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VET433: Cardio/Respiratory > Acquired Heart Diseases > Flashcards

Acquired Heart Diseases Flashcards

1
Q

what is MMVD

A

degeneration and thickening of the mitral valve leading to incompetency (regurgitation), left atrial enlargement, volume overload, and CHF

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2
Q

is pulmonary venous hypertension the same as pulmonary hypertension (arterial)

A

NO - venous hypertension should resolve when L-CHF is treated

can become clinically significant and require treatment

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3
Q

what factor determines if MMVD patients require treatment

A

LA enlargement

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4
Q

what are common outcomes of MMVD

A
  1. L-CHF (possibly biventricular)
  2. pulmonary hypertension
  3. LA rupture
  4. atrial fibrillation
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5
Q

pimobendan

A

inodilator - positive inotrope + peripheral vasodilation

increases inotropy by increasing Ca sensitivity in cardiomyocytes NOT increasing overall amount of Ca

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6
Q

enalapril/benazepril

A

ACE inhibitors

inhibits RAAS activation to slow volume overload to the left heart

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7
Q

furosemide

A

diuretic

promotes excretion of excess fluid volume (pulmonary edema)

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8
Q

spironolactone

A

aldosterone inhibitor

inhibits RAAS activation to slow volume overload

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9
Q

sildenafil

A

PDE inhibitor

dilates pulmonary vasculature to reduce pulmonary hypertension

RARELY used for MMVD - venous hypertension often resolves with CHF management

risky bc dilation of pulmonary vessels will increase volume to L heart

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10
Q

MMVD prognosis

A

~15 mo from stage B2 to development of CHF

~12 months after onset of CHF

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11
Q

what is dilated cardiomyopathy

A

heart muscle disease with characteristic ventricular dilation leading to systolic dysfunction

primarily affects the LV

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12
Q

pathology of DCM

A

severe dilation of LV + LA +/- RV

myofiber degeneration and necrosis with minimal to no inflammation

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13
Q

is the mitral valve abnormal in DCM

A

NO - normal mitral valve at the start of disease, stretch from LV dilation causes regurgitation

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14
Q

how is the occult phase of DCM diagnosed

A

occult phase is often long and difficult to diagnose

requires Holter monitoring, NT-proBNP, C-TNI, or PDK4 genetic testing

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15
Q

outcomes of DCM

A
  • exercise intolerance
  • syncope
  • L-CHF (cough, resp effort)
  • sudden death
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16
Q

is the murmur from MMVD or DCM louder

A

MMVD

DCM is quieter because it is not a primary mitral valve problem

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17
Q

prognosis of DCM

A

occult: months to years with pimobendan

DCM w/ CHF: 9-12 months with treatment

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18
Q

what is canine ARVC

A

heart muscle disease with characteristic right ventricular tachyarrhythmias + fibro-fatty infiltration of the right ventricle (+ left if progressed)

leads to syncope and death

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19
Q

what does incomplete penetrance of the mutation mean

A

not all boxers with the mutation are affected with clinical ARVC

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20
Q

what does variable expressivity of the mutation mean

A

boxers with the mutation are affected with variable severity

homozygous: earlier onset, accelerated disease course, increased risk of sudden death

21
Q

outcomes of ARVC

A
  • RV arrhythmias
  • collapse or syncope
  • sudden death
22
Q

what are the three forms of ARVC

A
  1. asymptomatic
  2. collapse and syncope
  3. structural changes
23
Q

asymptomatic ARVC

A

no clinical signs but meets diagnostic criteria on holter monitor

24
Q

collapse/syncope ARVC

A

clinical signs + meets diagnostic criteria on holter monitor

25
Q

structural changes of ARVC

A

DCM-like changes on echocardiogram (LV, LA dilation)

if NOT a boxer - structural changes occur on the R side

26
Q

sotalol

A

beta blocker

anti-arrhythmic drug - prevents ventricular arrhythmias

27
Q

mexiletine

A

anti-arrhythmic often prescribed alongside sotalol alone

28
Q

prognosis for ARVC

A

good if heterozygous

poor if homozygous or type III disease

cause of death is usually sudden death

29
Q

what is hypertrophic cardiomyopathy

A

heart muscle disease with characteristic left ventricular wall thickening leading to diastolic dysfunction

