Cardiology 2015-2019 Flashcards
What is the clinical utility of circulating trimethylamine N-oxide in regards to dogs wiith MVD w/ or w/o CHF?
Dogs w/ CHF had higher concentrations compared to those w/o
JVIM 2019
A pilot study investigating circulating trimethylamine N‐oxide and its precursors in dogs with degenerative mitral valve disease with or without congestive heart failure
What are general prognositc indicators for increased likelihood of death with presumed MVD?
Dogs w/ higher NT-proBNP and cTNI higher HR older dogs femals exercise intolerance Receiving diuretics JVIM 2019 Prognostic factors in dogs with presumed degenerative mitral valve disease attending primary‐care veterinary practices in the United Kingdom
What are some general factors associated w/ disease progression in preclinical MVD?
Increased plasma NT-proBNP HR, HR intensity presence of a cough CKCS breed pimobendan administration
Factors associated with disease progression in dogs with presumed preclinical degenerative mitral valve disease attending primary care veterinary practices in the United Kingdom JVIM 2019
Is synthetic BNP1-32 a viable treatment option in dogs with MVD?
No positive impactive on urine output, BP or HR.
Cardiorenal and endocrine effects of synthetic canine BNP1‐32 in dogs with compensated congestive heart failure caused by myxomatous mitral valve disease JVIM 2019
What additional echocardiographic abnormalities (beyond chamber size) are present in dogs with preclinical DMVD
Regurgitant fraction ≥50%, EROA (effective regurgitant orifice area) body surface area ≥0.347 and QMR:QAo ≥0.79 were strongly associated with LA:Ao ≥1.6 and LVIDdN ≥1 are better than chamber size to determine severity of disease.
Echocardiographic indices and severity of mitral regurgitation in dogs with preclinical degenerative mitral valve disease (JVIM 2019)
What are the known clinical and lab findings that correlate with a short survival time in dogs with heart disease?
cachexia, clinically important tachyarrhythmias, azotemia, and being under‐ or overweight were associated with shorter survival times
Clinical and laboratory findings and survival time associated with cardiac cachexia in dogs with congestive heart failure (JVIM 2019)
What was the hazard ratio of LVIDDN and LA:Ao noted in the EPIC study?
Hazard ratio for a 0.1 increase:
LVIDDN: 1.26
LA:Ao 1.14
At day 35, heart size had reduced in the pimobendan group: median change in (Δ) LVIDDN −0.06 and LA:Ao −0.08
Cardiomegaly values:
LA:Ao > 1.6
LVDDN > 1.7
VHA 10.5
Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study
JVIM 2018
In one small study of echocardiographic what findings was most tightly associated with prognosis?
LAVmax (> 3.53 ml/KG appears the strongest predictor of cardiac death, being superior to LA/Ao and STE-derived variables.
Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease Jvim 2018
What is the noted survival time for dogs with advanced heart failure?
281 days median (8 months)
Clinical findings and survival time in dogs with advanced heart failure
JVIM 2018
What are some prognostic factors for dogs with advanced heart disease?
Dose of pimobendan, furosemide, spironolactone
Clinical findings and survival time in dogs with advanced heart failure
JVIM 2018
Can treatment of CHF based on NT-proBNP levels?
Possible - treatment success based only on NT-proBNP and no other values
Effect of prespecified therapy escalation on plasma NT‐proBNP concentrations in dogs with stable congestive heart failure due to myxomatous mitral valve disease JVIM 2018
Are right or left sided atrioventricular accessory pathways more common?
Right
Atrioventricular accessory pathways in 89 dogs: Clinical features and outcome after radiofrequency catheter ablation (JVIM 2018)
What is the typical signalment of a dog with an atrioventricular accessory pathway?
GI signs with tachyardia
male labradors overrepresented
Atrioventricular accessory pathways in 89 dogs: Clinical features and outcome after radiofrequency catheter ablation (JVIM 2018)
What is the overall success rate of radiofrequency catheter ablation?
98.8% of dogs
Complication in 5/89
recurrence in 3 - responded to second procedure
Atrioventricular accessory pathways in 89 dogs: Clinical features and outcome after radiofrequency catheter ablation (JVIM 2018)
What are the noted affects of Entresto in dogs?
Reduces progression of urinary aldosterone to creatinine ratio
No affect on NT-prBNP
No diff in echo, thoracic radiographs, SAP or serum biochemical testing
Safe drug
A prospective, randomized, double‐blind, placebo‐controlled pilot study of sacubitril/valsartan (Entresto) in dogs with cardiomegaly secondary to myxomatous mitral valve disease (JVIM 2018)
Is thoracic ultrasound an adquate surrogate to thoracic radiographs for detection of pulmonary edema?
The use of B lines results in sens 90% and spec of 93%
Assessment of ultrasound B lines in dogs with different stages of chronic valvular heart disease (JVIM 2017)
What is the clinical relevance of mitral regurgitation severity as a predicting factor for young CKCS?
Hazard ratio of 3 for predictions of death with the presence of intermittent moderate or moderate to severe MR
Males with moderate to severe had a sig all cause mortality compared to females
Mitral regurgitation severity and left ventricular systolic dimension predict survival in young Cavalier King Charles Spaniels (JVIM 2017)
Is there any affect of body position, exercise or sedation for estimation of pulmonary artery pressure in dogs?
Sedation changed values in up 78% of dogs
Effect of body position, exercise, and sedation on estimation of pulmonary artery pressure in dogs with degenerative AV valve disease (JVIM 2017)
What correlations have been drawn between kidney and cardiac disease and how may they affect survival time?
MMVD had increase prevalence of CKD and anemia
Stage of cardiac disease nd stage of kidney disease were sig correlated
Severe heart disease, severe kidney disease, advanced age at the time of diagnosis and the use of furosemide associated with shorter survival time
(JVIM 2016)
What correlation exists between leptin and adiponectin in dogs with MMVD?
