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Small Animal Medicine > Cardio - DCM > Flashcards

Cardio - DCM Flashcards

1
Q

What is the structural component of DCM?

A

Primary myocardial disease, defect in cytoskeleton or metabolism

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2
Q

How does DCM affect general heart function?

A

Decreased LV systolic function (decreased contractility)

LV dilation

Ventricular arrhythmias

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3
Q

What is the cause for primary DCM?

A

Genetic, idiopathic

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4
Q

What breed gets primary DCM?

A

Dobermans

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5
Q

What are secondary causes of DCM?

A

Nutritional deficiencies (taurine/carnitine), infectious/inflammatory, tachycardia-induced, sepsis-induced myocardial dysfunction, doxorubicin cardiotoxicity

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6
Q

What do DCM hearts look like?

A

Attenuated (shrinking) wavy myofibers, myocardial fibrosis and fatty replacement, myocyte atrophy/degeneration/necrosis

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7
Q

What is the most common arrhythmia seen with DCM? When do they occur in relation to changes seen on echo?

A

ventricular arrhythmias;

OFTEN precede echo changes (esp. Dobermans)

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8
Q

What other arrhythmia can happen with DCM? When does this happen in relation to changes seen on echo?

A

atrial fibrillation (due to large atrium);

OFTEN precedes echo changes (esp. in Irish Wolfhounds) and is common in advanced DCM/CHF in all breeds

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9
Q

What is the average age that DCM occurs?

A

6 years

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10
Q

How prevalent is DCM in Dobermans?

A

50% of them have it >6 years

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11
Q

What historically causes DCM in cats?

A

taurine deficiency

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12
Q

What sex gets DCM more often?

A

Males > females

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13
Q

What are 3 ways by which DCM can be detected?

A

Breeder screening, veterinarian screening, Dx following a complication

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14
Q

What 3 things can be used in a breeder screening to detect DCM?

A

Echo/holter monitor, cardiac biomarkers (NT-proBNP, cTnI), genetic testing

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15
Q

How is DCM diagnosed on echo?

A

Decreased LV systolic function (FS%, EF%), increased LV size

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16
Q

What is the gold standard for diagnosis of ventricular arrhythmias?

A

Holter (>50 VPCs/24 hours)

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17
Q

How can ventricular arrhythmias be diagnosed with ECG?

A

1+ VPCs/5 min

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18
Q

Severity of ventricular arrhythmias is correlated with severity of _____ _____.

A

myocardial dysfunction

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19
Q

Other than ventricular arrhythmias, what else can ECGs/Holter monitors detect when DCM is suspected?

A

A-Fib

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20
Q

What are the 2 biomarkers for DCM?

A

NT-proBNP and cTnI

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21
Q

What does increased NT-proBNP mean and what is the cutoff?

A

myocardial stretch; >450 pmol/L

22
Q

What does increased cTnI mean and what is the cutoff?

A

myocardial damage; >0.22 ng/ml

23
Q

How can nutritional deficiency be ruled out as a secondary cause of DCM?

A

consider diet history and supplement taurine if low

24
Q

How can infection/inflammation be ruled out as a secondary cause of DCM?

A

Consider history and test for infectious diseases such as Trypanosoma, Toxo/Neospora, Bartonella, Borrelia, Ehrlichia, Lepto

25
Q

How can tachycardia-induced myopathy be ruled out as a secondary cause of DCM?

A

Treat tacharrhythmia and recheck

26
Q

How can sepsis-induced myocardial dysfunction be ruled out as a secondary cause of DCM?

A

treat sepsis and recheck

27
Q

How can Doxorubicin cardiotoxicity be ruled out as a secondary cause of DCM?

A

Consider history

28
Q

What are CS associated with DCM?

A

Signs of CHF: dyspnea/tachypnea, cough exercise intolerance/inappetence/ADR, abdominal distention

29
Q

____ breed dogs hide CHF better than _____ breed dogs

A

large, small

30
Q

Other than signs of CHF, what 2 things can happen in DCM?

A

Syncope, sudden cardiac death (arrhythmic)

31
Q

Where does the fluid go in CHF in dogs?

A

L-CHF = pulmonary edema

R-CHF = ascites

32
Q

Where does the fluid go in CHF in cats?

A

L-CHF = pulm edema, pleural eff, pericardial eff

R-CHF = pleural eff, ascites, pericardial eff

33
Q

DCM can cause _____ CHF.

A

biventricular

34
Q

How does DCM progress in Dobermans that are asymptomatic?

A

Avg time to CHF is 2 years

35
Q

How does DCM progress in Dobermans following syncope?

A

Average survival 7 months

36
Q

How does DCM progress in Dobermans after an episode of CHF?

A

average survival 6 months

37
Q

What is the time to CHF in other breeds that have asymptomatic DCM?

A

2-5 years

38
Q

What is the average survival of other breeds with DCM following an episode of CHF?

A

6 months-2 years

39
Q

What are the 2 main causes of death in DCM?

A

2/3 CHF, 1/3 sudden cardiac death

40
Q

What are negative prognostic indictors for DCM?

A

Severe ventricular arrhythmias, poosrly controlled A-Fib rate, younger age of onset, pleural eff, being a Doberman/Great Dane

41
Q

What 2 medications are used in DCM to optimize HR?

A

Sotalol and Mexiletine

42
Q

What treatments are used in asymptomatic DCM (stage B)?

A

Inotropy, cardioprotection, tx arrhythmias

43
Q

What drugs are used for inotropy and cardioprotection in DCM?

A

Pimobendan, ACEi, +/- Atenolol

(Atenolol NEVER given to P with CHF)

44
Q

What drugs are used to treat arrhythmias in DCM?

A

Ventricular arrhyth = Sotalol, Mexiletine

A-Fib = Digoxin, Diltiazem

45
Q

What is more common in dogs with DCM than it is in DVMD?

A

cardiogenic shock - use dobutamine to treat

46
Q

What is arrhythmogenic R ventricular cardiomyopathy (ARVC)?

A

Disease of the desmosome due to a genetic mutation in striatin, resulting in fibrofatty infiltration of the RV +/- the LV and ventricular arrhythmias (RV) +/- DCM phenotype (10%)

47
Q

What is the signalment for ARVC?

A

middle-aged Boxers

48
Q

What are 3 possible clinical presentations of ARVC?

A

Asymptomatic (incidental arrhythmia), symptomatic (syncope >>> CHF), sudden death (arrhythmic)

49
Q

What is the preferred method for diagnosis of ARVC?

A

Holter/ECG

50
Q

What is the preferred treatment for ARVC?

A

Sotalol (also mexiletine) +/- treat CHF

51
Q

What is the prognosis if the dog has ARVC only?

A

Good

52
Q

What is the prognosis if the dog has ARVC and the DCM phenotype?

A

same as “regular” DCM

Small Animal Medicine (100 decks)

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