Congenital Dz Mutha Fucka Oh and Acquired too Flashcards by Jonathan Webber | Brainscape

Q

Common Dog Congenital Heart Conditions

A

PDA – Patent Ductus Arteriosis
Aortic & pulmonic stenosis
Atrial Septal defect (ASD)
Mitral Dysplasia

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Q

Common Cat Congenital Heart Conditions

A

Not a big problem in cats
AV dysplasia – most common VSD
James like cock
PDA
Tetrology of Fallot

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Q

Describe a L —-> R PDA

A

**1st L—>R shunting, leads to volume overload (ECCENTRIC Hypertrophy) & L-HF

A Massive L—->R PDA can switch to R—->L

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Q

Describe a R —-> L PDA

A

**2nd R—>L shunting – VERY large PDAs – occurs 6-8 weeks old

“Pink in front & Blue in Back” – Right heart overloaded

***Stimulates EPO from the kidney – can lead to erythrocytosis & hyperviscosity

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Q

PDA clinical signs

A

L–>R = machinery murmur thrill, water hammer pulses (due to changes in pressure)

R–>L = may have systolic murmur, cyanosis, split S2, INCREASED PCV

“Blue in the back pink in the front”

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Q

Radiograph Dx PDA

A

1.

-Ductus Diverticulum
-Enlarged Aorta
-L or R Heart Enlargement

Lung Vessels
- –L-R = lung vessels are prominent – big LEFT heart
—R-L = lung vessels are underperfused – will NOT see vessels

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Q

PDA definitive DX method

A

Contrast Echo for definitive Dx

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Q

PDA breed signalment

A

Min/Toy Poodle, GSD, Collie
Poodles = polygenic trait
Females (3:1)

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Q

PDA L—>R Sx closure complications

A

Aorta, Vagus & Phrenic nerve
PDA will tear & bleed badly 10% of time
Branham sign = marked decrease in HR after tie off, Tx w/Atropine
Animals will wake up PU/PD for a few hours after Sx

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Q

1 Predisposed location for Aortic Stenosis

A

Subvalvular

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Q

Aortic Stenosis is common in what type of dogs?

A

*Common in LARGE BREED DOGS (Newfoudland, Retriever, Boxer, Rotties)
*Cannot certify free of Dz until > 12 mo of age!

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Q

Pathophysiology of Aortic Stenosis

A

Increased afterload —> concentric hypertrophy —-> wall thickens —> decreased contractility
Clinical Signs
Sudden death due to arrhythmias (DDx = VPC

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Q

Dx of Aortic Stenosis (US)

A

**Best way to Dx Heart Dz

Look for concentric LEFT Ventricular Hypertrophy
Narrowing of the left ventricular outflow

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Q

Tx of Aortic Stenosis

A

**Tx is palliative – Tx if see more than 3 VPDs

***Do NOT use Digoxin
DOC = Sotolol
Beta Blockers
Control arrhythmias w/ Sotolol, Lidocaine, Mexilitine

**Sx – lowers pressure gradient but does NOT increase survival
Balloon valvuloplasty

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Q

Aortic Stenosis Prognosis

A

***20% will die w/I 3 years – 70% w/I 1 year

***Predisposes to bacterial endocarditis —> CHF – why control of infections is important

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Q

What occurs with Pulmonic Stenosis?

A

Usually valves – Subvalvular, Valvular (most common), or supravalvular
Valves tend to be dysplastic/thickened & valve cusps can be fused together
Narrowing hypoplastic annulus
Dynamic Obstruction

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Q

Pathophysiology of Pulmonic Stenosis

A

**Resistance to ejection ===> CONCENTRIC hypertrophy of R Ventricle & Arrhythmias (pressure overload)

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Q

Pulmonic Stenosis breed signalment

A

**Beagle, English Bulldog, Chihuahua, Spaniel, ect.

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Q

Pulmonic Stenosis Clinical signs

A

Incidental finding on PE normally
Exercise intolerance, weakness, syncope, sudden death, etc.
Systolic murmur near L heart base
Weak Pulse & mm are normal

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Q

DX Pulmonic stenosis (Radiograph, US)

A

Radiographs

R Atrial Enlargement
Pulmonary Trunk dilation

US

Right ventricular hypertrophy
Flattening of the septum
Enlarged right atrium

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Q

Describe what Ventricular Septal Defect is (VSD)

A

***Failure of septal development – hole in the heart

***Blood will be shunted (L-R) = volume overload ==>L heart enlargement and eventually failure

***Blood goes almost directly to pulmonary artery

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Q

Where is VSD loudest and prognosis?