Leptin was higher in class 3 vs class 1-2 cardiac Adiponectin sig lower in class 1 vs healthy and sig higher in class 3 compared to class 1
Serum concentrations of leptin and adiponectin in dogs with MMVD (JVIM 2016)
Has there been success in implimenting breeding restrictions in CKCS?
MMVD has decreased in the breed over 8-10 years
Breeding restrictions decrease the prevalence of MMVD in CKCS over an 8- to 10-year period (JVIM 2016)
What is the clinical benfit for the administration of pimobendan in dogs with stage B2 disease?
Prolonged preclinical period by 15 months
Effect of Pimobendan in dogs w/ preclinical MMVD and cardiomegaly: the EPIC study – a randomized clinical trial
(JVIM 2016)
What is the cut-off for pulmonary vein to pulmonary artery ration to predict CHF in dogs?
1.7
Sens 96% and spect 91%
Pulmonary vein-to-pulmonary artery ratio is an echocardiographic index of CHF in dogs w/ MMVD (JVIM 2015)
How does the biopsy of left atrial tissue differ from left ventricular tissue in dogs with MVD?
Left ventricule is hypertrophied
LA is degenerate with immune cell infiltration and fibrosis
Pathologic manifestations on surgical biopsy and their correlation with clinical indices in dogs with MMVD (JVIM 2015)
What is the overall prevalence and prognositc importance of pulmonary hyertension in dogs with MMVD?
(39%) had PH.
PH was more commonly identified in stage C compared to B
Moderate to severe PH worsens outcome
Cut off:
La:AO 1.7
TRPG > 55 mH
Prevalence and prognostic importance of pulmonary HTN in dogs with MMVD
(JVIM 2015)
Is telmasartan a viable treatment option in cats with hypertesnion?
Capable of reducing mmHG by 23 mmHg from baseline
Not contigent on starting SABP
Efficacy of long‐term oral telmisartan treatment in cats with hypertension: Results of a prospective European clinical trial (JVIM 2019)
What are the general population statistics in felines with restrictive cardiomyopathy?
Median age 8.6 years, BW 4.0 kg
myocardial form more common (90%) than enomycocardial fibrosis (10%)
Clinical, epidemiological and echocardiographic features and prognostic factors in cats with restrictive cardiomyopathy: A retrospective study of 92 cases (2001‐2015) (JVIM 2019)
What are the expected C/S an prognostic considerations for survival in cats with restrictive cardiomypathy?
70% symptomatic- Dysnpnea related to CHF in 89%
81 % had abnormal cardiac auscultation
Of the mycodardia form: MST 667 days
Biatrial enlargement
arrhythmias
increase in LA to AO Presence of severe LA:AO > 2.0
All linked to shorter time to cardiac death
Clinical, epidemiological and echocardiographic features and prognostic factors in cats with restrictive cardiomyopathy: A retrospective study of 92 cases (2001‐2015) (JVIM 2019)
What is the clinical relavence of cTNI concentrations in cats with hypertrophic cardiomyopathy?
> 0.06 ng/mL was 91.7% sens and 95.4% spec for healthy cats vs HCM
also was 87.7% sens and 95.4% specific for diagnosis of HCM in asymptomatic cats
Evaluation of a sensitive cardiac troponin I assay as a screening test for the diagnosis of hypertrophic cardiomyopathy in cats JVIM 2019
- 163 ng/mLlhad sens of 62% and spec of 100% normal vs asymptomatic
- 234 ng/mL for CHF cats
Diagnostic utility of cardiac troponin I in cats with hypertrophic cardiomyopathy
How does the presence of cardiac disease affect overall survival time and likelihood of death in cats with HCM or HOCM?
Cats with preclinical disease had no reduction in life span. Risk of death increased.
Cats with HCM/HOCM and concurrent CKD did have a negative effect on survival.
Most common cause of death cancer > CKD > unknown vomiting/diarrhea/other
Long‐term incidence and risk of noncardiovascular and all‐cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy (JVIM 2019)
What are some possible causes for transient myocardial thickening and CHF and cats and what are the expected outcomes?
Anesthesia, recent vehicular trauma
Thickening resolved in 3.3 months
1/21 TMT cats had recurrence of CHF
Transient Myocardial Thickening in Cats Associated with Heart Failure (JVIM 2018)
How may the presence of HCM or Diabetes Mellitus in cats affect SDMA levels?
SDMA is uneffected by cardiac disease
SDMA decreases with DM
Symmetric Dimethylarginine in Cats with Hypertrophic Cardiomyopathy and Diabetes Mellitus (JVIM 2018)
What is the clinical utility of cTnI concentration in cats with HCM?
A plasma cTnI concentration of 0.163 ng/mL had a sens of 62% and spec 100% to disinguish normal cats from asymptoatic cats w/o cardiac enlargement
- 234 ng/mL is 95% sens and 77% spec to assess heart failure
4) Diagnostic utility of cardiac troponin I in cats with hypertrophic cardiomyopathy (JVIM 2018)
What is the clinical value of NT-proBNP in cats treateed for CHF?
Cats w/ larger % decrease in NT-proBNP from admission to discharge had a longer survival time (182 vs 60).
In humans, a 30% reduction is used, this degree was not sig associated w/ chance of survival
Association between survival time and changes in NT-proBNP in cats treated for congestive heart failure (JVIM 2017)
What is the sens and spec of a POC ELISA for NT-proBNP to diagnosis cardiac disease in cats?
64.5% and 100%
Investigation of an NT-proBNP point of care ELISA in clinically normal cats and cats with cats with cardiac disease (JVIM 2017)
In regards to hypertension, which of the following biomarkers are changed?
NT-proBNP,
VEGF
cTnI
HT-ocular TOD had sig higher VEG than healthy
HT-non target organ damage and CKD as well had higher NT-proBNP than healthy cats
NT-proBNP decreased w/ hypertensive treatment
Plasma NT-proBNP, VEGF, cTnI as novel biomarkers of hypertensive disease and target organ damage in cats JVIM 2017
What echocardiographic findings of the right ventricle are noted in HCM vs CHF?
