Adult-onset Valvular Heart Disease

Question 1

What’s the most common signalment for MMVD?

Answer 1

small to medium dog
- Cavalier
- Dachshunds
- mini Poodles
- Yorkies

Question 2

What are some clinical signs of MMVD?

Answer 2

• exercise intolerance
• cough
  If decompensated CHF:
• tachypnea, dyspnea
• anxious, restlessness, sternal recumbency
• syncope

Question 3

What are some of the clinical signs associated with decompensated CHF?

Answer 3

1. respiratory distress, cough (increase LA and pulmonary venous pressures –> pulmonary edema, bronchial compression)
2. weakness, reduced stamina (reduced LV or RV forward flow)
3. pleural effusion, ascites (increased RA and systemic venous pressure)\
4. acute decompensation/ sudden death (rupture of chordae tendinea, atrial rupture, or ventricular fibrillation

Question 4

What’s the main cause of the abnormal cardiopulmonary functions in dogs with MMVD?

Answer 4

increased pulmonary blood volume

Question 5

What are the different stages for canine MVDD?

Answer 5

Stage A: no clinical signs, breeds a risk
Stage B: heart murmur present, but no other clinical signs
B1: mild mitral valve regurgitation, AV valve regurgitation, no cardiomegaly
B2: significant valvular regurgitation, cardiomegaly
Stage C: past or present signs of CHF, associated with structural changes with the heart
Stage D: end-stage disease, required advanced/ specialized treatment to maintain QoL

Question 6

What’s the treatment recommendations for MVDD?

Answer 6

Start treatment in stage B2 - pimobendan
Stage C: pimobendan, furosemide, spironolactone, (ACEi, weak evidence)
- monitor for respiration rate
- digoxin and diltiazam for atrial fbrillation
- diet: low sodium, high Omega-3
Stage D: all of the above, dobutamine, hydralazine, nitroprusside, sildenafil (if pulmonary hypertension), bronchodilators

Question 7

What’s the signalment for endocarditis?

Answer 7

medium to large breed, mainly purebreds, middle age

Question 8

Are patients with MVDD at an increased risk for infective endocartidis?

Answer 8

no

Question 9

What’s the thromboembolic risk for patients with infective endocarditis?

Answer 9

30-40%
Lungs > kidneys > distal part of aorta

Question 10

What’s the most common presenting complaint for infective endocarditis?

Answer 10

Lameness, fever, heart murmur = classical signs
- lethargy, anorexia, respiratory abnormalities, weakness, (recurrent) fever, weight loss, GI disturbances