Acquired Valvular Diseases

Question 1

what is the most common canine heart disease?

Answer 1

myxomatous mitral valve disease

Question 2

what is the main cause of acquired valvular disease?

Answer 2

myxomatous degeneration

Question 3

what dogs are most commonly affected by myxomatous mitral valve disease?

Answer 3

small to medium-size breeds
cavalier king charles spaniels
middle-aged or older
male>female

Question 4

what makes up the mitral valve apparatus?

Answer 4

mitral leaflets
chordae tendinae
papillary muscles
mitral annulus
left ventricular wall
left atrial wall

Question 5

what are the four layers of a valve?

Answer 5

atrialis
spongiosa
fibrosa
ventricularis

Question 6

what can the chordae tendinae look like in myxomatous mitral valve disease?

Answer 6

thickened or ruptured

Question 7

what is arteriosclerosis?

Answer 7

small vessel narrowing

Question 8

what enlarges with myxomatous mitral valve disease?

Answer 8

left atrium
left ventricle

Question 9

what parts of the valve are affected by myxomatous mitral valve disease?

Answer 9

mitral and tricuspid leaflets

Question 10

how many dogs with myxomatous mitral valve disease progress to CHF?

Answer 10

20-30%
most severely affected ones do

Question 11

what are some signs of myxomatous mitral valve disease?

Answer 11

history of murmur or click
cough, dyspnea, syncope with advanced disease

Question 12

what type of click is associated with myxomatous mitral valve disease?

Answer 12

mid-systolic click

Question 13

where is the murmur with myxomatous mitral valve disease?

Answer 13

left sided, systolic
apical location

Question 14

what vertebral left atrial size has a high likelihood of left atrial enlargement?

Answer 14

> =3.0v

Question 15

what can you see with myxomatous mitral valve disease on electrocardiography?

Answer 15

P mitrale
QRS prolongation
LV enlargement pattern
ST segment slurring, depressiom
arrhythmias possible

Question 16

what can be found on echocardiography with myxomatous mitral valve disease?

Answer 16

thickened mitral leaflets
mitral valve prolapse
mitral +/- tricuspid regurgitation
LV volume overload: LV, LA dilation
pulmonary artery dilation +/- right heart dilation

Question 17

what laboratory testing do you want to do for myxomatous mitral valve disease?

Answer 17

minimum database
urinalysis before furosemide
NT-proBNP or c-BNP

Question 18

what is stage B2 of heart disease?

Answer 18

cardiac enlargement sufficient to benefit from treatment

Question 19

what is the progression of myxomatous mitral valve disease?

Answer 19

no clinical signs
left mainstem bronchus compression by left atrium that causes cough
left sided congestive heart failure
ruptured chordae tendinae
syncope
endocardial split/left atrial tear: hemopericardium

Question 20

should you treat dogs with cardiac enlargement, but no CHF, with pimobendan?

Answer 20

yes: live longer, no increase in adverse effects

Question 21

should you start ACE inhibitors in dogs with myxomatous mitral valve disease?

Answer 21

probably does not help a lot, if at all

Question 22

when should you start pimobendan in a dog with asymptomatic myxomatous mitral valve disease (owner with unlimited funds)?

Answer 22

murmur >=III/VI
VHS =>10.5
echo criteria LA/Ao >1.6
echo criteria LV enlargement

Question 23

what is the surgery for myxomatous mitral valve disease?

Answer 23

Japan experience
annuloplasty and chordal repair

Question 24

what does transcatheter edge-to-edge repair do?

Answer 24

limits mitral regurgitation using a clip

Question 25

what do candidates for transcatheter edge-to-edge repair have to have?

Answer 25

severe mitral regurgitation
advanced stage B2, C, +/- D
leaflets must not be “flail”
A2-P2 prolapse

Question 26

who gets acquired mitral stenosis?

Answer 26

uncommon in veterinary medicine
bull terriers
cats

Question 27

what is the median survival after murmur detection in myxomatous mitral valve disease?

Answer 27

25 months of CHF

Question 28

what valves are affected by myxomatous mitral valve disease?

Answer 28

mitral valve usually
tricuspid 30%
aortic rarely- old dogs

Question 29

is there an inherited component to myxomatous mitral valve disease?

Answer 29

identified in some breeds

Question 30

what are the predominant cell types in valves?

Answer 30

valvular interstitial cells: extracellular matrix
valvular endothelial cells

Question 31

what can be seen grossly with myxomatous mitral valve disease with the valve?

Answer 31

thickened, curled, nodular margins
non-inflammatory, myxomatous degeneration
valvular fibrosis, hemorrhage, calcification
chordae tendinae thickened or ruptured
atrial jet lesions

Question 32

what is often the first auscultation finding with myxomatous mitral valve disease?

Answer 32

mid-systolic click

Question 33

what is the mid-systolic click in myxomatous mitral valve disease associated with?

Answer 33

mitral and/or tricuspid valve prolapse

Question 34

what are some signs of left atrial enlargement on thoracic radiographs?

Answer 34

LAA bulge 2-3 o’clock
bow-legged cowboy: separation mainstem bronchi
lateral: tracheal elevation, left atrial bulge

Question 35

what are the clinical syndromes of myxomatous mitral valve disease?

Answer 35

no clinical signs
left mainstem bronchus compression by left atrium
left sided congestive heart failure
ruptured chordae tendinae
syncope
endocardial split/left atrial tear: hemopericardium

Question 36

what are some causes of mitral regurgitation and stenosis?

Answer 36

myxomatous mitral valve disease
DCM/HCM/RCM
mitral valve endocarditis
congenital mitral dysplasia
mitral stenosis
traumatic mitral injury
neoplasia