Size and funciton increase w/ HCM and decrease with CHF
Echocardiographic assessment of right ventricular size and function in cats with HCM JVIM 2017
What is the sensitivity and specificity of NT-proBNP to differentiate between cardiogenic and noncardiogenic pleural effusion? (POC vs second generation quantitiative)
Lab can do either plasma or fluid
POC, use plasma d/t low spec on fluid
Differentiation of cardiac from non-cardiac causes of pleural effusions in cats using second generation quantitative and POC NT-proBNP measurements (JVIM 2016)
How does BW effect echocardiographic measurements in cats?
All dimensions increased w/ body weight
Most sig: Ao, LV end-diastolic, LA dimensions, left free wall thickness
Effect of Body Weight on Echocardiographic Measurements in 19,866 Pure-Bred Cats with or without Heart Disease (JVIM 2016)
What is the best predictor of sudden cardiac death in Dobermans with DCM?
Volume overload of the LV
Predictors of sudden cardiac death in Dobermans with DCM (JVIM 2016)
What is the most commen presentation of GSD with PDA?
Often presents with w/ CS (50%), concurrent congenital cardiac disease (35.7%), arrhythmias (29%)
Most 12 months at the time of presentation
Mostly type II anatomy
Successfully closed in all
Anatomy, baseline characteristics, and procedural outcome of patent ductus arteriosus in German Shepherd dogs JVIM 2018
What are the unique characteristics of PDA in cats?
Typically do not display C/D and have the do not have the typical characterstics of PDA in dogs
Increased prevalence of concurrent cardiacabnormalities and PHT in 50 case summary
Thoracic radiographs and echocrdiogram were best for dx and tx recommendations
PDA closure carries a good long-term prognosis
Patent ductus arteriosus in cats (Felis catus): 50 cases (2000-2015) (JCard 2017)
What are some key clinical features of adult dogs that present for PDA at > 5 years of age?
GSD most common (female > male)
60% presened asymptomatic hearrt murmur, 40% symptomaic - cough, lethargy
Left basilar murmur in 91.4% of dogs
Low incidence of concurrent congenital defects
Cardiomegaly in majority - LV 91%, LA 86%
PDA shunt left to right in 33 and bidirectional in 2 (35 total dogs)
Closure in 26 - clinical and echo improvment
Clinical characteristics of adult dogs more than 5 years of age at presentation for PDA JVIM 2017
What is the value of right atrial area index in dogs?
Correlates with tricuspid rergitaion.
RA index is higher in dogs w/ moderate or severe PHT as well as dogs in CHF.
severity of tricusped regurgitation is the main determinant of right atria area index
JVIM 2018
Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension
Is lidocaine a viable treatment option for treatment of a unique orthodromic artioventicular reciprocating tachycardia in dogs?
Yes - 84.4% success rate
Lidocaine for chemical cardioversion of orthodromic atrioventricular reciprocating tachycardia in dogs
JVIM 2019
What role does a focused cardiac ultrasound (ultrasound performed by a trained but non boarded cardiologist) have in the diagnosis of heart disease in cats?
FCU increases diagnosis of cats with moderate to marked heart disease (cardiologist confirmed) when combined with PE and EKG
The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats JVIM 2019
Body weight most strongly correlates with what ehocardiographic indcies?
Linear LA and LV chamber size measurements
Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability JVIM 2019
Is there a clinical benefit to the admininstration of benazepril in cats with cardiac disease?
None noted in regards to treatment failure for heart disease
No sig difference w/ echocardiographic findings, QOL, adverse events, plasma or hematologic abnormalities.
JVIM 2019
What is the target heart rate to improve survival in dogs with atrial fibrillation?
Survival time in dogs w/ adequate control vs non control:
125 bpm
1037 days vs 105 days
Retrospective Evaluation of the Effect of Heart Rate on Survival in Dogs with Atrial Fibrillation JVIM 2018
What are the additional diagnostic recommendations dogs in which angiostrongylosis is suspected but initial fecal and in-clinic rapid serologic tests are negative?
ELISA for ab detecion and qPCR on BAL material
Angiostrongylosis in dogs with negative fecal and in‐clinic rapid serological tests: 7 Cases (2013‐2017) JVIM
What is the affected of sotalol administration on echocardiographic evaluation of ventricular systolic function?
Decreased HR, number of VPC/5 minutes and arrhythmia grade.
No proarrhythmic effect observed
Acute echocardiographic effects of sotalol on ventricular systolic function in dogs with ventricular arrhythmias JVIM 2018
What lung ultrasound abnormalities correlated best with CHF diagnosis in cats?
> 1 site positive for > b lines - 79% sens, 83% spec
Subjective LA enlargement - 97% sens 100% spec
Presence of pericardial effusion - 60% snes 100% spec
Blood NT-proBNP 93% sens and 72% spec
Evaluation of point‐of‐care thoracic ultrasound and NT‐proBNP for the diagnosis of congestive heart failure in cats with respiratory distress
JVIM 2018
Is pentamidine analouge 6 a viable treatment option for refractory. crhonic afib in dogs?
No
Respiratory distress with laryngeal stridor, subtle muscle twitching, and mild generalized muscular weakness were noncardiac adverse effects observed in 5 dogs.
Efficacy of pentamidine analogue 6 in dogs with chronic atrial fibrillation (JVIM 2018)
What is the expected clinical progression of cats with hypertension attending primary care veterinary clinics in the UK?
Few cats had BPA amongs the general population.
19.8% were noted to be hypertension - only a few had UPC
Of those noted to have hypertension and were treated, there was increased survival
JVIM 2017
Have obese dogs been shown to have ehocardiographic and metabolic derrangements?
Cardiac - increased IVS width, increased fractional shortening and ejection fraction percentages
Metabolic - increased insulin:glucose ratio, choleterol, triglycerides, IL-8, decreased adiponectin
Cardiac and metabolic variables in obese dogs (JVIM 2017)
What is the prefered measurement technique to estimate pulmonary arterial pressures in dogs?
