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SEM 5: SAM 1 > Acquired Heart Diseases: DCM and ARVC > Flashcards

Acquired Heart Diseases: DCM and ARVC Flashcards

1
Q

List the dog breeds associated with familial DCM

A
  1. Dobermans
  2. Great danes
  3. Irish wolfhound
  4. Newfie
  5. Portugese water dog
  6. Toy manchester terrier (practically a mini doby)
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2
Q

DCM is a primary myocardial disease characterized by ________ dysfunction, leading to _______ hypertrophy

A

systolic, eccentric

(dilation occurs secondary to systolic dysfunction)

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3
Q

DCM is an acquired condition seen in adult dogs. Exceptions are juvenile forms of DCM found in _________ breeds

A
  • Portugese water dog
  • Toy manchester terrier
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4
Q

What is true about DCM?

A. More common in females
B. More common in males
C. No sex predilection
D. Common in small breed dogs

A

B. More common in males

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5
Q

How is DCM staged?

A

2 stages:

  1. Occult (asymptomatic)
  2. Overt (symptomatic)
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6
Q

True or False: DCM is not associated with sudden death

A

FALSEEEE

Sudden death due to ventricular arrhythmias!!

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7
Q

________ is the test of choice for diagnosis of overt DCM

A

Thoracic radiographs

(bc overt= symptomatic)

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8
Q

_________ is the test of choice for diagnosis of occult DCM

A

Echocardiogram

(Asymptomatic, so echo > rads)

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9
Q

If a patient has overt DCM, what would you expect to see on thoracic radiographs?

A
  1. Atrial dilation (LA usually)
  2. Interstitial pulmonary infiltrates
  3. +/- pulmonary edema
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10
Q

List 3 blood tests used to differentiate DCM from non cardiac causes of myocardial dysfunction

A
  1. Taurine levels (taurine deficiency can cause myocardial dysfunction, mimics DCM)
  2. Thyroid testing (hypothyroidism can mimic DCM)
  3. NT-proBNP
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11
Q

What is the drug treatment protocol for a patient with occult DCM?

A

(AKA asymptomatic)

  1. Benazepril (cardioprotective)
  2. Pimobendan (inodilator)

shown to delay progression to CHF

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12
Q

What is the drug treatment protocol for a patient with acute overt DCM?

A

(AKA symptomatic of CHF)

  1. Furosemide
  2. Pimobendan
  3. O2
  4. Dobutamine if LOHF
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13
Q

What is the drug treatment protocol for a patient with chronic overt DCM?

A

(AKA symptomatic of CHF)

  1. Furosemide
  2. Pimobendan
  3. ACEi
  4. Spironolactone

+ antiarrhythmic drugs if a-fib or VPCs
(core 4 for CHF in dogs)

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14
Q

Most common arrhythmias found in patients with DCM?

A
  • VPCs
  • Atrial fibrillation
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15
Q

What is the prognosis for a patient with occult DCM?

A

(AKA asymptomatic)

  • Fair to guarded (worse prognosis than an asymp patient with DMVD)
  • Sudden death is possible
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16
Q

What is the prognosis for a patient with overt DCM?

A

(AKA symptomatic of CHF or LOHF)

  • Poor (6-12 months)
  • 50% of dobys with CHF due to DCM die suddenly :(
17
Q

List the secondary causes of myocardial dysfunction that must be ruled out first before considering DCM?

A
  • Tachycardia induced
  • Taurine deficiency
  • Hypothyroidism
  • Doxorubicin induced
  • Inflammatory/infectious processes
18
Q

What is the reason for the decline in cats seen with DCM?

A

Better diets!!

(Used to have taurine deficient diets causing DCM in cats)

19
Q

Physical exam findings on a patient with DCM?

A
  • Low grade left apical systolic murmur
  • S3 gallop
  • Decreased heart sounds
  • Decreased or weak femoral pulses
  • CS of L-CHF or LOHF
20
Q

True or False: Patients who have DCM and are asymptomatic don’t require drug therapy

A

FALSE

  1. Benazepril (cardioprotective)
  2. Pimobendan (inodilator)

shown to delay progression to CHF

21
Q

DCM and myocarditis both can cause VPCs. What test can be done to rule in/out myocarditis?

A

Cardiac troponin I

22
Q

_________ is the most common adult-onset heart disease in Boxers

A

ARVC (arrhythmogenic RV cardiomyopathy)

23
Q

List the 3 forms of ARVC

A

I: Asymp with VPCs
II: Symptomatic with VPCs
III: Ventricular dilation, systolic dysfunction, and ventricular and supraventricular tachyarrhythmias

24
Q

What dog breeds are associated with ARVC?

A
  • Boxers (heritable)
  • Bulldogs

(+ cats and horses)

25
Q

What is the underlying cause of ARVC?

A
  • Genetic mutation in the striatin gene
26
Q

What is true about ARVC?

A. More common in females
B. More common in males
C. No sex predilection
D. Common in small breed dogs

A

C. No sex predilection

27
Q

What are the most common presenting complaints in a patient with ARVC?

A

Syncope and exercise intolerance

28
Q

True or False: ARVC is associated with sudden death

A

TRUE

due to lethal ventricular arrhythmias
(although many present asymp)

29
Q

PE findings on a dog with ARVC?

A
  • Many have a normal PE
  • VPCs
  • Murmurs are not common
30
Q

What is the first choice anti-arrhythmic in dogs with ARVC and no evidence of CHF?

A

Sotalol (Class 3, K+ channel blocker) PO

(Mexiletine is 2nd choice)

31
Q

What is the first choice anti-arrhythmic in dogs with ARVC and resulting CHF?

A

Amiodarone (Class 3, K+ channel blocker) (better than sotalol if systolic dysfunction/CHF)

(+ CHF drugs)
- Pimobendan
- ACEi
- Spironolactone
- Furosemide

32
Q

What drugs should be prescribed to a patient with Stage III ARVC?

A
  • Amiodarone (Class 3, K+ channel blocker) (better than sotalol if systolic dysfunction/CHF)
  • Omega-3 FA

(+ CHF drugs)
- Pimobendan
- ACEi
- Spironolactone
- Furosemide

33
Q

What is the prognosis for patients with Type I, II and III ARVC?

A

Type I and II: guarded (bc risk of sudden death), but most have normal lifespan

Type III: Poor (3-9 months)

34
Q

An asymptomatic boxer with ARVC. What type and how to treat?

A

Type I

Treat with sotalol PO

35
Q

_________ is the first line DOC for patients with ARVC

A

Sotalol

SEM 5: SAM 1 (26 decks)

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