30
Q

what is HOCM

A

hypertrophic obstructive cardiomyopathy

subset of HCM that progresses to the point where the thick ventricle wall blocks the left ventricular outflow tract

31
Q

what are other cardiomyopathies in cats

A
  • RCM (restrictive): diastolic dysfunction despite normal wall thickness
  • UCM (unclassified/non-specific)
  • DCM - associated with taurine deficiency
32
Q

what are acquired heart diseases in cats

A

secondary changes to the heart in response to systemic disease

  • systemic hypertension
  • hyperthyroid associated CM
  • endocarditis

**mmvd is NOT in cats, endocarditis is RARE

33
Q

what diagnostics should always be performed in cats found to have LV hypertrophy

A

blood pressure
free T4

34
Q

are heart murmurs a reliable indicator of heart disease in cats

A

NO
- 50% of cats with murmurs do NOT have cardiac disease
- 50% of cats wit1h heart disease do NOT have murmurs

can be prioritized in older cats

35
Q

are gallop sounds reliable indicators of heart disease in cats

A

yes - highly sensitive

always investigate if S4 gallop is heard

36
Q

when are thoracic radiographs beneficial to use in suspect heart disease cats

A

symptomatic cats

can ID cardiomegaly (specific for heart failure)

can NOT see concentric hypertrophy on radiographs

37
Q

at what value is a quantitative NT ProBNP test positive for heart disease

A

> 99

good for disease detection in occult stage cats

38
Q

at what value is a SNAP NT-ProBNP test positive for heart disease

A

> 200

good for differentiating cardiac disease from respiratory disease in emergency settings

39
Q

is ECG beneficial for diagnosing occult HCM

A

specific but not sensitive

only indicated if cat has arrhythmias or pulse deficits
- abnormal complexes are highly specific for heart disease

40
Q

what ventricular or IVS wall thickness is diagnostic for HCM

A

> 6 mm

41
Q

clopidogrel

A

platelet inhibitor

used in EVERY cat with HCM due to high risk of arterial thromboembolism from LA dilation

42
Q

atenolol

A

beta blocker
used for SYMPTOMATIC (collapse) but NOT YET CHF cats
- most commonly HOCM w/ severe outflow tract obstructions

do NOT use with evidence of chamber enlargement

43
Q

5 functions of atenolol

A
  1. anti arrhythmic
  2. negative inotropy - decreases myocardial O2 demand
  3. negative chronotrophy - decreases HR to increase time in diastole
  4. negative lusitropy - relaxes the heart
  5. antifibrotic
44
Q

why can HCM in cats present similarly to respiratory disease

A

HCM can progress to L-CHF –> in cats, can cause pleural and pericardial effusion

45
Q

thoracic radiograph findings in cats w/ HCM + CHF

A
  • cardiomegaly
  • pulmonary edema
  • pleural effusion

always tap the chest and treat with furosemide before and after radiographs

46
Q

b lines

A

interstitial lung disease - indicative of pulmonary edema

47
Q

does pericardial effusion associated with CHF need to be tapped

A

no - will resolve with HCM and CHF treatment

48
Q

management of acute respiratory distress in cats

A
  1. sedate - butorphanol
  2. O2 supplementation
  3. furosemide
  4. albuterol
  5. diagnostics - thoracocentesis, thoracic radiographs, echo
  6. at home management once stabilized
49
Q

treatment for HCM w/ CHF

A
  • furosemide
  • ACE inhibitors
  • clopidogrel
  • pimobendan
  • STOP use of B-blockers

VET433: Cardio/Respiratory (17 decks)

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