Cardio Flashcards
what is wrong with ? 12 YO Bichon mix with hx of frequent cough, esp. at night, high RR and HR, crackles on lung fields, left systolic HM, and many B lines on all lung fields with LA:Ao >2:1.
MVD. note the alveolar pattern (can see bronchi), LA enlarged, sternal contact, the enlarged heart vessels, and the raised trachea (other causes of raised trachea are PCE, mediastinal mass, pleural effusion).
what is MVD
mitral valve disease = acquired myxomatous degeneration of left AVV causing mitral regurgitation (MR) and therefore systolic left-sided apex murmur; can take 4-6 years from murmur to CHF.
common! 80% of canine acquired heart disease
once left-sided acute CHF develops due to mitral valve disease, sinus arrhythmia disappears. why?
increased vagal tone causes sinus arrhythmia. when stressed, decreased vagal tone, so no sinus arrhythmia
what heart condition is most common in small/toy breeds, inherited in CKC Spaniels and male dachshunds? is early onset (3 years to CHF) and poorer prognosis in CKC Spaniels
mitral valve disease MVD
when do we start treatment for mitral valve disease?
MVD stage B2 (asymptomatic dogs with advanced MR and imaging showing left chamber enlargement)
they benefit from treatment to DELAY ONSET of CHF
what is the gold standard for MVD diagnosis
echocardiography to see contractility, leaky valve, LA and ventricular enlargement
other non gold standard: cardiac POCUS, brain natriuretic peptide, and thoracic radiographs
briefly describe tailored therapy for stage B2 MVD
pimobendan, ACEi, weight control diet +/- sodium reduction
(more details: pimobendan 0.25-0.3 mg/kg PO q12h
ACEi (benazepril, enalapril) if progressive left chamber enlargement
weight control diet and possible sodium reduction
controversially) cough suppressants
exam 2-4x year)
briefly describe chronic therapy for dogs with MVD post-CHF who have NOT had recurrent episodes
lower sodium diet and weight control, furosemide, pimobendan, and ACEi
(more details: furosemide 2 mg/kg PO q12h tapered to lowest possible dose, pimobendan 0.25-0.3 mg/kg PO q12h, ACEi (benazepril or enalapril 0.5 mg/kg PO q12-24h
labwokr and PE 1 week after start, then 1 month, then q3mo, with thoracic rads, and checking renal values and K+)
briefly describe chronic therapy for dogs with MVD post-CHF who HAVE had recurrent episodes
increase furosemide dosage beyond 2 mg/kg and add spironolactone (diuretic)
increase pimobendan to q8h dosage (0.25-0.3 mg/kg PO)
increase ACEi to q12h dosage (benazepril or enalapril 0.5 mg/kg PO)
strictly control weight, exercise, and low sodium diet
carefully monitor renal values to avoid cardio-renal syndrome
MVD post CHF prognosis: treatment with pimobendan and ACEi ______ survival after CHF, increasing dosage of furosemide _____ survival, and ruptured chord tendinae have ______ prognosis
increases; decreases; worse
asymptomatic phase of MVD lasts _____ years before progressing to CHF, and post-CHF survival time is ____ years
4-6; 1-2
what is pulmonary arterial hypertension often secondary to?
secondary to chronic lower airway disease, eg. pulmonary bronchitis or pulmonary fibrosis
what is wrong
PAH, pulmonary arterial hypertension. see large RV, RA, pulmonary artery.
lateral view showed enlarged LA and heart vessels. what is wrong?
DCM. this was lat view
what is dilated cardiomyopathy, DCM? what is it linked to?
acquired myocardial disease, cause unknown in most cases, but linked to certain GRAIN FREE DIETS. most common in large/medium breed dogs; it is autosomal recessive in Dobermans
what are PE findings for DCM
related to poor circulation…
– Gallop, soft systolic murmur
– New murmur or arrhythmia
– Atrial or ventricular tachyarrhythmia
– Pulse deficits
– Jugular distension/pulses, ascites
– Weight loss, cool extremities
– Exercise intolerance
– Syncope, sudden death (especially Doberman)
what is gold standard diagnosis for DCM?
echocardiography
biomarkers (brain natriuretic peptide) are not Sp; thoracic rads, and ECG are not Se or Sp
what medication do you give cats with CHF until respiratory effort improves
furosemide start at 2 mg/kg
when would you perform thoracocentesis for cat with CHF
ONLY if pleural effusion is significant enough to be part of cause for dyspnea
what is hypertrophic cardiomyopathy
most common acquired heart disease in cats; left ventricular concentric hypertrophy; a myocardial disease that leads to reduced diastolic filling
do cats always get a heart murmur with hypertrophic cardiomyopathy
no
ragdoll cat presents with crackles, dyspnea, quiet lung sounds, open-mouth breathing, mitral regurgitation, and cardiac POCUS with LA:Ao 3:1 and B-lines. what is likely diagnosis?
CHF from HCM
what is gold standard for diagnosis of HCM in cats
echocardiogram
at what stage do you start treating CHF in cats?
stage B2, same as in dogs
what does treatment of stage 3 CHF in cats involve
furosemide 1-2 mg/kg q12h, ACEi 0.25-0.5 mg/kg q24h, clopidogrel or aspirin if large LA or presence of “smoke’ (pre-thrombi), +/- beta blockers and pimobendan
what is prognosis for lifespan with HCM in cat? what influences prognosis?
asymptomatic 3-4 years, after CHF 1-2 years
left atrial size and age decreased prognosis
if. at develops ATE, poor prognosis and very short survival
progresses rapidly in purebreds
won’t be examined, but what is DCM often associated with in cats
taurine deficiency
6 year old boxer presents with multiple episodes of syncope each day for last several days. what electrical disease do you suspect?
arrhythmogenic right ventricular cardiomyopathy (ARVC)
this autosomal dominant disease leads to ventricular arrhythmias, syncope, and possibly sudden death.
it presents at age 6-10 years in Boxers
what is gold standard diagnosis for arrhythmogenic right ventricular cardiomyopathy
ECG: look for VPCs. need holder monitor and echocardiography
how is ARVC treated in Boxers
antiarrhythmics
sotalol, mexiletine (decrease number and complexity of VPCs and improve syncope), atenolol
(not always treated. depends on C/S and how many VPCs)
how is heart worm disease diagnosed in dogs?
Snap 4DX: heartworm antigen
other options: direct smear showing microfilaria, thoracic rads, and echocardiography
