answer 4

Chronic degenerative valve dz
Degenerative valve dz
Endocardiosis of the mitral valve
Myxomatous degeneration of the mitral valve

Question 5

Mitral valve function

Answer 5

Allows blood to flow from the left atrium to the left ventricle during diastole
Prevents blood from flowing back into atrium during systole

Question 6

Mitral valve leakage

Answer 6

Mitral regurgitation/ mitral insufficiency
Leaking blood from ventricle through MV into atrium during systole —> systolic heart murmur

Question 7

What causes MR?

Answer 7

Abnorms of the valve leaflets (CDVD*, dysplasia and bacterial endocarditis)
Abnorms of the chordae tendinae (CDVD and dysplasia)
Valve annulus dilation (ventricular dilation)
Abnorms of papillary muscles (maloreintation and dysplasia)

Question 8

Degenerative lesions of MR

Answer 8

Thickening of valve leaflets
Nodular thickening of leaflet margins
Weakening and lengthening of chordae

Question 9

Pathophysiology of endocardiosis

Answer 9

Volume overload of heart
Reduced forward SV → Na/ H20 retention
Systolic pump failure (rare, chr.)
Decompensation of stable CDVD patient

Question 10

Progression of MR (over years)

Answer 10

Mitral valve prolapse (+/- systolic click)→
Mild mitral valve regurg →
Moderate MR →
Servere MR (+/- mumur on PEc)

Question 11

The end result of CDVD is ______________

Answer 11

LCHF (pulm. edema)
Myocardial failure, pulm. hypertension and arrhythmias

Question 12

Predisposed signalments of CDVD

Answer 12

Small breeds, middle aged to geriatric
Cavalier King Spaniels
Mini/toy poodles (mixed with poo in name)

Question 13

Presenting complaint of CDVD

Answer 13

Incidental finding (murmur with no CS) OR
Coughing, resp. distress, weakness, leth and exercise intolerance, syncope

Question 14

CDVD dx

Answer 14

ECG: wide P waves (LA enlargement) and tall R waves (LV enlargement)

Question 15

Clin path associated with endocardiosis

Answer 15

Pre-renal azotemia
↓ Na, K, and Cl (if severe)

Question 16

International small animal cardiac health council heart failure classification (ISAHCH)

Answer 16

Class 1: asymptomatic (no CS with heart dz)
Class 2: Mild to mod heart failure (coughing, exercise intolerance, tachypnea and mild distress)
Class 3: Advanced heart failure (exercise intolerance, resp. distress, ascites, cardiogenic shock)

Question 17

ACVIM cardiology group consensus classification (A)

Answer 17

Identifies high risk patients but no current structural dz

Question 18

ACVIM cardiology group consensus classification (B)

Answer 18

Asymptomatic patients with structural heart dz
B1: no mild radiographic/ echo changes
B2: structural change (pimobendan)

Question 19

ACVIM cardiology group consensus classification (C)

Answer 19

Past or current CS of heart failure associated with structural heart dz
Acute (furosemide, O2, pimobendan, dobutamine infusion) or chr. (furosemide, ACE inhibitor, pimobendan)

Question 20

ACVIM cardiology group consensus classification (D)

Answer 20

End-stage refractory to “standard therapy”
Acute or chr.
Tx: left atrial decompression

Question 21

VLAS __________ suggests LAE

Answer 21

> 2.3

Question 22

MV surgical repair

Answer 22

Open heart sx with bypass → RA approach, chordae replacement, double annuloplasty
Recover 7d in hospital

Question 23

Transcatheter edge to edge repair (mitral clip)

Answer 23

Hybrid procedure requires sx approach to apex and interventional cardiologist to deliver device
Clips pull middle leaflets together

Question 24

When is mitral clip considered?

Answer 24

Dogs in stage C and D
King Charles earlier in stage B2

Question 25

What causes decompensation

Answer 25

1. Chordinae tendinae rupture
2. Increased salt
3. Atrial tear
4. Arrhythmia

Question 26

Endocardiosis prognosis

Answer 26

Months to 2 years once heart failure develops
Normal life with no or few CS

Question 27

Infectious endocarditis

Answer 27

Inflammatory destructive lesion of valve
Endothelial damage with fibrin deposition
Vegetation induces valvular dysfunction

Question 28

Risk factors of infectious endocarditis

Answer 28

Pre-existing valvular damage (congen cardiac dz)
Source of bacteremia

Question 29

What valaves are involved in infectious endocarditis?

Answer 29

Mitral, aortic and mural endocarditis

Question 30

Pathophysiology of infectious Endocarditis

Answer 30

L-CHF
Arrhythmias (ven. tachyarrhythmias and AV block)
Systemic septic emboli (can cause death)
Vegetative lesion (fibrin, inflamm cells)
Myocardial abscesses
Aortic sinus rupture/ fistulae

Question 31

Signalment of infectious endocarditis

Answer 31

Any age
Large breeds, male predominance

Question 32

CS of infectious endocarditis

Answer 32

Systemically ill, febrile, leth and shocky
Cough, dyspnea, exercise intolerance
Swollen hot painful joints, abdominal pain, CNS signs
Syncopal episodes

Question 33

Cardiac ausculatations for infectious endocarditis

Answer 33

S3 gallop
Crackles/ wheezes if pulm. edema/ pulm abscesses

Question 34

Femoral pulses of infectious endocarditis

Answer 34

Pulse deficits
Hyperkinetic

Question 35

Most common organisms causing infectious endocarditis

Answer 35

Corynebacterium spp
Streptococcus spp.
Staphylococcus spp.

Question 36

Clinical management of infectious endocarditis

Answer 36

Antibiotic therapy: bacteriocidal or
Empirical (aminoglycoside, penicillin)
2-6w of therapy