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Small Animal Medicine > Cardio - DMVD > Flashcards

Cardio - DMVD Flashcards

1
Q

What is the most common heart disease in dogs?

A

Degenerative Mitral Valve Disease (DMVD)

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2
Q

What is DMVD?

A

Progressive, age-related degeneration of the heart valves that results in valve regurgitation, progressive heart dilation, and ultimately results in CHF.

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3
Q

What valves are most commonly to least commonly affected in DMVD?

A

Mitral > tricuspid > aortic >> pulmonic (dogs)

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4
Q

What are some other names for DMVD?

A

Degenerative Valve Disease (DVD)

Myxomatous Mitral Valve Disease (MMVD)

Chronic Valvular Heart Disease (CVHD)

Endocardiosis

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5
Q

What is the etiology of DVMD?

A
  1. Myxomatous degenerative valve apparatus changes
  2. Thickening of valve and chordae tendinae
  3. Regurgitation
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6
Q

Valvular regurgitation is a _____ overload disease.

A

volume

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7
Q

What pathophysiology is caused by DMVD?

A
  1. Valvular regurgitation is a volume overload disease
  2. Excess volume in the ventricle results in eccentric hypertrophy and dilation
  3. Complications of progressive disease: L-CHF, arrhythmias, atrial rupture
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8
Q

What is the common signalment for DMVD?

A

Dogs (more common) and horses, middle aged to older, male > female;

Small-medium sized dogs more common

Breeds: CKCS, mini poodle, Schanuzers, Fox terriers, Pomeranian, Yorkie, Chihuahua, Dachshund

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9
Q

What happens in stage A of HF?

A

At risk breeds and/or signalment with no murmur

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10
Q

What happens in stage B1 of HF?

A

Degenerative valve changes –> regurgitation and a murmur (L apical systolic regurgitant) with normal heart size or mild L atrial dilation

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11
Q

What happens in stage B2 of HF?

A

Murmur with moderate or severe LA dilation

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12
Q

What happens in stage C of HF?

A

Progression to CHF, can have concurrent arrhythmias and/or multiple episodes of CHF

(Heart dilated, fluid starting to back up into lungs)

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13
Q

What happens in stage D of HF?

A

Episode of CHF that is refractory to tx

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14
Q

What is the presentation of stage A?

A

Asymptomatic, no murmur

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15
Q

What is the presentation of stage B1?

A

Asymptomatic, murmur and/or mid-systolic click, normal rads or mild LA dilation

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16
Q

What is the presentation of stage B2?

A

Asymptomatic or symptoms of cough, exercise intolerance;

Murmur with moderate-severe LA dilation on rads

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17
Q

What is the presentation of stage C?

A

Signs of CHF - soft cough, increased RR and effort, weakness, exercise intolerance, collapse, restlessness at night, weight loss, reduced appetite;

Murmur, tachycardia, crackles, +/- arrhythmia and/or pulse deficits;

Moderate-severe L cardiomegaly and pulmonary edema on rads

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18
Q

What is the presentation of stage D?

A

Same as stage C often with cachexia and/or hypotension;

Tx requires hospitalization and more advanced CHF therapies

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19
Q

What diagnostics can be done in GP to assess HF/DMVD?

A

Thoracic rads, BP, +/- labs (chem, U/A, NT-proBNP), +/- echo, +/- ECG

20
Q

What stage of DMVD is shown here?

A

Appears normal due to normal silhouette but is stage B1

(may sometimes have mild LA dilation)

21
Q

What stage of DMVD is shown here?

A

B2 - moderate LA enlargement

22
Q

What stage of DMVD is shown here?

A

C;

Moderate to severe LA dilation, pulmonary venous dilation, interstitial to alveolar pattern

23
Q

What is the definitive diagnostic for DMVD?

A

Echocardiogram

24
Q

What echo findings are consistent with stage B1 DMVD?

A

Thickened valve leaflets with mitral regurgitation

Normal heart size or mild LA dilation

25
Q

What echo findings are consistent with stage B2 of DMVD?

A

Eccentric hypertrphy that appears as dilated LA and LV with normal wall thickness

Thickened valve leaflets with regurgitation

+/- valve prolapse or ruptured chordae tendinae

26
Q

What echo findings are consistent with stage C DMVD?

A

Same as B2; +/- systolic dysfunction (and end-stage finding in volume overload disease)

27
Q

What stage of DMVD does this image show? (Would also see “party colors” when the doppler is shown)

A

Stage B2;

2 leaflets and thickened/nodular/lumpy, open mitral valve, LA dilation, LV dilation

28
Q

What is relative systemic hypertension?

A

When a BP is WNL but unacceptably high in the context of a given heart disease

29
Q

What is the goal in regards to BP in dogs with moderate to severe DMVD?

A

To maintain it in the low-normal range (~100 mmHg) without signs of hypotension at home (GI upset, weakness, lethargy, collapse)

30
Q

What stages of DMVD commonly have hypotension? What are the clinical signs? What is the treatment?

A

Stage C or more commonly stage D;

Cardiogenic shock with low BP;

Tx = positive inotropes (dobutamine)

31
Q

What is the normal BP of the LA?

A

8-10 mmHg

32
Q

What is the normal BP of the aorta?

A

120 mmHg

33
Q

What would you be looking for in a chemistry or U/A?

A

Renal and electrolyte abnormalities

34
Q

What can serial monitoring with NT-proBNP show?

A

A progressive increase in NT-proBNP with progressive heart dilation

35
Q

If a patient has LA enlargement, what would the ECG show?

A

Wide P wave (P-mitrale)

36
Q

If a patient has LV enlargement, what would the ECG show?

A

Tall R wave, wide QRS

37
Q

What arrhythmias would an ECG show if the origin was ventricular?

A

Ventricular premature beats or ventricular tachycardia

38
Q

What arrhythmias would an ECG show if the origin was supraventricular?

A

Sinus tachycardia, supraventricular premature beats, atrial fibrillation

39
Q

What medications and follow up would you recommend for a patient with stage A DMVD?

A

No meds;

CE and exam q 6-12 months to monitor for murmur development

40
Q

What medications and follow up would you recommend for a patient with stage B1 DMVD?

A

Antihypertensives if indicated by BP;

Exam, rads, BP, +/- NT-proBNP q 6-12 months

RRR at home

41
Q

What is the prognosis for a patient in stage B1?

A

Good

42
Q

What medications and follow up would you recommend for a patient with stage B2 DMVD?

A

Pimobendan, +/- ACEi, +/- antihypertensives;

Exam, thoracic rads, BP, +/- NT-proBNP q 6-12 months

RRR at home

Dietary Na restriction

43
Q

What is the prognosis for a patient in stage B2?

A

Good to fair

44
Q

What medications and follow up would you recommend for a patient with stage C DMVD?

A

Meds = diuretic (furosemide, spironolactone), ACEi, Pimobendan, +/- anti-arrhythmic, +/- antihypertensive (amlodipine);

Exam, thoracic rads, BP, chemistry, +/- NT-proBNP q 6 months or sooner if signs of CHF or renal disease

RRR at home

Dietary Na restriction

45
Q

What is the prognosis for a patient in stage C?

A

Guarded (average 1-2 years survival after first episode of CHF)

46
Q

What medications and follow up would you recommend for a patient with stage D DMVD?

A

Meds = diuretic (furosemide, spironolactone, hydrochlorothiazide), ACEi, Pimobendan

Hospitalization with frequent monitoring of vitals and BP

RRR daily

Dietary Na restriction

47
Q

What is the prognosis for a patient in stage D?

A

Guarded to poor

Small Animal Medicine (100 decks)

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