Cardiac Valvular Disease

Question 1

What is the big name for endocardiosis?

Answer 1

Myxomatous Atrioventricular Valvular Degeneration

85% of all older sm breed dogs have this condition, not seen in cats

Cavalier King Charles Spaniels - develop by 3 yrs

Question 2

What are some sequelas of endocardiosis

Answer 2

mainly mitral valve involved but can be both AV valves!

Regurgitation into L atria ⇒ volume overload ⇒ eccentric hypertrophy

Ruptured chordae- can lead to acute onset HF!

Question 3

How much regurg is necc before HF?

Answer 3

≈ 70%

little regurg - asymptomatic w/ murmur

enlarged L atr → cough which can occur w/o HF but exacerbate by environment

large amt regurg - LCHF → cough

Question 4

Endocarditis

Answer 4

Bacteremia affecting the endocardium & heart valves

vegatations

mainly aortic and mitral valves but can be anywhere

caused by Bartonella vinsonii, Strep, Staph, e. coli, Coryn, Pseudo

from urinary, skin, bite wounds, post sx

Question 5

Outcomes of Endocarditis

Answer 5

CHF

dysrythmias if infection on side of heart damages bundle branches:

VPDs/Blocks

Septic emboli

polyarthritis + glomerulonephritis

Question 6

CS of endocarditis

signalment

Answer 6

Hx of infection or diagnostic/sx procedures

intermittent malaise, anorexia

wt loss

shifting lameness

diastolic murmur

pulses bounding due to decr pres in diastole due to leaky valves

may have systolic murmur due to vegetative lesions

can sound like a murmur of PDA or Aortic stenosis

older male dogs, sudden onset murmur

lg breed dogs, middle age (>4y)

rare in cats

Question 7

Dx of endocarditis

Answer 7

CBC: neutrophilic leukocytosis +/- L shift, toxic change, anemia (of chronic inflammation), thrombocytopenia

d/t emboli: renal, liver dysfunction

blood culture

PCR esp for Bartonellas

Question 8

what can be seen on echo

Answer 8

vegetations on valves

Question 9

Tx of endocarditis

Prevention

Px

Answer 9

control arrhythmias + CHF

antibiotics: must be bactericidal!

parenteral then PO

2-4 months

prophylaxis: amp/amoxi 1 h pre sx (2-3 d post)

SubAortic Stenosis (SAS) predisposed not endocardiosis

Poor to grave w/ CHF!

Question 10

Peridcaridal effusion

causes

Answer 10

incr. fluid in pericardial sac d/t

Dogs: 1. 70% = neoplasia: hemangiosarcoma!, heart base tumors

2. 10% CHF, hypoalbuminemia, hemorrhge, FB (more in ruminants w/ hardware dz)

3. 20% idiopathic

Cats: FIP & lymphoma

Cardiac tamponade (diastolic filling problem) → RCHF,

dilated veins classic sign

rate of formation depends! sudden vs slow

Question 11

Pericardial effusion signalment

CS

Answer 11

Retreivers, GSD = hemangiosarcomas

Brachycephalic breeds = paragangliomas

Lg breed mid/old = idiopathic

Hx: Lethargy, dyspnea, collapse, decr wt., vomiting, adb distension

PE: incr CRT, muffled heart sounds, decr pulse, vein distension, ascites

Question 12

Diagnostics pericardial effusion

Answer 12

CBC: NRBCs - shistocytes = hemangiosarcoma

Perdicardiocentesis - cytology

globus heart

Ddx: DCM (would have enlg L atrium)

Question 13

echo of pericardial effusion definitive!

Answer 13

Question 14

Tx for PE

Answer 14

Famous NAVLE Q: Can we give furosemide? NO!!

Emergency - centesis!

Specific treatments - etiology

Idiopathic - recur?

Px: idiopathic - excellent

neoplasia - grave