Cardio Flashcards
A dog presents to your clinic for congestive heart failure. What clinical signs do you expect to see?
- resp distress / dyspnea
- tachypnea
- tachycardia
- heart murmur
- crackles on lung fields
- syncope
- hx of frequent cough, worse at night
Bitey is a 12 yo Bichon mix that presents to your clinic in respiratory distress. He has a history of a frequent cough, a 5/6 heart murmur, crackles on all lung fields, a HR of 140 and a RR of 60.
What 2 things should you do now?
Stabilize! –> O2, anxiolytics (butorphanol)
POCUS –> heart and lungs
You have a dog presenting for congestive heart failure. You do a POCUS of the heart and lungs. What do you expect to see?
lots of B lines in the lungs
La:Ao >2
You have a dog presenting in respiratory distress. He has a 5/6 murmur and crackles on lungs. You stabilize him and do POCUS, revealing B lines and La:Ao >2. What is your diagnosis? What do you do now?
congestive heart failure
furosemide!
You have a dog presenting in respiratory distress. He has a 5/6 murmur and crackles on lungs. You stabilize him and do POCUS, revealing B lines and La:Ao >2. You diagnose him with CHF and give furosemide. He is stable and you decide to do rads. What do you expect to see?
lung: interstitial to alveolar pattern, perihilar to caudodorsal
heart: enlarged, left atrium enlarged specifically, vein and artery enlarged
What is MVD? What happens to the animal who gets it? Like timeline and symptoms and stuff. Who gets it?
myxomatous degeneration of left AV valve causing mitral regurg, causing left sided apex murmur
80% of canine acquired heart disease
small/toy breeds, inherited in Cavalier King Charles Spaniels
can take 4-6 years from development of murmur to CHF
Gorp is a 11 yo Maltese cross presenting for a left sided systolic heart murmur. Based on C/S and signalment, what is the diagnosis?
mitral valve disease/mitral regurgitation
tell me about the disease progression of MVD.
starts with just a left-sided systolic heart murmur (no CHF, for 4-6 years).
murmur progression = worsening of disease. can lead to coughing without CHF (due to bronchial compression secondary to enlarged heart)
goes to CHF: progressive cough, dyspnea, syncope, crackles on auscultation, tachypnea , tachycardia
tell me about the MVD stages
WHEN DO WE WANT TO TREAT?????
A: breeds at risk. No structural disease. Cavalier King Charles spaniels are automatically stage A
B1: asymptomatic, no rad/echo evidence of disease - mild remodelling, mild murmur present
B2: asymptomatic, mild-mod heart murmur, rad/echo evidence of left sided enlargement
C: current or past C/S of CHF caused by MVD
D: end-stage MVD, C/S of HF are refractory to standard treatment
WE WANT TO TREAT AT STAGE B2 (i.e before symptoms of CHF!!!!)
what are the ways to diagnose MVD?
- thoracic rads (3 view): not always sensitive –> can see left atrial enlargement as disease progresses
- brain natriuretic peptide (BNP): not specific to MVD, but (-) result of this = most likely no cardiac disease
echocardiography = gold standard:” sensitive + specific –> La:Ao
What is the recommended treatment for MVD stage A
no therapy, yearly exam
What is the recommended treatment for MVD stage B1
no therapy, exam q 6-12 mo, BP, labs, early echocardiograms, thoracic rads
What is the recommended treatment for MVD stage B2
Pimobendan
Ace inhibitors (benazepril, enalapril) can be added
what is the treatment for MVD post-CHF? AKA stage C-D
- pimobendan
- ACEi (benazeprile, enalapril)
- furosemide (taper to lowest effective dose)
- diet lower in Na, weight control
labwork and PE 1 week after start, then 1 mo, then every 3 mo (with thoracic rads). make sure to check renal Vals and K+
Why should you monitor the kidneys in patients post-CHF and those using diuretics?
cardio-renal syndrome: less perfusion to kidneys leads to decreased kidney function and possible renal failure (furosemide will dehydrate you and lower GFR)
tell me about MVD post-CHF prognosis
- pimobendan and ACEi treatment increases survival after CHF
- increasing dosage of furosemide deceases survival
- ruptured cordae tendinae decreases survival
- asymptomatic phases of MVD: 4-6 years before progressing to CHF
- post CHF: 1-2 years survival
What is pulmonary arterial hypertension? How do you diagnose? How do you treat?
often a consequence of MVD, commonly secondary to chronic lower airway disease (ex. chronic bronchitis, pulmonary fibrosis)
dx: large right ventricle, large right atrium, large pulmonary artery, echocardiography
tx: Sildanefil (viagra)
Cutter is a 7yo Doberman with a 3-day history of cough that’s worse at night. He has a history of exercise intolerance. Cutter is presenting for breathing hard today. on PE, his temperature is 37.9, P: 186, RR: 42 and dyspneic. There are crackles bilaterally, his mm are cyanotic, and CRT 2 sec. What should you do next?