Peak velocity of tricuspid valve regurgitation
A chnage of greater than 0.3 m/s is clinically significant
Measurement variation and repeatability of echocardiographic variables used to estimate pulmonary artery pressure in dogs JVIM 2017
What components of the RAAS system hae been shown to be diffrent betweenn greyhound and non-greyhound dogs?
Creatinine, sodium and SMA are sig higher in greyhounds
Plasma aldosterone sig lower in gryhouds vs non-greyhounds
Plasma renin activity and ACE activity are not sig different among groups, did not correlate w/ higher BP and urine alubmin in greyhouds
The renin-angiotensin-aldosterone system in greyhounds and non-greyhound dogs
JVIM 2017
What was the out come of balloon valcuoplasty for tricuspid stenosis in 5 Labrador retrievers?
Successful in 4/5 - clinical improvement in 3/4 - recurrence requried additional procedure in 2 dogs
Balloon valvuloplasty of tricuspid stenosis: a retrospective study of 5 labrador retrievers JVIM 2017
Does ophthalmic 5% timolol maleate decrease heart rate in cats?
Yes - can facilitate assessment of diastolic function
Effects of 0.5% timolol maleate ophthalmic solution on heart rate and selected echocardiographic indices in apparently healthy cats
jvim 2016
What is the most significant factor in determining amlodipine dose required to adequately control hypertension in cats?
higher BP at the time of presentation
Factors influencing the relationship between the dose of amlodipine required for BP control and change in BP in hypertensive cats
JVIM 2016
What is the gene associated with sudden death in English Springer Spaniels?
KCNQ1
This results in a long QT interval
Sudden death associated w/ QT interval prolongation and KCNQ1 gene mutation in a family of English Springer Spaniels (JVIM 2015)
What occurs with the vitamin D status in dogs at various stages of cardic disease in dogs?
Decrease occurs at the begining of CHF
There is a significant negative association between vitamin D and La:Ao and LV end-diastolic diamter when normalized to BW
Vitamin D status in different stages of disease severity in dogs with chronic valvular heart disease JVIM 2015
What is thought to be the main cotributing factor to innocent murmurs in puppies?
Lower hematocrit compared to adult.
Innocent cardiac murmur in puppies: prevalence, correlation with hematocrit, and auscultation characteristics (JVIM 2015)
What is the reported diagnostic benefit of CT over echocardiogram in the diagnosis of cardiac tumors in a study of 11 dogs?
None in this study- 5 were right atrial and 1 was heart base
Use of a multidetector CT in the assessment of dogs with pericardial effusion
JVIM 2015
Is a chewable formulation of amlodipine a viable arternative to traditional pill form?
73% acceptance rate
63% response rate vs 18% w/ placebo and no comparison to other produtions.
Randomized placebo-controlled clinical trial of a chewable formulation of amlodipine for tx of hypertension in cats
JVIM 2015
What is the affect of environment on PR, rectal temp, RR and systolic arterial BP?
Home vs clinic: Mean bp <16% Mean RT < 1% Mean PR <11% 63% panting at clinic vs 17% at home
Evaluation of the effects of hospital visit stress on physiologic variables in dogs (JAVMA 2015)
What are the exepected hemodynamic influences of dexmedetomidine as a premedication?
Bradycardia, hypertension, significant CO decrease - improved uring isoflurane anesthesia.
Hemodynamic influence of acepromazine or dexmedetomidine premedication in isoflurane-anesthetized dogs
JAVMA 2015
What are the expected hemodynamic influences of acepromazine as a premedcation?
Hypotension w/ maintenance of CO during isoflurane anesthesia
Hemodynamic influence of acepromazine or dexmedetomidine premedication in isoflurane-anesthetized dogs JAVMA 2015
What is the effect of cardiac and respiratory cycle on VHS during fluoroscopy?
Mean VHS was larger in right vs left lateral recumbency
This change was greatest during diastole.
Effect of cardiac and respiratory cycles on vertebral heart score measured on fluoroscopic images of healthy dogs (JAVMA 2015)
What is the typical signalment, clinical feaures, echocardiographic findings and outcome of VSD in dogs and cats?
isolated in 48.6% patients
Most membranous or perimembranous
Terrier and French bull dogs
No asymptomatic dogs developed symptoms
3/8 affected died from cardiac related causes
median age from death from all causes was 12 yrs
signalment, clinical features, echocardiographic findings, and outcome of dogs and cats with ventricular septal defects: 109 cases (1992–2013) (JAVMA 2015)
What are the expected outcomes of cats undergoing surgical and nonsurgical management of PDA?
Most cats had murmur but were asymptomatic
26% had multiple defects
65% attenutation - success in 11/15 surgical and 2/2 coil
Medical and surgical had similar survival time (suvival up to 196 months reported)
Surgical and nonsurgical management of patent ductus arteriosus in cats: 28 cases (1991–2012) (JAVMA 2015)
What is the known sensitivity, specificity, and interobserver variability of survey thoracic radiographs for the detection of heart based masses in dogs?
Poor sens (60%), high spec (98%), moderate interobserver agreement (50%)
Mass-like opacities effacing or silhouetting w/ the cranial aspect of the cardiac silhouette, focal elevation of the terminal trachea had a high PPV and were most specific
Sensitivity, specificity, and interobserver variability of survey thoracic radiography for the detection of heart base masses in dogs (JAVMA 2016)
What is the validity of a smart-phone-based electrocardiograph?
Inter observer agreement high, good correlation to reference EKG
Detection of heart rate and rhythm with a smartphone-based electrocardiograph versus a reference standard electrocardiograph in dogs and cats
JAVMA 2016
What are the epidemological, clinical and echocardiographic features and survival times of dogs and cats w/ tetralogy of Fallot?
