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Small Animal Medicine (GP cert) > Cardiology 2 AI > Flashcards

Cardiology 2 AI Flashcards

1
Q

What is the workable theory behind using tricuspid regurgitation velocity to infer PAP?

A

Tricuspid regurgitation velocity is dependent on the pressure difference between the RV and right atrium (RA).

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2
Q

What does a tricuspid regurgitation velocity of 4.4 m/s indicate?

A

Severe pulmonary hypertension (PA pressure at least 77 mmHg in systole).

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3
Q

What does the pulmonic regurgitation velocity correspond to?

A

Mean pulmonary arterial pressure.

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4
Q

What is the end pressure gradient of pulmonic regurgitation representative of?

A

Diastolic pulmonary arterial pressure.

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5
Q

How can radiography be helpful in identifying a pericardial effusion?

A

Radiography can show a well-demarcated, crisp cardiac silhouette in pericardial effusion.

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6
Q

What is the best way to diagnose a pericardial effusion?

A

Echocardiography is the best diagnostic tool for pericardial effusion.

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7
Q

What is the significance of an anechoic effusion on echocardiography?

A

An anechoic effusion highlights the outline of cardiac masses well.

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8
Q

What is a common feature seen in cases of cardiac tamponade?

A

Dynamic collapse of the right atrium is expected in cardiac tamponade.

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9
Q

How can neoplastic pericardial effusions be confirmed?

A

Neoplastic pericardial effusions can be confirmed through echocardiographic imaging.

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10
Q

What percentage of pericardial effusions in dogs have a neoplastic cause?

A

Approximately 49% of pericardial effusions in dogs are neoplastic.

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11
Q

What should be considered if a mass is not obvious on initial echo for pericardial effusion?

A

Referral to a cardiologist should be considered to evaluate the possibility of neoplasia.

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12
Q

What is the recommended approach for cases of presumed idiopathic pericardial effusion?

A

Two main options are waiting for recurrence or performing additional tests for metastatic neoplasia.

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13
Q

What is the role of cytology in diagnosing neoplastic pericardial effusions?

A

Cytology is useful for detecting exfoliative neoplasia, such as lymphoma.

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14
Q

Why should cytologic confirmation of mesothelioma be questioned by the primary clinician?

A

Mesothelioma diagnosis can only be made on histopathology, not cytology.

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15
Q

What is the best course of action for echo negative cases of pericardial effusion suspecting neoplasia?

A

The best test is to wait and see if the effusion recurs.

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16
Q

What are the three commonest types of cardiac neoplasia?

A

Haemangiosarcoma, chemodectoma, and mesothelioma.

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17
Q

What is the prognosis for haemangiosarcoma?

A

Poor prognosis with likely metastasis and regrowth at excision site.

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18
Q

Which part of the heart is the most common site for diagnosis of haemangiosarcoma?

A

Right atrium/auricle.

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19
Q

What can cause pericardial effusion in haemangiosarcoma?

A

Acute hemorrhage.

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20
Q

What is the characteristic appearance of haemangiosarcomas on ultrasound?

A

Heterogenous, cavitating, intramural lesions.

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21
Q

Which imaging modality is not effective for subtle cardiac lesions unless ECG gating is present?

A

CT.

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22
Q

What imaging modality is useful for detecting nodular interstitial pattern in the lungs suggestive of metastasis?

A

Radiography.

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23
Q

What type of masses tend to arise from the heart base?

A

Chemodectomas.

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24
Q

What is the cytology appearance of chemodectomas?

A

It shows ‘naked nuclei’ seen in neuroendocrine tumors.

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25
Q

What is the treatment of choice for pericardial effusions associated with heart base tumors?

A

Pericardiectomy.

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26
Q

How can pericardiectomy be performed to minimize patient pain and hospitalization time?

A

Thoracoscopically.

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27
Q

What type of tumor can be associated with systemic signs like episodic hypertension and syncope?

A

Paragangliomas.

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28
Q

What can be performed to lift a heart base tumor and restore venous return?

A

Trans-atrial stent.

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29
Q

What is the usual appearance of pericardial effusions associated with heart base tumors?

A

Haemorrhagic in appearance.

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30
Q

What is the treatment of choice after pericardiocentesis and stabilization?

A

Pericardiectomy.

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31
Q

What is the median survival time in dogs with a heart base tumour after pericardiectomy?

A

Over 500 days

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32
Q

What is the most challenging heart tumour to diagnose?

A

Mesothelioma

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33
Q

How can mesotheliomas appear on CT imaging?

A

Nodular

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34
Q

What is the definitive diagnosis of mesothelioma?

A

Histopathological review of the pericardial tissue

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35
Q

Is echocardiography useful for diagnosing mesothelioma?

A

Rarely

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36
Q

What primary treatment option is recommended for mesothelioma?

A

Chemotherapy

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37
Q

What is the purpose of a pleuraport in treating mesothelioma?

A

Drain recurrent pleural effusions and administer intra-cavitary chemotherapy

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38
Q

What type of neoplasia can be diagnosed based on cytology?

A

Lymphoma

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39
Q

What does the effusion often look like in cases of lymphoma?

A

Serosanguinous with a low PCV

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40
Q

What type of surgery is recommended for dogs with lymphoma?

A

Sub-total pericardiectomy

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41
Q

What chemotherapy protocol is often used for lymphoma?

A

CHOP

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42
Q

Why should the chest tube be withdrawn rapidly after the fenestrated side holes emerge from the skin surface?

A

To avoid creating pneumopericardium.

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43
Q

What should be used to monitor ventricular ectopy during pericardial drainage?

A

ECG.

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44
Q

What should be done if ventricular tachycardia occurs during pericardial drainage?

A

Reposition/withdraw the needle and administer intravenous lidocaine.

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45
Q

What may occur if pericardiocentesis is rapid?

A

Atrial fibrillation.

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46
Q

Why can it be difficult to replace the needle/catheter if it is displaced during drainage?

A

Loss of intrapericardial pressure and tissue properties that prevent immediate sealing of the hole.

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47
Q

What is the recommended management for dogs post-pericardiocentesis?

A

Observation once clinical signs improve.

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48
Q

What imaging technique is the first choice for re-staging dogs with recurring effusion?

A

CT imaging of the chest.

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49
Q

What is the recommended approach for pericardiectomy?

A

Minimally invasive thoracoscopic approach or via thoracotomy.

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50
Q

Why is pericardiectomy recommended?

A

To prevent recurrence of cardiac tamponade and permit tissue analysis.

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51
Q

What should be done with the pericardium after pericardiectomy?

A

It should be submitted for histopathological review by an experienced anatomic pathologist.

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52
Q

What are some causes of pericardial effusions other than neoplastic or idiopathic?

A

Septic process, trauma, right-sided heart failure, or systemic inflammatory diseases.

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53
Q

What is neurocardiogenic syncope?

A

Neurocardiogenic syncope is a condition characterized by bradycardia and vasodilation.

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54
Q

What triggers the cardiac depressor reflex?

A

Excessive motion or high pressure within the ventricles can trigger the ventricular mechanoreceptors, activating the cardiac depressor reflex.

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55
Q

What are the functions of the pericardium?

A

The functions of the pericardium are unknown but may include protecting the heart from infection and providing mechanical protection.

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56
Q

What are the layers of the serous pericardium?

A

The layers of the serous pericardium are the parietal pericardium and the visceral pericardium.

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57
Q

What is the role of the pericardial space?

A

The pericardial space contains a small amount of fluid that lubricates the heart’s motion.

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58
Q

What are the possible causes of pericardial effusion?

A

Possible causes of pericardial effusion include idiopathic inflammation, neoplastic tumors, bacterial infection, and trauma.

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59
Q

When do we tend to re-check the echo in our clinic?

A

After 2-3 weeks

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60
Q

Why do we re-check the echo in our clinic?

A

To detect any dogs with transient pulmonary hypertension

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61
Q

What is an example of a condition that can cause transient pulmonary hypertension?

A

Acute pulmonary thromboembolism

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62
Q

How can AV reciprocating tachycardias be treated?

A

They can be treated medically or potentially cured via radiofrequency catheter ablation.

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63
Q

When should supraventricular tachycardias be treated?

A

If the heart rate is >180 bpm or if there are clinical signs.

