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Year 4 Small Animal Studies > Cardiology: Valvular Heart Disease > Flashcards

Cardiology: Valvular Heart Disease Flashcards

1
Q

What is the most common cardiac disease in the dog?

A

Myxomatous degeneration of the atrioventricular valves
Usually the mitral valve

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2
Q

What is the mean survival time once a dog develops congestive heart failure?

A

Less then one year

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3
Q

What is the definition of myxomatous degenerative valvular disease?

A

Nodular thickening of the cardiac valve leaflets associated with proteoglycan accumulation

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4
Q
  1. What breeds are affected?
  2. How are different breeds affected differently?
A
  1. Affects small breed dogs in particular- usually middle aged
  2. Large breeds can be affected and usually progress more rapidly

CKCS have earlier age of onset

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5
Q

What are potential aetiologies of myxomatous degenerative valvular disease

A

Idiopathic
* Abnormalities in collagen and ECM
* Abnormalities of serotonin signalling
* Mechanical stress
* Genetic basis

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6
Q

Describe the pathology of MDVD?

A

Macroscopically
* Deformed, thickened leaflets- rolled edges, can prolapse
* Elongation and thickening of chordae tendinae
* Jet lesions/left atrial tears
* LA dilation
* LV dilation

Microscopically- accumlation of glycosaminoglycans

Eccentric hypertrophy- volume overload

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7
Q

Describe the pathophysiology of MDVD

A
  • Prolonged, compensated, preclinical phase- gradual development of left atrial and left ventricular remodelling
  • Congestive heart failure develops- severe mitral regurgitation, elevated left atrial pressure and RAAS increases preload
  • Pulmonary hypertension occurs to chronially elevated left atrial pressure and can be seen secondary to concurrent respiratory/lung pathology
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8
Q

Describe how mitral regurgitation leads to increased afterload

A
  • Mitral regurgitation causes reduced forward stroke volume
  • Increase in volume of blood entering LV in next diastole- volume overload
  • This causes drop in blood pressure- activation of RAAS
  • Vasoconstriction which increases afterload
  • Increased mitral regurgitation
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9
Q

What are the neurohumoral effects of MDVD?

A

Sympathetic nervous system activation
* Tachycardia
* Positive inotrope
* Vasoconstriction

RAAS
* Retention of Na and fluid
* Increased circulatory volume
* Vasoconstriction

Remodelling
* eccentric myocardial hypertrophy- improved systolic function

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10
Q

What are the sequalae of MDVD neurohumoral effects?

A

Sympathetic-tachy/vasoconstriction
* toxic for myocytes intracellular Ca overload
* Increased O2 demand
* cell death- decrease in systolic function

RAAS
* Increased volume- congestion- increased hydrostatic pressures

Remodelling- eccentric hypertrophy
* fibrosis (arrhythmias)
* Increased wall stress
* Dilation of the valvular annulus-

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11
Q

What is the ACVIM consensus statement on MDVD staging?

A
  • A- at risk
  • B1- murmur no enlargment
  • B2- murmur and enlargment
  • C1- hospitalised CHF
  • C2- CHF at home
  • D1- refractors hospitalised
  • D2- refractory at home
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12
Q

What are the likely clinical presentations to MDVD?

A
  • Adult dogs
  • Small breeds
  • Heart murmur- asymptomatic
  • Cough
  • Breathing changes
  • Excercise intolerance
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13
Q

What is marked left atrial enlargment usually associated with?

A

Severe disease
* Compression of the caudal mainstem bronchi- chronic cough
* Increased filling pressures-backpressure pulmonary oedema
* Forwards/backwards failure leads to reduced capability to excercise

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14
Q

What may the history of MDVD be?

A
  • Abnormal respiration
  • Cough
  • Excercise intollerance
  • Heart murmur
  • Collapse, syncope
  • family history
  • Increased water intake
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15
Q

What should be assessed in a physical examination with suspected MDVD?

A
  • Breathing pattern- before touching patient
  • Tacypnoea/dyspnoea
  • MMs- often normal
  • Ausculatation
    Lungs- increased sounds, crackles, tachy/dys (oedema)
    Heart
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16
Q
  1. What different heart diseases hypotension/hypotension suggest?
  2. How can blood pressure be measured?
A
  1. Hypertension- increased mitral regurgitation
    Hypotension- CHF
  2. Doppler, oscillometric- forelimb/hindlimb, tail
17
Q

What are the different cardiac biomarkers used in clinical pathology?
What are they markers of?