Terrier breeds, DSH
Most animals had c/s at the time of dx - cyanosis was common (52%)
Pulmonic stenosis had a median of 108 mmHG
Most VSD were large
Median survival time w/ cardiac related death - 23.4 months; no sig diff dogs/cats
Median survival time shorter w/ low grade or no murmur vs high grade (3.4 months vs 16.4 months
Epidemiological, clinical, and echocardiographic features and survival times of dogs and cats with tetralogy of Fallot: 31 cases (2003–2014) JAVMA 2016
What is seroprevalence of heartworm infection, risk for seropositivity and frequency of presribing hw preventatives in cats in the US and Canada
Seropos w/ POC 0.4% in USA - higher in souther and outdoor
2/5 increase in dx w/ unhealthy vs healthy cats
Coinfection w/ FelV/FIV increased risk
Prevention in 12.6%
Seroprevalence of heartworm infection, risk factors for seropositivity, and frequency of prescribing heartworm preventives for cats in the United States and Canada Javma 2017
What affect does hyperlactemia have on hypotensive cats?
hypotensive w/ normal lactate had higher 5 day survival rate when compared to hyperlactemia (57% vs 17%)
Age, BW, duration of hospitalization, PCV, illness severity did not correlate w/ hypotension w/o or w/o hyperlactemia
Survival analysis of hypotensive cats admitted to an intensive care unit with or without hyperlactatemia: 39 cases (2005–2011) JAVMA
What were the results of ambulatory electrogarography in t he evaluation of arrhythmias in healthy Salukis?
All 25 dogs had at least one vpc in 24 hours
no sig dif male vs female
Ambulatory electrocardiographic evaluation of the occurrence of arrhythmias in healthy Salukis JAVMA 208
What are the effects of the administration of milbeymicin oxime w/ spinosad when administered to heart worm positive dogs?
32 beagle dogs
Blood antigen and microfilaremia test positive throughout
Increased microfilaria in non treated
Reduction in patients treated w/ MO (from 61.5% -96.5% reduction)
Effects of milbemycin oxime, combined with spinosad, when administered orally to microfilaremic dogs infected with adult heartworms (Dirofilaria immitis)
JAVMA 2018
What is the diagnostic value of left atrial size determined on thoracic radiographs?
A moderate positive correlation bt VLAS and echo findings is noted
VLAS = line from ventral carina to caudal LA compared to cranial aspect of T4 caudally.
Diagnostic value of vertebral left atrial size as determined from thoracic radiographs for assessment of left atrial size in dogs with myxomatous mitral valve disease (JAVMA 2018)
How does surgical ligation vary from ductal occluder compare in respect to complications and survival rate in dogs w/ left-to-right shunting PDA?
Surgery for occluder is longer than SX
Major complications 10% comared to occluder
Surgical succes slightly less thatn CDO
Overall survival 99%
Comparison of major complication and survival rates between surgical ligation and use of a canine ductal occluder device for treatment of dogs with left-to-right shunting patent ductus arteriosus (JAVMA 2018)
What is the sens and spec of doppler to detect hypotension in anesthesia dogs?
70% sens and 85% spec
Bias, sensitivity, and specificity of Doppler ultrasonic flow detector measurement of blood pressure for detecting and monitoring hypotension in anesthetized dogs (JAVMA 2018
What proportion of dogs with AV nodal conduction disturbances showed regression after pacemaker implantation?
What proportion of these returned to a normal sinus rhythm
67%
13%
consider acute lymphocytic myocarditis as a possible cause for these?
Long-term intrinsic rhythm evaluation in dogs with atrioventricular block JVIM 2016
Are increased LV systolic dimension at 1-3 years of age in CKCS associated with - increased cardiac ortality later in life
yes
Risk of cardiac and all-cause death increased w/ increasing left ventricular end-systolic internal dimension normalized to weight
Comparison of the mitral valve morphologies of Cavalier King Charles Spaniels and dogs of other breeds using 3D transthoracic echocardiography
Does the presence of AFib in medium to large breed dogs with MMVD affect prognosis?
Yes - associated with shorter MST (142 d) compared to those without AF (234d)
Atrial fibrillation as a prognostic indicator in medium to large-sized dogs w/ MMVD and CHF JVIM 2016
What is the MST for medium to large breed dogs with MMVD and CHF:
- no AFib
- AFib with HR <160 bpm via medication
- AFib with HR >160 bpm with medication
- no AFib: 234d (7.5m)
- AFib with HR <160 bpm via medication: 171d (5.5m)
- AFib with HR >160 bpm with medication: 61d (2m)
Atrial fibrillation as a prognostic indicator in medium to large-sized dogs w/ MMVD and CHF JVIM 2016
Is diltiazem or diltazem + digoxin recommended for control of Afib in medium to large breed dogs with MMVD?
MST for digoxin + Diltazem = 130d (3m)
Diltiazem alone = 35d (1m)
Atrial fibrillation as a prognostic indicator in medium to large-sized dogs w/ MMVD and CHF
Why is it important to control the heart rate in medium to large breed dogs with MMVD and AFib?
Increased heart rate associated with shorter MST and higher rate of mortalities
Chronic tachycardia >160bpm for 2-4 weeks least to tachycardia induced myocardial failure.
Cut off of HR <160bpm was associated with significantly better outcomes.
Administratio of diltiazem improves outcome
Atrial fibrillation as a prognostic indicator in medium to large-sized dogs w/ MMVD and CHF JVIM 2016
In regards to cardiorenal syndrome and MMVD in dogs, what factors were associated with shorter survival times?
- Severe heart disease
- severe renal disease
- both severe heart and renal disease
- frusemide administration
- advanced age at diagnosis of heart disease.
Preliminary investigation of cardiovascular-renal disorders in dogs with MMVD JVIM 2016
True or False:
Dogs being treated for heart failure had higher prevalence of CKD compared to dogs that had not received treatment?
True
Preliminary investigation of cardiovascular-renal disorders in dogs with MMVD JVIM 2016
Does body size influence CKD severity?
Does it influence heart failure severity?
False
True
Preliminary investigation of cardiovascular-renal disorders in dogs with MMVD JVIM 2016
True or False:
Hb was negatively correlated with serum creatinine and IRIS stage but not with classes of heart failure?