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64
Q

What are some clinical signs that indicate the need to treat supraventricular tachycardias?

A

Hypotension, pulse deficits, right-sided CHF, or systolic dysfunction on echo.

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65
Q

What is the systolic blood pressure threshold that is concerning when considering treatment for supraventricular tachycardias?

A

If systolic BP is <100 mmHg.

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66
Q

What parameter should be monitored during treatment of supraventricular tachycardias?

A

The patient’s ECG.

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67
Q

What is the recommended dose and administration method of intravenous diltiazem for supraventricular tachycardias?

A

0.1-0.25 mg/kg boluses, repeat up to total 0.75 mg/kg. Can also follow with a CRI.

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68
Q

What are the potential toxicities of intravenous diltiazem?

A

Bradycardia, hypotension, and AV block.

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69
Q

How long does it take for oral doses of diltiazem to take effect?

A

60-90 minutes.

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70
Q

What is the administration method and dosage range of intravenous esmolol for supraventricular tachycardias?

A

0.05-0.5 mg/kg boluses, followed by a CRI. (I use 0.1-0.2 mg/kg)

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71
Q

What are the potential toxicities of intravenous esmolol?

A

Severe bradycardia, suppressive effect on systolic function leading to acute pulmonary edema (echo should be performed prior to use).

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72
Q

What is the recommended initial drug to administer for supraventricular tachycardias if no response is achieved through vagal maneuvers?

A

Diltiazem IV.

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73
Q

How can vagal maneuvers be performed to break the arrhythmia rhythm for a few beats?

A

By applying pressure to the eyes, carotid bodies, inducing a swallow or a gag.

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74
Q

What drug can be administered for reciprocating supraventricular tachycardias?

A

Lidocaine IV.

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75
Q

What are the risks associated with Sotalol in the treatment of supraventricular tachycardias?

A

Risk of congestive heart failure due to its beta blocker effect.

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76
Q

What is the risk associated with amiodarone IV in the treatment of supraventricular tachycardias?

A

Risk of anaphylaxis.

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77
Q

What is the recommended dosage range of oral diltiazem for supraventricular tachycardias?

A

1-2 mg/kg (10 mg tablets TID or 60 mg tablets BID).

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78
Q

What are the objectives in treating atrial fibrillation?

A

Heart rate control, rhythm control, and not necessarily restoration of sinus rhythm.

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79
Q

What medication can be used for heart rate control in atrial fibrillation?

A

Digoxin (3-5 mcg/kg PO BID).

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80
Q

What is the therapeutic index of digoxin?

A

Narrow.

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81
Q

What is the mechanism of action for digoxin?

A

Inhibits sodium/potassium ATPase by competing with K+ binding site.

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82
Q

What risk should be considered when administering digoxin to hypokalemic patients?

A

Risk of toxicity.

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83
Q

What is the effect of diltiazem on AV node conduction?

A

Reduced AV node conduction

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84
Q

How does reduced AV node conduction affect heart rate?

A

Reduces heart rate

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85
Q

What is the recommended dosage of diltiazem?

A

5mcg/kg BID

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86
Q

How should the tablet size be selected when prescribing diltiazem?

A

Use the tablet size below the calculated dose

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87
Q

When should the trough serum concentration of diltiazem be checked?

A

6-8 hours post pill

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88
Q

For how long into treatment should the trough serum concentration of diltiazem be checked?

A

5-7 days

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89
Q

What additional markers should be checked when monitoring diltiazem?

A

Renal markers and electrolytes

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90
Q

What should be done if a dog vomits after taking diltiazem?

A

Stop the medication

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91
Q

What is the target trough serum concentration of diltiazem?

A

1-1.2 nanograms/ml

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92
Q

What are some toxic signs of diltiazem?

A

Inappetence, GI signs, arrhythmias, kidney injury

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93
Q

What is the dosage range for amiodarone?

A

1-2mg/kg BID-TID

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94
Q

What are some side effects of amiodarone?

A

Idiosyncratic liver issues, GI signs

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95
Q

What is the dosage range for sotalol?

A

1-2mg/kg BID

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96
Q

What is the purpose of electrical cardioversion?

A

To reset the heart into a normal rhythm

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97
Q

What are the two methods of electrical cardioversion?

A

Trans thoracic and trans venous

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98
Q

What is an important consideration when selecting patients for electrical cardioversion?

A

Contraindicated in structural heart disease

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99
Q

What type of dogs are more likely to have lone atrial fibrillation?

A

Giant breed dogs

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100
Q

What is the success rate of cardioverting lone atrial fibrillation?

A

Relatively low

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101
Q

How should a patient be prepared for electrical cardioversion?

A

Anaesthetised, given opiates and muscle relaxants

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102
Q

What is the key factor in identifying if it is supraventricular tachycardia or atrial fibrillation?

A

Know whether to use a drug to return to sinus rhythm or to control heart rate

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103
Q

Do large breed dogs in atrial fibrillation require drugs?

A

Often, they do not

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104
Q

What are some signs of ventricular arrhythmias?

A

Irregular rhythms, pulse deficits, premature beats, runs of tachycardia

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105
Q

What can be seen on an ECG trace for isolated premature ventricular complexes?

A

Wide and bizarre complexes

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106
Q

What is an accelerated idioventricular rhythm?

A

Ventricular rhythm slightly faster than the sinus rhythm

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107
Q

What should be checked when encountering a ventricular idioventricular rhythm?

A

The whole dog, including neoplasia, sepsis, and painful abdomen

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108
Q

How many ventricular premature complexes in a row are considered ventricular tachycardia?

A

4 or more

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109
Q

What is the concern with ventricular tachycardia?

A

R-on-T phenomenon

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110
Q

What is the characteristic finding on an ECG trace for ventricular tachycardia?

A

Wide bizarre complexes with no baseline between them

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111
Q

What is the R-on-T phenomenon?

A

The R-on-T phenomenon is when the second complex comes straight off the T wave of the first complex.

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112
Q

What does the R-on-T phenomenon indicate in Boxer dogs with arrhythmias?

A

The R-on-T phenomenon indicates a significant risk of sudden death and the need for anti-arrhythmic drugs.

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113
Q

What does a triplet run of ventricular beats with R-on-T phenomenon indicate?

A

A triplet run with R-on-T phenomenon indicates an electrically unstable state and a precursor to ventricular fibrillation.

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114
Q

What does ventricular fibrillation appear as on the ECG trace?

A

Ventricular fibrillation appears as a random wave on the ECG trace.

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115
Q

When should ventricular tachyarrhythmias be treated?

A

Ventricular tachyarrhythmias should be treated when the heart rate is >180bpm, there is little baseline between the complexes, and R-on-T phenomenon is present.

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116
Q

What are the considerations when treating ventricular tachyarrhythmias?

A

Consider measuring systolic BP, monitoring ECG during and after drug administration, and assessing if the patient exhibits clinical signs, hypotension, or significant pulse deficits.

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117
Q

What is the recommended treatment for ventricular tachyarrhythmias?

A

The recommended treatment is intravenous lidocaine, with bolus doses of 2mg/kg repeated up to 3 times for a total of 8mg/kg.

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118
Q

What is the toxicity concern when using lidocaine?

A

Vomiting and nausea can indicate lidocaine toxicity, and treatment should be stopped if these symptoms occur.

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119
Q

What is the recommended administration after intravenous lidocaine for ventricular tachyarrhythmias?

A

After intravenous lidocaine, a continuous rate infusion (CRI) of 50-100mcg/kg/minute can be used, and the rate should be weaned off when adding an oral anti-arrhythmic.

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120
Q

What are some alternative treatments for ventricular tachyarrhythmias?

A

Some alternative treatments include quinidine, amiodarone, mexiletine, flecainide, and sotalol.

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121
Q

What is the recommended oral treatment for ventricular tachyarrhythmias when lidocaine is not effective?

A

Amiodarone and mexiletine can be used orally. Amiodarone may take 36-48 hours for the best effect, while mexiletine can cause gastrointestinal or neurological signs at high doses.

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122
Q

What are the non-pharmacologic therapies for treating ventricular tachyarrhythmias?

A

Non-pharmacologic therapies include pre-cordial thump and electrical cardioversion.

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123
Q

What is the purpose of a pre-cordial thump?