ECG= look for Afib
POCUS: lungs for B lines, heart for mushroom view and La:Ao
you have a Doberman who presents to your clinic for resp distress. You stabilize him and take rads when stable. You find this. What are your top 2 differentials? How would you tell the difference?
- DCM
- pericardial effusion
Do POCUS
What is dilated cardiomyopathy? who is affected? what causes it?
acquired myocardial disease. left ventricle more often affected but can affect both ventricles
cause unknown in most cases: but GRAIN FREE DIETS, taurine deficiencies are important
large/medium breed dogs … DOBERMANS esp!!!
You have a dog that has DCM. what C/S do you expect to see?
- gallop, soft systolic murmur
- new murmur or arrhythmia (Afib)
- pulse deficits (pulsis paradoxis)
- jug distension/pulses, ascites
- weight loss, cool extremities
- exercise intolerance
- syncope
- sudden death (esp Dobermans)
how do you diagnose DCM?
- echocardiography = gold standard
- ECG, Rads, biomarkers (BNP) not sensitive or specific
You have a 5yo Doberman patient on a grain free all fish diet with a newly diagnosed heart murmur. He is asymptomatic otherwise. You diagnose dilated cardiomyopathy. How do you proceed?
- Pimobendan + ACEi
- get him off that grain free all fish diet (all fish = taurine deficient)
You have a 7yo Great Dane with DCM who just recently got diagnosed with CHF. He is stable now. How should you continue to treat him?
- pimobendan
- diuretics (furosemide)
- ACEi
- low salt diet
tell me about the prognosis for DCM
worse prognosis: young, pleural effusion, pulmonary edema, ascites, AFib
better px: pimobendan treatment
overall, guarded to poor (90-300 days from time of DCM diagnosis) (dobermans have sudden death 30% of the time)
You have a 7yo DSH named Witten who presents to your clinic for lethargy and anorexia for 24h. He has been less active for the last 2 weeks. on PE, you find T: 37.2, HR: 240, RR: 70, BP 106 mmHg, nasal flaring, dyspneic, orthopneic stance. Harsh lung sounds on thoracic auscultation. How can you differentiate heart failure from other feline respiratory distress?
- POCUS (lung and heart)
- thoracic rads when stable
- pulse ox
- ECG
You have a cat presenting for respiratory distress and are worried about CHF. You do a POCUS of the heart and go into “mushroom” view. This is what you see. What are your top 2 differentials and how do you differentiate between the two?
- HCM
- hypovolemia
both show a thickened wall and small lumen.
Look at the La:Ao. Hypovolemia will have a small ratio and HCM will have a big ratio
should you give pimobendan to a cat?
no
true or false: you can see pleural effusion in cats with CHF
true
You have a cat that comes in with CHF in resp distress. what do you do?
- stabilize: O2 and butorphanol (anxiolytic)
- POCUS (and rads when stable) to diagnose CHF (HCM most likely)
- furosemide
you have a cat that comes in with CHF with pleural effusion. Should you perform thoracocentesis?
only if pleural effusion is significant enough to be part of the cause for dyspnea
we want to avoid stress
What is hypertrophic cardiomyopathy? who gets it?
most common acquired heart disease in cats
left concentric hypertrophy, myocardial disease (decrease luminal vol –> dilation of L atrium –> CHF)
genetic: rag doll, maine coone, American shorthair, British shorthair, bengal, Siberian, rex, DSH…
middle aged to older
do cats always get a heart murmur with HCM?
no!!! up to 30-50% of cats with HCM don’t have murmurs
what are the C/S of HCM?
often nothing prior to CHF!!!!
can be a gallop prior to CHF, or sometimes mitral regurg
once in CHF: crackles, dyspnea, quiet lung sounds, open-mouth breathing, pleural effusion, aortic thromboembolism
how do you diagnose HCM?
echocardiograph = gold standard
thoracic rads and POCUS
TT4*: hyperthyroidism can cause HCM and it’s reversible when you treat the hyperthyroidism
true or false: HCM stages are the same as MVD stages for dogs
true
how do you treat HCM?
same stages as dogs… but DO NOT USE PIMOBENDAN!!!
ACEi at stage B2
when there’s CHF: O2, anxiolytic, furosemide
chronic therapy after CHF: furosemide, ACEI, ± beta blockers
what is the prognosis for HCM?
asymptomatic 3-4 years
after CHF: 1-2 years
if ATE, very poor prognosis with very short survival
left atrial size and age decreases prognosis
You have a 5yo Boxer named Tammy who presents for the complaint of “seizures”. She’s actually experiencing syncope multiple times a day. PE is normal. What is going on? How do you find out for sure?
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
ECG = gold standard, VPCs BUT these can be intermittent, so you need a holter monitor (12 hour read)
what is arrhythmogenic right ventricular cardiomyopathy? who gets it? what happens? what is the usual chief complaint?
mainly an electrical disease. Boxers, 6-10 yr old
syncope
VPC’s on ECG, but these are intermittent so you need a 12hr ECG (Holter monitor)