True
Preliminary investigation of cardiovascular-renal disorders in dogs with MMVD JVIM 2016
What role does adiponectin play in relation to the heart and cardiac disease?
Capabple of slowing the progression of cardiovascular diseases including hypertrophy, ischaemic injury and athelerosclerosis in people.
Serum concentrations of leptin and adiponectin in dogs with MMVD JVIM 2016
Is moderate to severe mitral regurgitation in CKCS <3 years associated with increased hazard of:
- all cause mortality
- cardiac death
Yes
Yes
and for intermittent moderate to severe mitral regurg in dogs <3 years of age
Mitral regurgitation severity and left ventricular systolic dimension predict survival in young Cavalier King Charles Spaniels
Are flow murmur in CKCS between ages 1-3 associated with increased cardiac mortality later in life?
No
Mitral regurgitation severity and left ventricular systolic dimension predict survival in young Cavalier King Charles Spaniels
Is mild mitral regurg in CKCS between ages 1-3 associated with increased cardiac mortality later in life?
No
Mitral regurgitation severity and left ventricular systolic dimension predict survival in young Cavalier King Charles Spaniels
Are markers of oxidative stress (plasma malondialdehyde, oxidized LDL and Vit E) associated with clinical stages of MMVD?
NOT assoc. with clinical stage of MMVD
Markers of oxidative stress in dogs with myxomatous mitral valve disease are influenced by sex, neuter status, and serum cholesterol concentration JVIM 2017
What is the cut off used for PV/PA measurement for CHF in dogs with MMVD?
What is the sensitivity and specificity of this?
> 1.7 = CHF
Sens 96%
Spec 91%
2) Pulmonary vein-to-pulmonary artery ratio is an echocardiographic index of CHF in dogs w/ MMVD
where does an AV block originate from?
Conduction abnormalities along the AV nodes, bundle of His/Purkinje system or both.
Santilli JVIM 2016
Is there any evidence for starting pimobendan in preclinical DCM in Irish Wolfhounds?
Yes - Vollmar JVIM 2016 found improved survival and significantly longer to sudden death or CHF in wolfhounds receiving pimobendan preclinical DCM and/or Afib
Long-term outcome of Irish Wolfhound dogs with preclinical cardiomyopathy, atrial fibrillation or both treated with pimobendan, benazepril or methyldigoxin monotherapy JVIM 2016
True or False?
MMVD - as the disease progresses (increases ACVIM stages) you would expect left atrial areas to increase and left atrial function to increase?
Left atrial area increases
Left atrial function decreases
Assessment of left atrial deformation and function by 2-dimensional speckle tracking echocardiography in healthy dogs and dogs with MMVD
Peak tricuspid regurgitant pressure gradient (TRPG) of what pressure is associated with worse outcomes in dogs with MMVD?
<55 mmHg
Prevalence and prognostic importance of pulmonary HTN in dogs with MMVD JVIM 2015
La:Ao greater than what value is associated with worse outcomes in dogs with MMVD?
1.7
Prevalence and prognostic importance of pulmonary HTN in dogs with MMVD JVIM 2015
What proportion of dogs with MMVD stage B2 have pulmonary hypertension?
Approx 1 third
Prevalence and prognostic importance of pulmonary HTN in dogs with MMVD JVIM 2015
Does butorphanol sedation impact peak tricuspid regurgitant flow velocity (when measured for pulmonary hypertension)?
No
Echocardiographic evaluation of velocity ratio, velocity time integral ratio, and pulmonary valve area in dogs with pulmonary valve stenosis
JVIM 2018
When tricuspid regurg is absent, what other other echocardiographic signs can be evaluated for to measure pulmonary hypertension?
- acceleration time of pulmonary ejection
- acceleration to ejection time ratio.
Abbott JVIM 2017
Is right atrial index higher in dogs with:
- mild pul. hypertension
- moderate pul. hypertension
- severe pul. hypertension
- R-CHF
- mild: 6.7 cm2/m2
- moderate 13.3 cm2/m2
- severe 12.1 cm2/m2
- R-CHF: 17.5 cm2/m2
Echocardiographic Evaluation of the Right Atrial Area Index in Dogs with Pulmonary Hypertension
What are the causes of a fib?
Structural heart disease Lone AFib (giant and large breed dogs, structural normal heart with erratic rhythm with significant exercise +/- GA) High vagal tone (shortens the refractory period) Hypothyroidism Anaesthesia/opiates Rapid, large vol pericardial effusion GI disease Vol overload causing atrial stretch
VCNA 2017. AFib Pariaut + ettinger
What is the bioavailability, half life and duration of action of oral:
- frusemide
- torsemide
Furosemide: 77%, 1-2h, 6h
Torsemide: 80-100%, 8h, 12h
Chetboul JVIM 2017
Apart from renal effects, what else does Torsemide do?
- vasodilating properties
- improves cardiac cunction and reduced cardiac remodelling secondary to anti-aldosterone effect.
Chetboul JVIM 2017
Does Pimobendan treatment in preclinical MMVD change heart size?
What difference is seen?
Yes reduce by day 35
LVIDDN - 0.06
La:Ao - 0.08
Longitudinal EPIC JVIM 2018
Is change in heart size associated with a change in survival in dogs with stage B2 MMVD?
Yes - reduction in heart sieze was associated with increased time to CHD for cardiac related death
Longitudinal EPIC JVIM 2018
What is the cut off, sensitivity and specificity of cardiac troponin 1 for detecting:
- Cats with HCM
- Asymptomatic cats with HCM
HCM:
Cut off: 0.06ng/ml
Sens: 91%
Spec: 95%
Asymptomatic HCM
Cut off: >0.06 ng/mL
Sens: 87%
Spec: 95%
Hertzsch JVIM 2019
What are the laboratory findings associated with cardiac cachexia?
What factors in dogs with CHF were associated with shorter survival times?