A

A pre-cordial thump is aimed at interrupting the arrhythmia, but there is a risk of R-on-T phenomenon if the timing is incorrect.

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124
Q

What is the indication for using electrical cardioversion?

A

Electrical cardioversion is indicated to convert the heart rhythm and requires the placement of pads on the patient.

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125
Q

What is the recommended quadruple therapy for treating congestive heart failure in dogs?

A

Furosemide, pimobendan, benazepril, and spironolactone

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126
Q

What is the mechanism of action for furosemide?

A

Loop diuretic, reducing reabsorption of Na, K, and Cl

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127
Q

What is the recommended starting oral dose for furosemide in dogs?

A

2 mg/kg, given every 12 hours

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128
Q

What is the mechanism of action for pimobendan?

A

PDE-3a inhibitor and arteriodilator

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129
Q

What is the recommended starting oral dose for pimobendan in dogs in stage D heart failure?

A

0.25 mg/kg, given every 12 hours

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130
Q

What is the mechanism of action for benazepril?

A

ACE-inhibitor, reducing vasoconstriction and acting as a mild diuretic

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131
Q

What is the recommended starting oral dose for benazepril in dogs?

A

0.25 mg/kg, given every 24 hours

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132
Q

What is the mechanism of action for spironolactone?

A

Aldosterone receptor antagonist

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133
Q

What is the recommended starting oral dose for spironolactone in dogs?

A

2 mg/kg, given every 24 hours with food

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134
Q

Is there a combination pill available for benazepril and spironolactone?

A

Yes, to minimize the number of tablets needing administration

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135
Q

Which combination pill is generally not recommended by cardiologists?

A

Pimobendan and benazepril in combination

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136
Q

What can be considered as minimum treatment if financial constraints limit medication use?

A

Furosemide and pimobendan

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137
Q

What term is used to describe the increasing requirement for furosemide over months of treatment?

A

Diuretic resistance

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138
Q

What is the recently licensed diuretic for veterinary use that can be administered once daily?

A

Torasemide

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139
Q

How did torasemide perform in a prospective trial compared to furosemide?

A

It was not shown to be superior to furosemide as a first line

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140
Q

When is torasemide typically used by cardiology specialists?

A

As a second-line ‘rescue’ drug for dogs with furosemide resistance

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141
Q

What is the WSAVA validation system used to assess in dogs with advanced heart disease?

A

Muscle condition score and body condition score

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142
Q

What was associated with a lower rate of cardiac cachexia and improved appetite in one trial?

A

Use of omega-3 fish oils (DHA/EPA mix)

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143
Q

What is the aim of a timed synchronised shock?

A

To ‘re-set’ sinus rhythm

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144
Q

Why is a timed synchronised shock delivered in time with the QRS complex?

A

To avoid the R-on-T phenomenon

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145
Q

What is the purpose of synchronising the electrical phase of all cells?

A

To stabilise the heart’s electrical activity

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146
Q

What are the clinical signs of right-sided heart failure in dogs with prolonged bradycardia?

A

Weakness, depression, lethargy

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147
Q

What is the significance of vagal tone in dogs?

A

Phasic variation of heart rate at rest

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148
Q

What happens to heart rate during inspiration in dogs?

A

Heart rate increases due to withdrawal of vagal tone

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149
Q

What effect does inspiration have on pacemaker currents within the sinoatrial node?

A

Increases heart rate

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150
Q

What happens to heart rate during expiration in dogs?

A

Heart rate decreases due to increase in vagal tone

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151
Q

What is meant by a slow and regular heart rate below 80 bpm?

A

It suggests a clinically significant bradyarrhythmia

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152
Q

How can you stimulate increased heart rate in a patient to confirm a bradyarrhythmia diagnosis?

A

By arousing the patient with a noise or movement

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153
Q

What is an escape rhythm in relation to bradyarrhythmias?

A

Slower pacemakers taking over when higher ones fail

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154
Q

What is a junctional escape rhythm?

A

When the heart escapes at the AV node

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155
Q

What is a ventricular escape rhythm?

A

When the heart’s escape focus is below the AV node

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156
Q

Which type of bradyarrhythmia is usually vagotonic?

A

Second Degree AV Block - Type I

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157
Q

What is the possible cause of sinus node dysfunction or sick sinus syndrome?

A

Failure of normal dominant pacemakers

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158
Q

What is sinus arrest?

A

A temporary cessation of sinus node activity

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159
Q

What are some possible causes of bradyarrhythmias in dogs?

A

AV node disease, primary heart disease, severe myocardial remodeling

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160
Q

What is the suggested treatment for hypoadrenocorticism causing bradyarrhythmias?

A

Treat hyperkalaemia

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161
Q

What type of disease can lead to upper respiratory tract obstruction resulting in bradyarrhythmias?

A

Severe gastrointestinal disease / intra-

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162
Q

When do we usually use digoxin?

A

If there is an AV node supraventricular arrhythmia, such as atrial fibrillation.

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163
Q

What are the five distinct phases of the ventricular action potential?

A

Phases 0-4.

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164
Q

Which ions are responsible for the predominant flux in the ventricular action potential?

A

Sodium and potassium.

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165
Q

How does the atrial action potential differ from the ventricular action potential?

A

It has little involvement of sodium channels and does not have a calcium-induced plateau.

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166
Q

Which ions mediate the atrial action potential?

A

Potassium and calcium.

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167
Q

Which part of the heart does the parasympathetic nervous system strongly innervate?

A

The sino-atrial node (SAN) and atrio-ventricular node (AVN).

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168
Q

What effect does activation of the parasympathetic nervous system have on the heart rate?

A

It slows the heart rate.

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169
Q

Is there parasympathetic innervation in the ventricles?

A

Hardly any.

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170
Q

What effect does activation of the sympathetic nervous system have on the heart?

A

It reduces the parasympathetic influence at the SAN and AVN, and increases the speed of conduction, contractility, and heart rate.

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171
Q

How can knowledge of the action potential and innervation of the heart help in selecting the appropriate anti-arrhythmic drug?

A

It helps in understanding which anti-arrhythmic drug is appropriate.

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172
Q

What classes of drugs can be used for a supraventricular arrhythmia?

A

Class IV (Calcium channel blocker), class III (potassium channel blocker), or class II (beta blocker).

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173
Q

Why is making an ECG diagnosis of the abnormal heart rhythm important before considering treatment with anti-arrhythmic medication?

A

Because antiarrhythmic drugs can be potentially dangerous and pro-arrhythmic.

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174
Q

What symptoms may dogs with a sudden onset of tachyarrhythmia at exercise present with?

A

A history of syncope.

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175
Q

What symptoms may dogs with more prolonged tachyarrhythmias like supraventricular tachycardia present with?

A

Weakness, depression, lethargy, and clinical signs of right-sided heart failure such as ascites.

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176
Q

What are the four mechanisms of cardiac arrhythmia generation?

A

Enhanced normal automaticity, abnormal automaticity, re-entrant circuits, and blocks.

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177
Q

What happens to cardiac filling when there is a higher heart rate?

A

It reduces because there is less time in diastole.

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178
Q

What problems can irregular contractions like atrial fibrillation or ventricular beats cause?

A

Reduction in cardiac output.

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179
Q

What can ventricular ectopy lead to?

A

Ventricular fibrillation.

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180
Q

What are the types of tachyarrhythmia?

A

Supraventricular and ventricular.

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181
Q

What dose of furosemide is recommended for cats?

A

3mg/kg BID

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182
Q

When should owners contact their vets regarding furosemide treatment?

A

If it is acutely >40

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183
Q

What should owners do if there is no improvement after giving an extra dose of furosemide?

A

They should see the vets as an emergency

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184
Q

When should owners contact their vets if a response is seen after giving an extra dose of furosemide?

A

The following day for advice

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185
Q

What tests are recommended after 5-7 days of diuretic therapy?

A

Renal biochemistry profile, PCV, and TS

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186
Q

What raises more concern in cats with chronic furosemide therapy?

A

Increased creatinine

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187
Q

When should blood work be checked in cats with chronic furosemide therapy?

A

When there are increases in diuretic treatment or signs of lethargy and/or anorexia

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188
Q

Do cats with heart failure and on treatment need routine re-examination?

