Cardiology

Question 1

Cardiomyopathy in cats

DCM is systolic or dyastolic dysfunction?

Answer 1

Systolic.

Question 2

What’s the most common cardiomyopathy in cats?

Answer 2

Hypertrophic cardiomyopathy (60%).

Question 3

3 causes of HCM in cats

Answer 3

Fixed stenosis (SAS/AS), systemic hypertension, hyperthyroidism.

Question 4

Cat breeds were genetic evidence of HCM.

Answer 4

Maine Coon, Ragdoll, Sphinx, Norwegian Forests, BSH.

Also reported in DLH an DSH.

Question 5

Mean age at diagnosis of HCM in cats.

Answer 5

6 years old.

Question 6

T/F. Clinical signs of HCM might be absent.

Answer 6

Correct!

Also: increase RR/effort, etc.

Question 7

T/F. Heart murmur in cats is indicative of heart disease.

Answer 7

False.

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Question 8

T/F. NT-proBNP is a screening tool.

Answer 8

Nope!!! That’s a wrong use of the test.

It’s for differentiation of respiratory vs cardiac biomarker.

There are a lot of things that can affect that biomarker, like anemia.

Question 9

T/F. Cats with left-CHF can have pulmonary edema and pleural effusion.

Answer 9

True! In dogs, they only have pleural effusion with R-CHF.

Question 10

Treatment for cats with HCM and normal left atrial dimensions.

Answer 10

None. Unproven benefit of beta-blockers.

Unless evidence of SAM (mitral valve abnormal).

Question 11

Traetment for cats with HCM AND enlarged left atrium (stage B2).

Answer 11

Clopidogrel.

Longer time free of thromboembolic event compared to aspirin in dogs.

Question 12

T/F. Furosemide and enalapril can be used in cats with HCM and heart failure.

Answer 12

True.

Also, clopidogrel, thoracocentesis if pleural effusion, treatment for FATE if present.

Question 13

T/F. Prognosis for HCM is fatal.

Answer 13

False. Highly variable.

Young age and absence of clinical signs: longer survival.
28% risk of cardiovascular death over 10 year follow-up.

Question 14

Most important prognositc indicator in cats with HCM.

Answer 14

Left atrial size.

Question 15

Second most common cardiomyopathy in cats.

Answer 15

Restrictive cardiomyopathy.

Median age 10 years old.

Question 16

T/F. Thrombi are uncommon with restrictive cardiomyopathy in cats.

Answer 16

False!

Presence of marked left atrial or biatrial enlargement.

Question 17

What’s the prognosis for cats with restrictive cardiomyopathy?

Answer 17

Poor.

Question 18

The deficiency of which nutrient is associated with DCM in cats?

Answer 18

Taurine.

Question 19

T/F. Gallop can be a CS of dilated cardiomyopathy in cats.

Answer 19

True.

Median age presentation 9 years old.

Question 20

Why optic examination should be performed in cats with DCM?

Answer 20

Changes in the eye due to taurine deficiency.

Retinal degenerative change.

Question 21

T/F. Prognosis in taurine induced DCM in cats is good if they survive the first month.

Answer 21

True.

Question 22

What’s the diagnostic test for arrhythmogenic cardiomyopathy?

Answer 22

Biopsy or necropsy.

To demonstrate fibrous and adipose tissue replacing myocardium. Fat doesn’t constrict normally.

Question 23

What are the CS of arrhythmogenic cardiomyopathy?

Answer 23

No clinical signs or related to R-CHF.
All the arrhythmias that they want.

Question 24

T/F. Prognosis for arrhythmogenic cardiomyopathy is good.

Answer 24

False. It’s poor.

Question 25

Causes of myocarditis in cats.

Answer 25

Viral infections (FIV), bacteria (Strepto, Bartonella), protozoan (Toxo). ## Footnote Very difficult to diagnose without biopsy.

Question 26

How many categories of pulmonary hypertension are in dogs?

Answer 26

6.

Question 27

Where is the localization of the lesion in pulmonary hypertension category 1?

Answer 27

Small pulmonary muscular arterioles.

Question 28

Where is the localization of the lesion in pulmonary hypertension category 2?

Answer 28

Pulmonary hypertension owing to left heart disease. (Systolic dysfunction -DCM, diastolic dysfunction -HCM, RCM, valvular heart diseases -MMVD, MV dysplasia).

Question 29

How common is to see pulmonary hypertension in cats?

Answer 29

Very very rarely.

Question 30

Where is the localization of the lesion in pulmonary hypertension category 3?

Answer 30

Pulmonary hypertension owing to lung disease and/or hypoxia.

Question 31

Where is the localization of the lesion in pulmonary hypertension category 5?

Answer 31

Parasitic disease.

Question 32

Where is the localization of the lesion in pulmonary hypertension category 4?

Answer 32

??

Question 33

Where is the localization of the lesion in pulmonary hypertension category 6?

Answer 33

Miscellaneous (lymphadenopathy, compression of pulmonary vessels, granulomatous disease, sarcoidosis, histiocytosis X...).

Question 34

3 mechanisms of pathophysiology of pulmonary hypertension in dogs

Answer 34

1. Increased pulmonary blood flow 2. Increased pulmonary vascular resistance 3. Increased pulmonary venous pressure

Question 35

Increased pulmonary venous pressure leading to pulmonary hypertension: due to LEFT or RIGHT heart disease?

Answer 35

LEFT! (LV systolic dysfunction, LV diastolic dysfunction, inflow obstruction, valvular disease -acquired/congenital).

Question 36

Most common causes of PH in dogs.

Answer 36

Left sided heart disease, primary respiratory disease, pulmonary arterial hypertension. dirofilaria.

Question 37

CS strongly suggestive of pulmonary hypertension.

Answer 37

Syncope, respiratory distress at rest, activity or exercise terminating in respiratory distress, right sided heart failure.

Question 38

General recommendations for pulmonary hypertension

Answer 38

Weight control, ,rellenar

Question 39

Medical treatment for pulmonary hypertension.

Answer 39

Sildenafil, tadalafil.

Question 40

Cases when medical treatment for PH is contraindicated.

Answer 40

Left-sided heart disease, left-to-right shunt (risk of pulmonary edema).

Question 41

Is oxygen a correct treatment for PH?

Answer 41

YES, it is.

Question 42

Are diuretics indicated or contraindicated in most cases of pulmonary hypertension?

Answer 42

Contraindicated unless they are in right-sided heart failure (and give with caution).

Question 43

Is echo the way to monitor pulmonary hypertension?

Answer 43

It is NOT. Improvement of clinical signs is. Estimated pulmonary pressures assessed with eco are NOT correlated with clinical improvement.