Lab findings with cachexia
- increase chloride
- lower HCT and HB
- lower albumin
Assoc with shorter survival times:
- Cardiac cachexia
- clinical tachyarrhythmia
- azotaemia
- under or over weight
Ineson JVIM 2019
What additional echocardiographic indices may be used to quantify mitral regurg severity in dogs with preclinical MMVD?
- Regurgitation fraction >/= 50%
- Effective regurgitant orifice area (EROA) to BSA >/= 0.347
- Ratio of mitral regurg to aortic flow rate >/= 0.79
all strongly associated with
La:Ao >/= 1.6
LVIDdN >/= 1.7
Larouche-Lebel. JVIm 2019
What type of PDA is most commonly seen in german shepherds?
What factors associated with this may change the approach to management?
Type II most common but type 1 and IV also noted.
Generally larger minimal ductal diameter of 4.4-4.9mm
Given abnormal changes can be seen and larger minimum ductal diameter, transoesophageal echo may be benificial for procedure planning.
Wesselowski JVIM 2019
What care should be taken when interpreting cardiac troponin 1 in cats?
What additional test can be used to help evaluate this further??
Cats with compromised renal function can have higher cardiac troponin 1 due to reduced excretion.
Cardiac troponin 1 in urine was more common in cats with renal disease than in cardiac disease.
Cardiac troponin I in cats with compromised renal function JFMS 2019
**Various studies argue different things; interpret with caution is the general consensus - Cardiac Troponins in Dogs and Cats
True or False:
The amount of frusemide administered during CHF for MMVD was directly correlated with Urea but not IRIS stage or serum creatinine?
True:
Decreased renal blood flow => decreased flow rate in renal tubules => increased reabsorption of urea, thus urea increases disproportionately to creatinine (not reabsorbed)
Martinelli JVIM 2016
What is the median age of cats diagnosed with RCM?
What % are symptomatic at diagnosis?
What is the most common clinical sign?
8.6 years
70% symptomatic at diagnosis
90% of these had dysponea secondary to CHF.
Clinical, epidemiological and echocardiographic features and prognostic factors in cats with restrictive cardiomyopathy: A retrospective study of 92 cases (2001‐2015)JVIM 2019
what is the MST of cats wtih RCM from diagnosis?
What echo features were associated with shorter survival time?
MST 667d (1.8 yr) with 20% experiencing cardiac death in the first 24h after diagnosis due to ATE or CHF
Shorter survival associated with increased La:Ao, and severe LA enlargement (La:Ao >/= 2)
Clinical, epidemiological and echocardiographic features and prognostic factors in cats with restrictive cardiomyopathy: A retrospective study of 92 cases (2001‐2015)JVIM 2019
Does the use of tissue plasminogen activator in cats with ATE:
- improve survival?
- reduce repurfusion injury
- reduce AKI
- clinical improvement?
survival:
TPA - discharge rate 44% but short term survival 56% vs 29% and 30% with standard of care but not statistically significant.
Repurfusion injury: no difference between groups
AKI - no difference between groups
Clinical improvement - TPA 56%, Standard of care 31% - not statistically significant
Thrombolysis with tissue plasminogen activator (TPA) in feline acute aortic thromboembolism: a retrospective study of 16 cases Guillaumin JFMS 2019
What is the benefit of focused cardiac utlrasound in cats?
What areas does the focused cardiac ultrasound assess?
- detection of occult heart disease, especially moderate (93%) to marked (100%) disease in cats but non-specialist practitioners.
Focused cardiac ultrasound assesses:
- LA enlargement
- LV hypertrophy
- Cavitary effusion
- decreased contractility
The use of focused cardiac ultrasound to screen for occult heart disease in asymptomatic cats JVIM 2019
What % of puppies have an innocent murmur?
What are the characteristics of this?
What may explain the presence of an innocent murmur?
15% had an innocent murmur
Systolic
muscial
maximum 2/6 intensity
PMI left cardiac base
Anaemia was noted in these and may contribute to initial murmur that resolves with age and improvement in HCT.
Szatmari JVIM 2015
Is there a difference in NT-proBNP in puppies with congenital heart disease vs innocent murmur?
What changes are suggestive of abnormality instead of innocent murmur?
NTproBNP was higher in puppies with congenital heart disease but not consistently. Elevation is likely abnormal, but normal doesn’t rule out an abnormality
Murmurs longer than 80% of systole are likely abnormal. shorter may be normal or abnormal.
N-Terminal Pro-B-Type Natriuretic Peptide and Phonocardiography in Differentiating Innocent Cardiac Murmurs from Congenital Cardiac Anomalies in Asymptomatic Puppies JVIM 2017
what changes are expected to be seen on echo after PDA closure?
- reduced preload
- reduction in LVIDd
- reduced La:Ao - Transient reduction in LV systolic function
- reduced FA
- LV dyssynchrony
Echocardiographic Evaluation of Myocardial Changes Observed After Closure of Patent Ductus Arteriosus in Dogs JVIM 2015
What are the cut offs, sens and spec of cardiac troponin 1 to detect:
- cats with asymptomatic heart disease withouth LA dilation
- cats with heart failure
Asympotmatic:
Cut off: 0.163mg/mL
Sens: 62%
Spec: 100%
Heart failure:
Cut off: 0.234ng/mL
Sens: 95%
Spec: 77%
Hori JVIM 2017
What % of cats with preclinical non obstructive or obstructive HCM develop:
- CHF
- ATE
- cardiovascular death
CHF, ATE or both occured in 30% of cats
CV death in 28%
risk at 1, 5 and 10 years
- CHF 7%, 20%, 24%
- ATE 3.5%, 10%, 11%
- cardiovascular death 6%, 22%, 28%
Fox JVIM 2017 REVEAL study
How does SDMA vary in cats with HCM or DM?
HCM - no change
DM - lower
Langhorn JVIM 2018
What is the MST for cats with RCM presenting
- with resp distress
- without resp distress
With resp distress MST 64 days (majority of cats)
Without resp distress MST 466 days.
Locatelli JFMS 2018
What tests may be benifitial in diagnosing CHF in cats with resp distress?