A

No, as long as they remain free of clinical signs and well at home

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189
Q

What is a good way to assess diuretic requirements in cats with heart failure?

A

Owner monitored respiratory rate

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190
Q

When should spironolactone be added to furosemide treatment?

A

If 1-2 dose increases of furosemide are made

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191
Q

What is the recommended dose of spironolactone to be added to furosemide?

A

2mg/kg PO SID

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192
Q

What can be considered when furosemide requirements exceed 8-10mg/kg/day?

A

Torasemide or hydrochlorothiazide

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193
Q

What should be done before using pimobendan in cats with poor response to treatment?

A

Get off-label consent forms signed by owners

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194
Q

What treatment was compared in the FAT CAT study for arterial thromboembolism?

A

Clopidogrel and aspirin

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195
Q

What were the cats that participated in the FAT CAT study at risk of?

A

Arterial thromboembolism (ATE)

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196
Q

How often was clopidogrel or aspirin administered in the FAT CAT study?

A

18.75mg once daily

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197
Q

What was the purpose of the study on Dobermans?

A

To evaluate the effects of pimobendan on occult DCM in dogs.

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198
Q

What is a composite end-point in a study?

A

An endpoint that includes multiple outcomes, such as death due to heart disease or clinical signs of heart failure.

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199
Q

Why is it important to consider a composite end-point when designing studies?

A

To avoid missing important information and not just focus on one outcome, like heart failure signs.

200
Q

What were the findings of the PROTECT trial regarding pimobendan?

A

Pimobendan significantly prolonged time to the development of heart failure signs and didn’t increase sudden death or arrhythmias.

201
Q

What is the main benefit of pimobendan in improving prognosis?

A

Making the left ventricle significantly smaller after 8 weeks of treatment.

202
Q

Why was the study conducted only on Dobermans?

A

Due to the high prevalence of DCM in this breed and its predictable nature.

203
Q

Why might the findings of the studies on Dobermans not apply to other breeds?

A

Different breeds may have different forms of DCM with varying responses to treatment.

204
Q

What is the potential effect of pimobendan on Irish Wolfhounds with pre-clinical DCM?

A

It may prolong symptom-free survival, as supported by a recent retrospective study.

205
Q

What were the first two trials that evaluated ACE-inhibitors in pre-clinical heart disease?

A

SVEP (2002) and VETPROOF (2007) studies.

206
Q

What did the SVEP and VETPROOF studies conclude about enalapril?

A

They didn’t provide evidence of a clinically significant benefit of enalapril.

207
Q

What trial evaluated pre-clinical treatment using pimobendan in dogs with stage B2 MVD?

A

The EPIC trial conducted by Boswood et al in 2016.

208
Q

What were the findings of the EPIC trial regarding pimobendan?

A

Pimobendan significantly prolonged time to the end-point and improved the quality of life in dogs with stage B2 MVD.

209
Q

What is the purpose of a validated owner scoring system?

A

To assess the quality of life and overall well-being of dogs in clinical trials.

210
Q

What are the potential effects of pimobendan on dogs with pre-clinical DCM?

A

Delaying heart failure signs and improving prognosis by reducing the size of the left ventricle.

211
Q

What is the more commonly used ACE-inhibitor in recent years for MVD?

A

Benazepril.

212
Q

Have any studies specifically evaluated benazepril?

A

No, but there is no reason to believe it would work differently than enalapril.

213
Q

What is the difference between supraventricular and ventricular beats?

A

Supraventricular beats have a P wave followed by QRS and T waves, while ventricular beats do not have a preceding P wave.

214
Q

What are the broad classifications of supraventricular beats based on regularity?

A

Regular rhythms - supraventricular tachyarrhythmias or atrial flutter; irregular rhythms - sinus rhythm with frequent atrial premature complexes or atrial fibrillation.

215
Q

How can ventricular beats be classified based on regularity?

A

Regular rhythms are ventricular tachycardia or accelerated idioventricular rhythm; irregular rhythms usually involve sinus rhythm with ventricular premature complexes or runs of ventricular tachycardia.

216
Q

What is an atrial premature complex (APC)?

A

APC is an early beat in the atrium characterized by a slightly different morphology and shorter duration compared to other sinus beats.

217
Q

What can APCs indicate in dogs?

A

APCs can indicate atrial dilation, atrial disease, or high catecholamine levels in stressed dogs.

218
Q

What is focal atrial tachycardia?

A

Focal atrial tachycardia is a rapid rhythm caused by an abnormal automaticity within the atrial cells.

219
Q

How does the P wave differ in focal atrial tachycardia?

A

In focal atrial tachycardia, the P wave may be negative in lead II, indicating the focus is either in the left atrium or low down within the right atrium.

220
Q

What does an ECG trace of atrial flutter look like?

A

The baseline of an ECG trace for atrial flutter has a sawtooth appearance and a fast atrial rate.

221
Q

What is the most common cause of atrial flutter?

A

Atrial flutter is usually caused by a circuit forming that passes around the right atrium.

222
Q

How does atrial fibrillation differ from atrial flutter?

A

Atrial fibrillation is irregular, while atrial flutter is regular. Atrial fibrillation also has a highly irregular fibrillatory baseline.

223
Q

What happens within the atrium during atrial fibrillation?

A

In atrial fibrillation, there are numerous circuits of electrical activity across both atria, resulting in tiny fibrillatory waves on the baseline.

224
Q

Why are P waves not discernible in atrial fibrillation ECG?

A

P waves are not discernible in atrial fibrillation because it is not a normal sinus rhythm and there are no normal currents from the sino-atrial node.

225
Q

How is AV reciprocating tachycardia characterized?

A

AV reciprocating tachycardia is characterized by a sudden switch between a very high heart rate (around 300 bpm) and normal sinus rhythm.

226
Q

What is the appearance of the first beat following AV reciprocating tachycardia?

A

The first beat following AV reciprocating tachycardia may look a little strange as the heart is recovering before normal sinus rhythm resumes.

227
Q

What can be prescribed at an appropriate dose rate prior to overt cachexia?

A

Omega-3s

228
Q

What is a common complication of longstanding left-sided heart failure?

A

Pulmonary hypertension

229
Q

What is the treatment used at 2 mg/kg q8-12h for dogs with pulmonary hypertension?

A

Sildenafil

230
Q

What is considered the treatment of choice for mitral valve disease in Japan?

A

Mitral valve repair

231
Q

What is the survival rate of dogs after mitral valve surgery with little or no long-term medication?

A

Extremely high 3-year survival rate

232
Q

What is the pathophysiology of heart failure in cats?

A

Diastolic failure

233
Q

How do cats with cardiogenic shock typically present?

A

Bradycardic, hypothermic, and hypotensive

234
Q

What is a concern when administering diuretic drugs to cats with heart failure?

A

Worsening of hypoperfusion

235
Q

Why are cats difficult to manage in acute heart failure?

A

Predisposition to stress-induced decompensation and sensitivity to diuretics

236
Q

What are some complications that can occur in cats with acute heart failure?

A

Hypokalemia and peripheral dehydration

237
Q

What is crucial for success in managing feline heart failure?

A

Sedation and minimal handling

238
Q

What is the recommended initial dose of furosemide for cats with acute heart failure?

A

2mg/kg as a bolus

239
Q

What can cause vagal tone?

A

Abdominal lesion, CNS lesion, intracranial mass, mediastinal mass, opiates

240
Q

Which drug can reverse vagolytic drugs?

A

Naloxone

241
Q

Name a drug that can reduce vagal tone.

A

Glycopyrrolate

242
Q

What is the treatment for paradoxical bradycardia?

A

No specific treatment

243
Q

Which AV block requires ongoing treatment?

A

Third degree AV block

244
Q

In which conditions is medical treatment of bradycardia often unsuccessful?

A

Primary cardiac conduction system disorders

245
Q

What are the drugs used for medical management of bradycardia?

A

Atropine, glycopyrrolate, theophylline, propentophylline, terbutaline

246
Q

What is the definitive treatment for primary bradyarrhythmias?

A

Permanent pacemaker implantation

247
Q

What is the position of the pacemaker pulse generator in dogs?

A

In the neck region

248
Q

What are the long-term rules for dogs with pacemakers?

A

MRI safety, no jugular samples, no neck leads, echocardiographic monitoring

249
Q

What should be done before cremation in dogs with pacemakers?