A

NT-proBNP
* marker of heart failure
* released by atrial/ventricular stretch
* Helpful to differentiate resp/cardiac cough
* Severity of disease
* Prognostic

NT-proANP
* released by atrial stretch
* More studies needed

Troponin I
* Myocardial cell damage marker
* Prognostic indicator
* Response to treatment

Pre-renal azotaemia in CHF with reduced cardiac output

18
Q

What radiographs can be used for diagnosis?

A

Consider patient stability
DV and right lateral
* Cardiac size- tracheal elevation, bulges, VHS
* Pulmonary vessels
* Lung infiltrate
* Effusions

19
Q

How is a heart measures using the VHS?

vertebral heart scale

A
  1. Draw a line from the base to the apex
  2. Draw a line at the widest point
  3. The number of vertabrae transversed from T4 are added together for the VHS
20
Q

What does this image show?
What is the arrow pointing to?

A

Cardiomegaly
Arrow = LA

21
Q

What is the arrow pointing to?

A

Dilated LA

22
Q

What does this image show?

A

Congested pulmonary lobar vessels

23
Q

What does this image show?

A

Congested pulmonary lobar vessels

24
Q

What are common arryhtmias of MDVD?

A
  • Supraventricular premature complexes
  • Atrial fibrillation
  • Ventricular premature complexes

DOES NOT MEAN CHF

25
Q

What can echocardiography be used for?
What does it show for MDVD?

A

Confirm diagnosis, Progression, severity

MDVD
* Enlarged LA>LV
* Significant mitral regurg
* Dilated LV
* Rounded LV
* Hyperdynamic systolic function
* Tricuspid regurg
* Pulmonary hypertension
* LA 1.5x size of aorta

26
Q

What is the purpose of an ambulatory ECG?

A
  • 24 hr ECG
  • Quantification of arrhythmias
  • Atrial fibrillation: response to treatment
  • VPC- number, complexity
27
Q

What treatment is indicated at each stage of CHF?

A
  • A- none
  • B1- none
  • B2- pibobendan
  • C- CHF therapy as standard: FPAS
  • D- as for C with increasing doses and additional (sequential nephron blockage)
28
Q

What is the standard CHF therapy?

A
  • Furosemide
  • Pimobendane
  • ACE inhibitors
  • Spironolactone
29
Q

What drugs can be used for the treatment of the following problems?
1. Arryhtmias
2. Pulmonary hypertension

What neutraceuticals can be given?

A
  1. Supraventricular- diltiazem, digoxin
    Ventricular- sotalol
  2. Sildenafil, Pimobendan

Neutraceuticals- Omega 3 fish oils, taurine

30
Q

What are the predictors of prognosis of MDVD?

A
  • LV dimensions
  • LA enlargment
  • Rupture of major chorda
  • NT-proBNP
31
Q
  1. What is the definition of endocarditis?
  2. What are the potential infectious agents?
A
  1. Infection of 1 or more endocardial surfaces
  2. Streptococcus spp, staph, E.coli, Pseudomona, Bartonella
32
Q

What are the requirements for infective endocarditis?

A
  • Bacteriaemia- infection, IV catheter, surgery (rancid teeth)
  • Damaged endothelium- turbulence, high velocities
  • Ability to adhere
  • Hypercoagulable states
33
Q

What does infective endocarditis cause in the heart?

A
  • Vegetations on endocardial surface of leaflets- small nodules, polypoid
  • Perforated, deformed, calcified
  • Microscopic findings- platelets, RBCs, WBCs, bacteria, fibrin, fibrous tissue
34
Q

How is infective endocarditis diagnosed?

A
  • Haematology
  • Biochemistry
  • Blood culture- prior to ABs, aseptic technique
  • Method- at least 3 puncture sites, 10ml per sample
  • Echocadiography
    Valvular vegetations
    Size- risk embolisation
    Regurg- murmur
35
Q

What are the different features that mean either major criteria or minor criteria for infective endocarditis?

A

Major
* Positive echo- vegetative, erosive, abscess
* New valvular insufficiency
* Positive blood culture- <2 positive cultures, >3 positive cultures with skin contaminant

Minor
* Fever
* Medium/large breed
* Subaortic stenosis
* Thromboembolic disease
* Immune-mediated disease
* Positive culture not meeting major criteria
* Bartonella serology >1:1024

36
Q

What therapy can be given for infective endocardititis?

A

ABs
* Bactericidal
* Combination
* IV initially
* Minimum 6 weeks

Anticoagulation- clopidogrel, asprin
Guarded prognosis

Year 4 Small Animal Studies (97 decks)

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