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M15: Cardiorespiratory > Acquired murmurs in dogs > Flashcards

Acquired murmurs in dogs Flashcards

1
Q

What are the 2 causes of acquired murmurs in dogs?

A

Endocardial disease and myocardial disease

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2
Q

Give examples of endocardial disease

A

Endocardiosis (usually mitral valve), endocarditis (rare)

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3
Q

In which breed is endocardiosis most prevalent?

A

CKCS (43% die from heart disease)

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4
Q

Describe the pathophysiology of endocardiosis

A
  1. valve leakage
  2. volume overload of LV
  3. eccentric hypertrophy of LV
  4. decreased cardiac output
  5. RAAS stimulated
  6. L CHF
  7. cough, dyspnoea, exercise intolerance, pulmonary hypertension and R CHF
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5
Q

Describe the signalment for endocardiosis

A
  • small breeds
  • males > females
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6
Q

What history may come with a dog with endocardiosis?

A
  • asymptomatic
  • low grade murmur
  • L CHF - cough, dyspnoea, tachypnoea, exercise intolerance
  • develop R CHF - ascites, dyspnoea (pleural effusion)
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7
Q

What are the clinical findings in a dog with endocardiosis?

A
  • systolic murmur over mitral +/- tricuspid valve (murmur grade proportional to severity of disease, >4 = CHF)
  • early stage of disease - good myocardial function and pulse quality
  • +/- dyspnoea
  • +/- ascites
  • +/- arrhythmias
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8
Q

These radiographic findings are associated with which endocardial disease?

  • early stage = LA/LV enlargement, normal R side
  • progressed = airway compression, generalised cardiomegaly, venous congestion in heart and lungs
A

Endocardiosis

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9
Q

What ECG findings are associated with endocardiosis?

A
  • tall R wave = LV enlargement
  • wide P wave = LA enlargement
  • early stage - supraventricular beats
  • ventricular arrhythmias (LV dilated and stretched)
  • hypoxia
  • occasional VPC
    *
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10
Q

What echo findings are associated with endocardiosis?

A
  • early stage = thickened mitral valve, may prolapse into L. Normal systolic function
  • progressed = thickened valve, remodelling of LV and LA (dilated). Regurgitation on Doppler
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11
Q

What are the tx options for endocardiosis?

A

Tx depends on the stage of disease

Use a CHF classification system to guide tx

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12
Q

Describe bacterial endocarditis

A
  • affects valves on the L side
  • aortic valve is most common site
  • mitral valve is second most common site
  • aortic stenosis predisposes to development of endocarditis
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13
Q

How do dogs with endocarditis present?

A
  • pyrexia
  • joint stiffness - shifting lameness
  • new L sided murmur
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14
Q

How is endocarditis diagnosed?

A
  • blood culture (bacteraemia)
  • urinalysis and culture
  • joint tap
  • echocardiography - vegetations
  • thoracic radiography - cardiomegaly, CHF
  • abdominal US - infarct in organ
  • haematology and biochem
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15
Q

What are the treatment options for endocarditis?

A
  • antibiotics and supportive therapy
  • guarded prognosis
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16
Q

Describe the aetiology of DCM

A
  1. Primary - idiopathic, hereditary (giant breeds)
  2. Secondary - toxic, taurine deficiency, carnitine deficiency, tachycardia induced (abnormal accessory pathways)
17
Q

Describe the pathophysiology of DCM

A
18
Q

Describe the signalment for DCM

A
  • medium - large breeds, and cocker spaniels
  • middle aged - older
  • males > females
19
Q

What hx may a dog with DCM present with?

A
  • exercise intolerance (forward failure)
  • L CHF
  • R CHF
  • ventricular arrhythmias
  • asymptomatic
20
Q

What findings on diagnostic imaging are indicative of DCM?

A
  1. radiography - LA and LV enlargement, +/-CHF, pleural effusion
  2. ECG - wide P wave, tall R wave, AF, ventricular arrhythmias
  3. echo - mitral valve insufficiency (small murmur), weak IVS movement, poor systolic function, enlarged LV and LA
21
Q

What are the treatment options for DCM?

A
  • increase systolic function - pimobendan, digoxin, dobutamine
  • decrease preload - diuretic, ACE inhibitors
  • decrease afterload - ACE inhibitors, inodilator
  • arrhythmias - digoxin, Ca channel blocker, B blocker
  • prevent further remodelling - ACE inhibitors, spironolactone, pimobendan
22
Q

In which breeds is ARVC most common?

A

Boxers, bulldogs

23
Q

Describe the pathophysiology of ARVC

A
  • arrhythmias cause forward failure = syncope
  • poor myocardial function = pulmonary oedema, ascites (backward failure)
  • rapid VT = cardiogenic shock
  • fatty infiltrate of R side (seen in boxers)
24
Q

How is ARVC managed?

A
  • pimobendan - supports systolic function
  • ACE inhibitors - prevent further remodelling
  • sotalol, mexilitine, atenolol, amiodarone - life threatening arrhythmias
25
Q

What criteria must be met before using anti-arrhythmic drugs?

A
  • runs of VT >180bpm
  • multiform VPCs
  • close coupling of ventricular ectopics
26
Q
A
27
Q

Describe myocarditis

A
  • hx and CS may not be specific for cardiac disease
  • may be secondary to toxoplasma, neospora, parvo, neoplasia
  • arrhythmias common
  • may develop poor systolic function, secondary dilation with low grade murmurs
  • dx difficult - increased serum troponin supportive
  • tx - treat primary disease, arrhythmias, CHF
  • prognosis guarded

M15: Cardiorespiratory (5 decks)

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