A

Remove the pacemaker

250
Q

How long should SNP be used for?

A

SNP should be used for 24 hours.

251
Q

What happens after 24 hours of SNP use?

A

After 24 hours, SNP can lead to secondary formation of cyanide.

252
Q

How should SNP be diluted?

A

SNP should be diluted with 5% dextrose saline (D5W).

253
Q

How should SNP be protected?

A

SNP should be protected from light.

254
Q

What is the initial infusion rate for SNP?

A

The initial infusion rate for SNP is 1mcg/kg/min.

255
Q

How should BP be checked after starting SNP?

A

BP should be checked after 3-5 minutes using an indirect Doppler method.

256
Q

What is the target blood pressure with SNP?

A

The target blood pressure is 80mmHg.

257
Q

What should be done if BP is >100mmHg with SNP?

A

The SNP rate should be increased to 2mcg/kg/min and BP checked again.

258
Q

How should SNP be weaned off?

A

SNP rate should be reduced by 30-50% of dose rate for 1-2 hours, then reduced further in a similar manner.

259
Q

What other drugs can be used if SNP is not available?

A

Amlodipine or hydralazine can be used as oral anti-hypertensive drugs.

260
Q

What should be avoided when using hydralazine?

A

Hydralazine should not be used in combination with ACE-inhibitors.

261
Q

What alternative drug can be used if SNP cannot be stopped?

A

Amlodipine can be used as an alternative, as it does not need to be titrated or stopped.

262
Q

What drug can be used in addition to SNP in patients with no improvement?

A

Dobutamine can be used to improve cardiac output.

263
Q

What should be monitored when using dobutamine?

A

The ECG should be continuously monitored.

264
Q

What can happen at higher doses of dobutamine?

A

Neurological signs such as seizures can occur at higher doses of dobutamine.

265
Q

What is the first lesson of this module about?

A

Treatment of heart failure in dogs

266
Q

Why is treatment in the preclinical phase important in dogs with heart disease?

A

It can have a positive impact on animal welfare and prolong the time before the onset of clinical signs.

267
Q

What is the abbreviation for dilated cardiomyopathy?

A

DCM

268
Q

What was the main objective of the trial by O’Grady et al?

A

To investigate whether benazepril treatment could delay the onset of heart failure signs in Dobermans with occult DCM.

269
Q

Was the trial by O’Grady et al a prospective, blinded, placebo-controlled trial?

A

No, it was a retrospective trial.

270
Q

What was the average time to onset of clinical signs of heart failure in Dobermans prescribed benazepril?

A

It was longer compared to those who were not prescribed benazepril.

271
Q

What is the name of the second key paper mentioned in the course notes?

A

The PROTECT trial

272
Q

What should be administered instead of parenteral doses for respiratory rate reduction?

A

Oral furosemide

273
Q

What can be used to confirm cardiac disease in cats?

A

Thoracic ultrasound

274
Q

What are the hyperechoic lines seen on ultrasound that suggest increased lung water content?

A

B-lines or comet tails

275
Q

What should be considered for cats with pulmonary edema and hypotension?

A

Dobutamine

276
Q

What should not be administered in cats with left ventricular outflow tract obstruction?

A

Positive inotropes like dobutamine

277
Q

What can be considered instead of dobutamine for cats with left ventricular outflow tract obstruction?

A

Pimobendan

278
Q

What is a round number starting dose of the liquid formulation of furosemide for a 4kg cat?

A

1ml

279
Q

What is crucial for heart failure management in cats?

A

Environmental control

280
Q

How long do most cats with heart failure live with a good quality of life?

A

9-12 months

281
Q

When should cats with heart failure be discharged?

A

As soon as possible

282
Q

Why is hospitalization stressful for cats with heart failure?

A

The stress of hospitalization leads to persistent heart failure and a poor response to therapy.

283
Q

What is the recommended medication for cats with hypokalemia?

A

Spironolactone can be introduced to help limit the loss of potassium.

284
Q

What medications are cats discharged on for heart failure?

A

Cats are discharged on furosemide and clopidogrel.

285
Q

Why are ACE-inhibitors not commonly used in cats with heart failure?

A

Evidence is lacking for their benefit and additional medication may not be helpful.

286
Q

What limitations were found in the study on ACE-inhibitors in cats?

A

The cats included were not well-defined and had varying conditions.

287
Q

Is there clear evidence of a benefit of ACE-inhibitors in cats with heart failure?

A

No clear evidence suggests a benefit, so caution is needed in their use.

288
Q

What did the SEISICAT study suggest about spironolactone for cats with cardiomyopathy?

A

The study found no survival benefit but suggested it might help.

289
Q

Why were the groups uneven in the spironolactone study?

A

Randomization or initial differences in heart disease severity led to uneven groups.

290
Q

What is the recommended respiratory rate for cats with well-controlled heart failure?

A

Respiratory rate should be below 30 breaths/minute.

291
Q

What should owners do if the respiratory rate of their cat increases?

A

Owners should increase furosemide and contact the veterinarian.

292
Q

What is the criteria for enrolment in the EPIC trial?

A

Stage B2 MVD based on the most recent consensus statement (2019)

293
Q

What is the name of the trial that considered preclinical treatment of MVD in dogs?

A

DELAY study

294
Q

What were the key findings of the DELAY study?

A

No significant difference in time to the onset of clinical signs of heart failure and no significant differences in quality of life measures between groups

295
Q

Which treatment has shown benefit in dogs with pre-clinical heart disease?

A

Pimobendan

296
Q

What are the four main categories of cardiac patients in terms of tissue perfusion and oedema?

A

Warm and dry, warm and wet, cold and dry, cold and wet

297
Q

What is the initial treatment for dogs with pulmonary oedema and no low-output signs?

A

Diuretics and oxygen therapy

298
Q

What is the aim of treating a dog with MVD and persistent pulmonary oedema?

A

To reduce left atrial pressure

299
Q

What is the first-choice drug to reduce afterload and increase forward flow in dogs with persistent pulmonary oedema?

A

Sodium nitroprusside

300
Q

What is the average interval of ATE recurrence in cats receiving clopidogrel?

A

192 days

301
Q

What is the standard of care for cats with heart disease at risk of ATE?

A

Clopidogrel

302
Q

Why is the use of pimobendan contraindicated in hypertrophic cardiomyopathy (HCM)?

A

Potential worsening of outflow tract obstruction

303
Q

What does the study on pimobendan in cats with HCM suggest about its safety?

A

Possibly safer than initially thought for cats with outflow tract obstruction

304
Q

What is the potential benefit of pimobendan in cats with heart failure caused by HCM?

A

Increase in survival time

305
Q

What is the main action of Digoxin as an anti-arrhythmic drug?

A

Exerts action mainly at the AV node

306
Q

What are the statistics for survival to 1 year of age for PDA cases?

A

50% chance they will survive to 1 year of age

307
Q

What is the chance of heart failure occurring if left untreated in PDA cases?

A

In 95-99% of cases heart failure will occur if left untreated

308
Q

Which breeds have a predisposition to PDAs?

A

GSDs, Newfoundlands, Maltese terriers, Chihuahuas, CKCS, Pomeranian, Poodle, Dobermans, Irish Setters, non-pedigree dogs

309
Q

Where should you auscultate for a PDA?

A

Above the heart base, dorsal to the heart base and cranial behind the triceps muscles

310
Q

What is the most common grade for PDAs?

A

Most are grade V/VI

311
Q

Describe the murmur of a small PDA.

A

Very focal if a small PDA is present

312
Q

Which type of congenital heart defect is most common in cats and 4th most common in dogs?

A

Ventricular septal defects

313
Q

What can be said about the clinical presentation of VSDs?

A

VSDs are often clinically silent but have a loud murmur (often on the right-hand side)

314
Q

What is interventional cardiology?

A

Cardiac surgery approached through access to peripheral blood vessels

315
Q

What can be used to open up stenotic areas in interventional cardiology?

A

Stents

316
Q

What can be used to close a PDA in interventional cardiology?

A

Coils

317
Q

What can be used to close PDAs in interventional cardiology?

A

Amplatz ductal occluders

318
Q

What can be used to balloon dilate pulmonic and aortic stenoses in interventional cardiology?

