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)