1. Lung ultrasound with >1 site having >3 B-lines. Sens 78%, spec 83% 2. Subjective La enlargement - sens: 97%, spec 100% 3. Presence of pericardial effusion sens60% spec 100% 4. Positive serum NTproBNP sens 93% spec 72%
At what cut off, what is the sensitivity and specificity of NTproBNP for discriminating between CHF and non-cardiac resp distress in dogs?
> 2447 pmol/L
sens 81%
spec 73%
Relationship of Plasma NT-proBNP Concentrations to Heart Failure Classification and Cause of Respiratory Distress in Dogs JVIM 2015
Do dogs in stage B2 MMVD have increased or decreased TAPSE?
increased
Echocardiographic Estimates of Right Ventricular Systolic Function in Dogs with Myxomatous Mitral Valve Disease JVIM 2018
What is a benefit of Holter monitoring of Afib over ECG?
ECG tents to over-estimate mean HR compared to Holter recordings in dogs with AFib
Pedro JVIM 2018
What phase of the ECG should the electrical cardioversioin be synchronised with?
R wave
What treatment is generally used for boxer ARVC?
Sotalol +/- Mexiletine or Amiodarone INI with above \+/- Fish oil If CHF treat as for DCM - pimobendan - ACEi - diuretics - L-Carnitine
Meurs VCNA 2017
What is the most common age of onset for boxer ARVC?
Adult between 5-7 years, however homozygous dogs may present between 1-3 years old.
Meurs VCNA 2017
What are urgent rate control drugs for dogs with AFib?
- Diltazem IV boluse or CRI * risk hypotension
- Esmolol CRi. * less effective.
VCNA 2017. AFib Pariaut
What are the three types of ARVC in boxer dogs?
- Asymptomatic with occasional VPC
- Tachyarrhythmia and clinical signs such as syncope or exercise intolerance
- Myocardial systolic dysfunction and ventricular dilation +/- CHF. Least common, more likely homozygous form
Meurs VCNA 2017
If an electrical cardioversion shock is delivered at the peak of the T-wave, what can occur?
Increased risk of a fib
ARVC: what is the diagnostic screening criteria for ARVC based on Holter monitoring?
Asymptomatic dog:
0-20 single VPC per 24h = wnl
20-100 VPC per 24h = indeterminate. repeat in 6-12m
100-300 single VPCs per 24h = suspicious
100-300 VPC per 24h with increased complexity (couplets, triplets, V.tach) = likely affected.
300-1000 single VPC per 24h = likely affected
>1000 VPC per 24h = affected, consider treatment
Meurs VCNA 2017
Are biomarkers useful in detection of ARVC in boxers?
Troponin I: inconsistent but when elevated can correlate with VPC number and grade or complexity of the arrythmia
BNP: only useful in boxers with myocardial dysfunction
Meurs VCNA 2017
ARVC: What does a positive heterozygous Striatin genetic test mean? What monitoring is recommended? What breeding is recommended?
At risk of developing ventricular arrhythmia and sudden death. Variable expression => only 40-60% of dogs will develop clinical signs.
Recommended monitoring:
- annual Holter monitor after 4 years of age,
- avoid breeding or only breed to negative
Meurs VCNA 2017
What echocardiographic finding may be a useful prognostic factor in ARVC?
TAPSE - tricuspid annual plan systolic excursion.
Lower in boxers with >50 VPC per 24h.
Lower TAPSE associated with more severe disease and shorter survival times.
Meurs VCNA 2017
What Holter findings in an asymptomatic dog would indicate commencing treatment for ARVC?
- Sustained VTach > 30 seconds.
- increased complexity of arrhythmia including frequent couplets, triplets, bigeminy and/or Ront.
- > 1000 VPC
Meurs VCNA 2017
ARVC: What does an increase in symptoms or increase in number of VPCs per 24h on post-treatment Holter monitor suggest?
Proarrhythmogenic effects of medications. must compare to pre-treatment holter.
Meurs VCNA 2017
TAPSE ……… mm in boxers with >5o VPC/24h on Holter is associated with ……. cardiac survival times and is an independant predictor of …… irrespective of the presence of CHF, echo evidence of LV systolic dysfunction and Holter detection of VT.
TAPSE <15.1 mm is associated with shorter cardiac survival times and is an independant predictor of time to cardiac death irrespective of the presence of CHF, echo evidence of LV systolic dysfunction and Holter detection of VT.
JVIM 2015
What are noted cardiovascular abnormalities that occur with hypothyroidism?
reduced LV function, weak apex beat and sinus bradycardia
What is the risk of a Doberrman Pinscher that has DCM to also develop hypothyroidism?
2.26 fold increased risk - this appears to be due to age and a general risk of the two diseases separatedly
Does hypothyroidism play a role in disease progressio or aiding with treatment success?
No - dogs w/ hypo T and DCM don’t progress more quickly
Treatment of hypothyroidism doesn’t improve DCM
Which two breeds suffer from juvenile DCM?
Portuguese water dogs
familial
autosomal recessie in canin chromosome 8
Died w/in 2-32 weeks from sudden death
Toy Macnhester terrier
Juvenile
sudden death < 1yr
Ettinger
What are key differences in the presentation of Dalmations with DCM?
No a fib oted
no biventricular failure
Low protein diet for urate stones may be associated with increased risk
ettinger
What are some key considerations in Irish Wolfhounds with DCM?
Progression of a fib to chf may be prolonged - 24 months
ettinger
How should a Doberman Pinscher with occult DCM be managed?
Administration of pimobendan has been shown to prolong the time to CHF in DM 718 days vs 441 days
Diagnosis based:
- on holter and >50 VPC / 24 hour period
- echocardiogram - LV end diastolic > 4.6 cm and end diastolic > 3.8
PROTECT study
What are negative prognostic indicators in dogs with DCM?
young age, biventricular failure, AF, severely increased end-systolic volume index, restrictive transmitral flow pattern
Ettinger/Kirks