A

Balloons

319
Q

What are the advantages of interventional procedures in cardiology?

A

Less peri-operative pain, lower risk of haemorrhage and wound infection, shorter hospitalization period, fewer unexpected costs

320
Q

Describe the procedure of balloon valvuloplasty for pulmonic stenosis intervention.

A

Passing a guide wire down the jugular vein, through the right atrium, tricuspid valve, right ventricle, stenotic pulmonic valve, and a branch of a pulmonary artery

321
Q

For which patients is balloon valvuloplasty not suitable in pulmonic stenosis intervention?

A

Patients with an aberrant right coronary artery

322
Q

What is a novel procedure that is suitable for hypoplastic arteries or severe pulmonic stenosis with an aberrant right coronary artery?

A

Pulmonic stent procedures

323
Q

What is the palliative treatment for aortic stenosis cases?

A

Balloon valvuloplasty

324
Q

For which dogs do we reserve the procedure of balloon valvuloplasty in aortic stenosis intervention?

A

Dogs with clinical signs that do not respond to medical treatment with a beta blocker

325
Q

What is the outcome for patients if a PDA is successfully fixed?

A

They will usually go on to live a normal life

326
Q

What is the occlusion rate of the Amplatz canine ductal occlude (ACDO)?

A

98% complete occlusion

327
Q

What is the occlusion rate of the vascular plug compared to the ACDO device?

A

Seemingly as good as an ACDO

328
Q

What is the occlusion rate of the thrombogenic coil?

A

Approximately 75% complete occlusion rate

329
Q

What are some complications of PDA interventions?

A

Device embolization, hemorrhage from vascular access, bradycardia after PDA closure

330
Q

What is the Branhams reflex in relation to PDA closure?

A

Bradycardia caused by increased diastolic pressure

331
Q

What are the learning objectives for this module?

A

Identify suitable dogs for endocarditis, use modified Duke criteria, treatment plan, myocarditis and its causes in dogs, congenital heart disease in juvenile dogs and cats, common congenital disorders in dogs, cardiac effects of hypertension, anaemia, and sepsis, endocrine diseases affecting the heart, evidence base on secondary cardiac changes, taurine deficiency causing dilated cardiomyopathy.

332
Q

How is endocarditis defined by pathologists?

A

Inflammation of the endocardium, the lining of the heart’s chambers and valves.

333
Q

What is the most common cause of endocarditis?

A

Bacterial infection, most commonly Staphylococcus and Streptococcus species.

334
Q

Are fungal infections a common cause of endocarditis in Europe?

A

No, fungal infections are unreported in Europe.

335
Q

What is the pathophysiology of endocarditis in companion animals?

A

Left-heart valve lesions, with about 50% affecting the mitral valve and 50% affecting the aortic valve.

336
Q

What is the pathophysiology of endocarditis in production animals?

A

Right-heart valve lesions, mainly affecting the tricuspid valve.

337
Q

What is the association between endocarditis and birth in production animals?

A

Maternal cases due to poor hygiene causing endometritis or immunosuppression during the periparturient period, or poor naval hygiene affecting the infant.

338
Q

Are dental disease or recent dental work associated with developing endocarditis?

A

No, dental disease or recent dental work is not associated with endocarditis.

339
Q

What are some predisposing factors for endocarditis in dogs?

A

Immunosuppressive drugs, previous diagnosis of sub-aortic stenosis, or a septic process elsewhere.

340
Q

What is the association between tricuspid endocarditis and liver abscesses in cattle?

A

There is an anecdotal association between tricuspid endocarditis and liver abscesses in cattle.

341
Q

What is the potential causative bacteria in endocarditis case reports from the USA?

A

Bartonella species.

342
Q

What is the potential source of soil commensals involved in endocarditis?

A

Contaminated wounds or a migrating foreign body.

343
Q

What is the main focus of the modified Duke criteria for the diagnosis of endocarditis?

A

Identifying infections involving the heart’s endocardium and valves.

344
Q

What should be considered when diagnosing endocarditis in dogs?

A

Suitable patient selection, appropriate testing, and application of modified Duke criteria.

345
Q

What should be considered when treating dogs with confirmed endocarditis?

A

Developing a treatment plan specific to the patient.

346
Q

What can cause myocarditis?

A

Various factors such as infections, autoimmune diseases, toxins, and drugs.

347
Q

When should myocarditis be considered in a dog?

A

When a dog in the clinic shows signs suggestive of heart muscle inflammation.

348
Q

What tests may be helpful in identifying cases of myocarditis?

A

Cardiac biomarkers, electrocardiography, echocardiography, and histopathology.

349
Q

When should congenital heart disease be suspected in juvenile dogs and cats?

A

When they show signs of heart-related problems at a young age.

350
Q

What are the common congenital disorders in dogs?

A

Examples include patent ductus arteriosus, pulmonic stenosis, and subaortic stenosis.

351
Q

Which patients with congenital heart disease are appropriate candidates for treatment?

A

Those with significant clinical signs or complications.

352
Q

Why is referral for cardiologic assessment beneficial in dogs with congenital heart disease?

A

To determine the best treatment options and improve outcomes.

353
Q

What are the cardiac effects of systemic hypertension, anaemia, and sepsis?

A

They can cause secondary changes in the heart.

354
Q

How can endocrine diseases affect the heart in cats and dogs?

A

They can lead to various cardiac abnormalities.

355
Q

What is the discussion about taurine deficiency and dilated cardiomyopathy?

A

Taurine deficiency has been implicated as a potential cause of dilated cardiomyopathy.

356
Q

What effect does systemic hypertension have on the heart?

A

Systemic hypertension causes an increase in afterload on the left ventricle.

357
Q

Is left ventricular hypertrophy a consistent finding in hypertensive individuals?

A

Left ventricular hypertrophy is not a consistent finding in hypertensive people.

358
Q

What is the expected degree of left ventricular hypertrophy in cats with systemic hypertension?

A

Mild (6-7mm) and symmetrical left ventricular hypertrophy is expected in cats with systemic hypertension.

359
Q

What are the possible cardiac lesions in a cat with left ventricular hypertrophy and systolic anterior motion?

A

The cat may have primary myocardial disease (e.g. HCM) alongside peripheral vascular disease.

360
Q

How does acute anemia affect the left ventricle?

A

Acute anemia may cause a hyperkinetic appearing left ventricle due to altered systemic vascular resistance and blood viscosity.

361
Q

What can echocardiography show in patients with acute blood loss or extreme dehydration?

A

Echocardiography may show reduced cardiac chamber volumes due to acute depletion of circulating volume.

362
Q

What happens to blood pressure when blood haemoglobin content reduces?

A

When blood haemoglobin content reduces, there is more free nitric oxide in circulation which causes vasodilation and a drop in mean blood pressure.

363
Q

What is the effect of chronic, moderate to severe anemia on the cardiac chambers?

A

Chronic, moderate to severe anemia may lead to increased circulating volume and eccentric hypertrophy of the cardiac chambers.

364
Q

What is the term for ventricular dilation caused by chronic anemia?

A

4-chamber dilation is the term used to describe ventricular dilation caused by chronic anemia.

365
Q

What are the patients at highest risk of heart failure in cases of anemia?

A

Patients with a gallop sound are at the highest risk of heart failure in cases of anemia.

366
Q

What cardiac dysfunction has been identified in septic dogs?

A

Systolic dysfunction has been identified in septic dogs.

367
Q

What are the possible causes of systolic dysfunction in septic dogs?

A

Systolic dysfunction in septic dogs may relate to the negative inotropic effects of circulating inflammatory mediators.

368
Q

What is a phaeochromocytoma in dogs?

A

A phaeochromocytoma in dogs is an uncommon adrenal neoplasm causing unpredictable and episodic neurohormonal surges.

369
Q

What is the specific cardiomyopathy associated with phaeochromocytomas in humans?

A

In humans, specific catecholamine-induced cardiomyopathy is known as ‘Takotsubo Cardiomyopathy’.

370
Q

What is the shape assumed by the left ventricle in Takotsubo Cardiomyopathy?

A

The left ventricle assumes a shape said to mimic a Japanese octopus catching pot.

371
Q

Why should carefully monitored and serial CRP measurements be used over the antibiotic course?

A

They may allow early detection of recrudescence of bacterial endocarditis.

372
Q

What is a relatively common occurrence in treated cases of bacterial endocarditis?

A

Embolisation of fragments of an endocarditis lesion.

373
Q

What are the potential effects of micro-embolisation in dogs?

A

It may affect their vision, behaviour, or sense of smell in a relatively minor way.

374
Q

What can a more dramatic embolization event in bacterial endocarditis result in?

A

Seizures, acute organ damage (e.g. acute kidney injury), or loss of use of a limb.

375
Q

How can owners be prepared for a potentially fatal embolization event in bacterial endocarditis?

A

By being made aware of the event’s potential from the outset.

376
Q

What is myocarditis?

A

Inflammation of the myocardium.

377
Q

What are the possible causes of myocarditis?

A

Bacteria, protozoa, fungi, viruses, or toxins.

378
Q

What is a common immune-mediated cause of myocarditis in humans?

A

Sarcoidosis.

379
Q

What is commonly observed in both cats and dogs with cardiomyopathy?

A

A small amount of inflammatory infiltrate, likely secondary to necrosis.

380
Q

Which disease has been associated with Bartonella-associated myocarditis in cats?

A

Endomyocardial fibroelastosis.

381
Q

What viral infections have been associated with viral myocarditis in cats and dogs?

A

FIV and FeLV in cats, Toxoplasma and Neospora species in dogs.

382
Q

Which disease is well-documented for causing myocarditis in both dogs and humans in the Southern USA?

A

Chagas disease (Trypanosoma cruzii infection).

383
Q

How is myocarditis diagnosed?

A

By biopsies of the myocardium using forceps passed through the right atrium and into the right ventricle.

384
Q

What criteria are used to diagnose myocarditis in humans?

A

The Dallas criteria, involving the presence of inflammatory cells and necrosis in one histopathology section.

385
Q

What are the challenges in diagnosing myocarditis in veterinary patients?

A

Limited published information, presumptive diagnosis based on cTnI, and lack of case reports or histopathology/PCR studies.

386
Q

What is insufficient to make a diagnosis of myocarditis?

A

Detection of positive infectious disease titres in blood.

387
Q

What additional samples are ideal for confirming myocarditis?

A

Tissue samples, along with blood samples, to detect an organism in the myocardium.

388
Q

What can complicate catheterisation of the pulmonary artery?

A

Subvalvular stenosis

389
Q

What may increase procedural risks during a balloon valvuloplasty?

A

Subvalvular stenosis

390
Q

What are the concurrent congenital heart diseases that echocardiography may detect?

A

Tricuspid dysplasia or patent ductus arteriosus

391
Q

What radiographic findings may hint at the presence of pulmonic stenosis?

A

Right ventricular enlargement, bump in the region of the pulmonary artery, hypovascular appearing lung fields

392
Q

What is the treatment of patients with valve leaflet fusion?

A

Pulmonic balloon valvuloplasty

393
Q

What is the success rate of pulmonic balloon valvuloplasty in patients with valve leaflet fusion?

A

Higher

394
Q

What is the recommended treatment for dogs with severe pulmonic stenosis or clinical signs?

A

Beta-blockers or intervention/surgery

395
Q

What might dogs with severe pulmonic stenosis eventually develop?

A

Right ventricular failure due to chronic pressure overload of the right ventricle

396
Q

What are the pressure gradient levels for classification of pulmonic stenosis?

A

Mild (<50mmHg), moderate (50-80mmHg), severe (>80mmHg)

397
Q

What may pulmonic stenosis be associated with in some breeds?

A

Coronary artery anomalies

398
Q

What is the classification of aortic stenosis performed according to?

A

Lesion location

399
Q

What is the most common location for aortic stenosis?

A

Sub-aortic region (subaortic stenosis, SAS)

400
Q

What develops in the left ventricular outflow tract in sub-aortic region?

A

Fibrous tissue

401
Q

What is the severity range of sub-aortic stenosis pathology?

A

Small nodules to fibrous ring or tunnel-like lesion

402
Q

Is sub-aortic stenosis a congenital or acquired disease?

A

Acquired disease

403
Q

What is valvular aortic stenosis characterized by?

A

Valve leaflet fusion narrowing the aortic valve orifice

404
Q

What is the prognosis based on for aortic stenosis?

A

Severity of the pressure gradient

405
Q

What is the treatment for dogs with severe aortic stenosis or clinical signs?

A

Beta-blockers or intervention/surgery

406
Q

What do both forms of aortic stenosis cause?

A

Fixed stenosis, limiting maximal stroke volume, leading to left ventricular pressure overload, and concentric hypertrophy

407
Q

What are the consequences of left ventricle hypertrophy?

A

Increased myocardial oxygen demand, relative ischemia, fibrosis, substrate for arrhythmias.

408
Q

What are the potential outcomes for untreated dogs with severe aortic stenosis?

A

Sudden death, ventricular arrhythmias, left ventricular failure, pulmonary edema.

409
Q

Can cats also have sub-valvular and valvular aortic stenosis?

A

Yes, cats can also be affected by aortic stenosis.

410
Q

What is the treatment option for dogs with severe SAS and ongoing clinical signs?

A

Cutting balloon procedure and high-pressure valvuloplasty.

411
Q

Is the cutting balloon procedure a cure for severe SAS?

A

No, it is considered a palliative procedure rather than a cure.

412
Q

What is Patent Ductus Arteriosus (PDA)?

A

Failure of ductus arteriosus to close, leading to continuous blood flow between systemic circulation and pulmonary vasculature.

413
Q

Which gender of dogs is more likely to be affected by PDA?

A

Female dogs are three times as likely to be affected as males.

414
Q

What are the consequences of PDA?

A

Left sided heart failure, increased mortality, left heart overload.

415
Q

What is the recommended treatment for small PDAs?

A

Occlusion is almost always recommended for effective prevention of clinical signs.

416
Q

Do most dogs require long-term care from a cardiologist after successful closure of PDA?

A

No, most dogs can be considered ‘cured’ after successful closure.

417
Q

What causes ventricular septal defects (VSDs)?

A

Failure of interventricular septum to completely fuse during cardiogenesis.

418
Q

Where are murmurs associated with VSDs located?

A

Right hemithorax, often radiating cranio-ventrally from the right apex.

419
Q

What other congenital malformations can be associated with VSDs?

A

Pulmonic stenosis, aortic stenosis, patent ductus arteriosus.

420
Q

Are small VSDs associated with a good long-term prognosis?

A

Yes, if they resist flow and maintain normal interventricular pressure difference.

421
Q

What are the complications of larger VSDs?

A

Reduced pressure gradient, reversal of flow, pulmonary hypertension.

422
Q

What type of cardiac remodeling is expected with a large VSD?

A

Left atrial and ventricular volume loading.

423
Q

What are the most common congenital heart diseases in dogs?

A

Pulmonic stenosis, subaortic stenosis, and patent ductus arteriosus.

424
Q

Which dog breeds are predisposed to pulmonic stenosis?

A

French Bulldog, Boxer, English Bulldog, Chihuahua, West Highland White Terrier, and Cocker Spaniel.

425
Q

What are the clinical signs of pulmonic stenosis in dogs?

A

Heart murmur, exercise intolerance, syncope, ventricular arrhythmias, and right-sided congestive heart failure.

426
Q

What are the types of pulmonic stenosis?

A

Valvular, sub-valvular (infundibular), and supra-valvular (limited to French Bulldogs).

427
Q

Which dog breeds are predisposed to aortic stenosis?

A

Dogue de Bordeaux, Boxer, Newfoundland, Rottweiler, Golden Retriever, and German Shepherd Dog.

428
Q

What are the clinical signs of aortic stenosis?

A

Heart murmur, exercise intolerance, syncope, ventricular arrhythmias, and left-sided congestive heart failure.

429
Q

What are the types of aortic stenosis?

A

Sub-valvular aortic stenosis and valvular stenosis.

430
Q

How can the severity of sub-aortic stenosis be determined?

A

Clinical signs, left ventricular hypertrophy, sub-endocardial ischaemia, ventricular arrhythmias, and trans-valvular pressure gradient.

431
Q

What is patent ductus arteriosus (PDA) in dogs?

A

A shunt vessel between the aorta and the main pulmonary artery, resulting in a left to right blood flow.

432
Q

What are the consequences of patent ductus arteriosus (PDA) in dogs?

A

Volume overload on the left side of the heart, leading to heart remodeling and congestive heart failure.

433
Q

What is the reported association between L-carnitine deficiency and cardiomyopathy in dogs?

A

L-carnitine deficiency is associated with cardiomyopathy in dogs.

434
Q

What is the potential effect of high legume content in grain free diets?

A

High legume content may cause changes to bile acid metabolism.

435
Q

What are the minor criteria for a definitive diagnosis of endocarditis?

A

Unexplained fever, medium to large breed dog (>15kg), predisposing heart disease, thromboembolic disease signs, immune-mediated disease signs, positive blood culture not meeting major criteria, atypical echocardiographic lesion, cardiac troponin I >0.6 ng/mL, Bartonella serology >1:1024.

436
Q

What are the criteria for a possible diagnosis of endocarditis?

A

1 major and 1 minor criteria, or 3 minor criteria satisfied.

437
Q

What does it mean if a patient’s endocarditis diagnosis is rejected?

A

A firm alternative diagnosis is made, signs resolve within 4 days of treatment, or there is no pathologic evidence.

438
Q

How should heart failure signs in dogs with endocarditis be treated?

A

Furosemide and pimobendan at appropriate doses.

439
Q

What antibiotic treatment should be based on in endocarditis cases?

A

Ideally, culture and sensitivity results.

440
Q

What antibiotics can be used if culture results are negative?

A

Amoxicillin-clavulanic acid and metronidazole, or marbofloxacin (or enrofloxacin) and clindamycin.

441
Q

How long should the initial intravenous antibiotic treatment for endocarditis last?

A

7-14 days.

442
Q

How long should the oral treatment course for endocarditis last after the initial intravenous treatment?

A

6-8 weeks.

443
Q

When should antibiotics be stopped in endocarditis cases?

A

This is a tough decision. Some clinicians consider normalizing CRP levels at 6-8 weeks as a guide.

444
Q

What complications may arise during endocarditis treatment?

A

Multi-systemic organ damage, embolic disorders, bacteria seeding, and excessive systemic inflammatory response.

445
Q

What can be done if signs recur during endocarditis treatment?

A

Re-hospitalization for a further week of IV antibiotics.

446
Q

What are the typical manifestations of myocarditis?

A

ECG abnormalities and systolic dysfunction.

447
Q

What percentage of congenital heart diseases account for all cardiovascular diseases in referral hospitals?

A

Approximately 21%.

448
Q

When do age-related flow murmurs in young animals usually disappear?

A

By 15-16 weeks.

449
Q

What are the common congenital heart diseases in European dogs?

A

Pulmonic stenosis, aortic stenosis, and patent ductus arteriosus (PDA).

450
Q

What is the most common congenital heart defect in cats?

A

Ventricular septal defects.

451
Q

What are the characteristics of non-pathological flow murmurs?

A

Focal, quiet (grade I or II), systolic, left-sided, dynamic, and solo.

452
Q

What does a quiet murmur with a ventricular septal defect indicate?

A

A larger hole in the heart and equilibrated pressures between both sides.

453
Q

What is pulmonic stenosis?

A

Narrowing of the pulmonary orifice at the level of the valve.

454
Q

What are the two types of pulmonic stenosis?

A

Type A (valve leaflet fusion) and Type B (annulus hypoplasia).

455
Q

Which types of breeds commonly have valvular leaflet fusion form of pulmonic stenosis?

A

Spaniels, terriers, Beagles, and Chihuahuas.

456
Q

Which types of breeds commonly have annulus hypoplasia form of pulmonic stenosis?

A

Bulldog breeds.

457
Q

What is the best method to diagnose pulmonic stenosis?

A

Echocardiography.

458
Q

What is typically observed in severe pulmonic stenosis?

A

Right ventricular hypertrophy.

459
Q

What region can hypertrophy occur in severe pulmonic stenosis?

A

Subvalvular (infundibular) region.

460
Q

What can contribute to dynamic pulmonic stenosis?

A

Severe right ventricular hypertrophy in the subvalvular region.

461
Q

What can cause damage to the valve endocardium in high velocity flow?

A

Micro-fissures

462
Q

What is deposited on the surface of the valve during endocarditis?

A

Immune-complexes and thrombus

463
Q

What are the signs of sepsis in a patient with endocarditis?

A

Sepsis and signs that may localize to a different site

464
Q

What happens to the bacteria during endocarditis?

A

They are protected by layers of fibrinous lesion

465
Q

What is the cause of endocarditis in dogs often unknown?

A

Yes

466
Q

Where does endocarditis in cats usually localize to?

A

Left-heart

467
Q

What triggers the clinician to consider endocarditis in dogs?

A

Pyrexia of unknown origin

468
Q

What are the key characteristics of an echocardiographic lesion consistent with endocarditis?

A

Oscillates independent of valve motion, located ‘behind the valve’, dynamic appearance

469
Q

What is the scoring system called to diagnose endocarditis?

A

The Modified Duke Criteria

470
Q

Are cardiac biomarkers useful in hyperthyroid cats to assess cardiac change?

A

No

471
Q

What are the primary goals in treating hyperthyroid heart failure?

A

Reduce circulating volume and reduce myocardial oxygen demand

472
Q

What changes are seen in left atrial size in cats on hyperthyroid treatment?

A

Reduction

473
Q

Do all cats on hyperthyroid treatment show normalization of left ventricular wall thickness?

A

No

474
Q

What is the term used to describe the syndrome of hypersomatotropism?

A

Acromegaly

475
Q

What concurrent condition is often seen in cats with hypersomatotropism?

A

Diabetes mellitus

476
Q

What are the facial bone and limb segment changes seen in cats with hypersomatotropism?

A

Growth

477
Q

What are the myocardial effects of growth hormone (GH) and insulin-like growth factor 1 (IGF-1)?

A

Increased myocyte number and size, interstitial fibrosis

478
Q

What is a common clinical effect of hypothyroidism in dogs?

A

Lethargy/dullness

479
Q

Is there a proven link between hypothyroidism and clinical heart disease in dogs?

A

No

480
Q

What cardiac manifestations are often seen in patients with phaeochromocytoma?

A

Inappropriate heart rate, unpredictable arrhythmias, hypertension

481
Q

Are phaeochromocytomas frequently a cause of collapse or unexplained hypertension?

A

Rarely

482
Q

What is a common finding in dogs with phaeochromocytoma?

A

Cardiac arrhythmias

483
Q

What type of tumour is a ‘paraganglioma’?

A

A ‘non-adrenal’ phaeochromocytoma

484
Q

What is the controversy regarding hyperthyroidism and left ventricular hypertrophy?

A

Whether hyperthyroidism causes left ventricular hypertrophy is still debated.

485
Q

What are the clinical signs of hyperthyroidism in cats?

A

Weight loss and polyphagia

486
Q

What is the gold standard treatment for feline hyperthyroidism?

A

Radioactive iodine

487
Q

What effect do thyroid hormones have on the myocardium?

A

Increased beta-receptor expression, pro-hypertrophic state, and chamber dilation

488
Q

What are the clinical manifestations of phaeochromocytoma?

A

Unexplained arrhythmias, syncope, and hypertension.

489
Q

What tests are used for the diagnosis of phaeochromocytoma?

A

Plasma or urine metanephrine tests and CT imaging.

490
Q

What are the primary effects of hyperadrenocorticism on the heart?

A

Mild left ventricular hypertrophy.

491
Q

What is the direct cardiac effect of hypoadrenocorticism?

A

No known direct cardiac effect.

492
Q

What is the role of taurine in myocardial metabolism?

A

It is used as part of normal myocardial metabolism.

493
Q

How is taurine deficiency related to dilated cardiomyopathy (DCM) in cats?

A

Deficiency in taurine can cause myocardial dysfunction and a DCM phenotype.

494
Q

What was the first association of heart disease with nutritional disorders?

A

The association of DCM in cats with taurine deficiency in cat food.

495
Q

Why is taurine supplementation important in cat food?

A

The manufacturing process denatures taurine, making it inaccessible for gastrointestinal absorption.

Small Animal Medicine (GP cert) (22 decks)

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