A

***Generates a murmur – loudest on the right ==> 1st 1 that is loudest on the right ==>

***louder the murmur = better prognosis is

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Q

VSD breed signalment

A

**Common in cats & bulldogs/Keeshunds

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Q

Clinical signs of VSD

A

Small VSD ==> usually incidental as 1st vax appointment
Large VSD ==> Stunted growth & may have Left CHF
Systolic murmur on the RIGHT side – may be a thrill over R-Thorax ==> loud but NORMAL

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Q

4 parts contributing to Tetralogy of Fallot

A

Pulmonic stenosis
Overriding aorta ==> aorta opens in the middle of the septum
VSD usually as large as aortic opening = severe stenosis/cyanosis BLUE ALL OVER
Hypertrophy of the RIGHT Ventricle

No Murmur w/hyperviscosity

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Q

Dx of Tetralogy of Fallot (Lab, Rad)

A

Lab – increased PCV from erythrocytes
Rad
Enlarged right heart (R==>L)
Reduced pulmonary vasculature from undercirculation

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Q

Drug Tx for Tetralogy of Fallot

A

Beta blockers for the right heart to relax
Get rid of excess RBC
Aspirin – increased PCV = prone to clots
No vasodilators – will increase L-R shunt ==> hypoxemia

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Q

What is happening with Atrial Septal Defect (ASD)?

A

Defect between the atria
Blood flows preferentially to RIGHT ventricle
Volume overload in RIGHT ventricle & pulmonary vessels
More blood tries to go through the normal pulmonary outflow tract and can cause turbulence

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Q

ASD are common in what breed?

A

Boxers

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Q

Signs of ASD?

A

Murmurs

*Most dogs are asymptomatic
*Large defects can lead to heart failure

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Q

Pathophysiology of AV Valve Insufficency?

A

Dysplasia of valve & muscles
If on tricuspid side ==> regurgitation during systole & volume overload
If on mitral side ==> regurg on left side
stenosis

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Q

AV Valve Insufficiency signalment?

A

Cats & Large Breed dogs (Labs)

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Q

Endocardial Fibroelastosis signalment

A

Siamese & Bermese Cats

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Q

Endocardial Fibroelastosis Pathophysiology?

A

**Fibrosis of ventricular endocardium – stiffening of the L Ventricular walls

**Stops heart from filling properly

**Leads to dilation & failure by 2-4 months old

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Q

PRAA Pathophysiology

A

PRSS ==> Ligamentum arteriosis constricts esophagus ==> megaesophagus
Will regurgitate when eating solid food
Ballooned esophagus in front of the heart
NOT congenital
May accidently aspirate food ==> foreign body pneumonia

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Q

Tx of Inherited Ventricular Arrhythmias in young GSD?

A

Give sotalol & Mexilitne until 18 mo – can taper off

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Q

3 phases of DCM in Dobermans?

A

Arrhythmogenic Stage 2-5 yo
Arrhythmias
Dobermans = just VPDs
Irish Wolfhounds atrial fibrillation
Occult stage 3-6 yo
Left ventricular enlargement
Classic stage 6-9 yo
Dog in heart failure

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Q

Signs of DCM?

A

**Sudden death – VPD

**L or R HF signs (L-CHF is more common)

**Thin & wasting

**Atrial fibrillations & VPD

**Soft systolic murmurs

**S3 gallop

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Q

(Lab & Rad) Dx of DCM?

A

Lab

*pre-renal azotemia
*Increased liver enzymes
*Low Taurine/Carnitine

Rad

*Dilated heart
*Lungs may show fluid ==>LCHF

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Q

DCM Treatment – ACM Stage

A

**Lone AF, Tx if average HR > 90
Use Holter Monitor

***Drugs to control increase HR = Beta Blockers, Diltiazem

**Digoxin slows heart but is a bad + inotrope – NOT good for controlling “Lone AF”

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Q

DCM Tx - Ventricular Arrhythmias

A

**Tx if they have clinical signs OR R-T phenomenon OR VPDs

***Beta blockers to control VPDs

***Sotolol or Mexilitine + Beta Blockers to control ventricular tachycardias

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Q

Tx - Occult Dilated Cardiomyopathy Stage

A

**Healthy but have decreased fractional shortening

Drugs used to delay onset of DCM:
===>Start @ lower dose and titrate upwards (ACE)

ACE inhibitors – cardioprotective
Beta-Blockers – cardioprotective if started early
Pimobendan: delays failure & increases survival time

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Q

Drugs to Tx @ home to prevent stress in Classic DCM & CHF – mild failure cases?

A

*Furosemide
*ACE inhibitors
*Digoxin/Pimobendan

***Pimobendan vasodilates arteries & veins

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Q

What to do with severe cases of CHF?

A

Hospitalize

**Tx w/ FONS = Furosemide, O2, Nitroglycerin, Sedation

**Improve contractility w/ Pimobendan (vetmedin)

**Tx arrhythmias
-Atrial Fibrillation = Digoxin + Diltiazem
-Beta Blockers

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Q

At home Tx severe CHF?

A

**Maintain low dose Furosemide +
Max ACE inhibitors

**Exercise restriction & low Na diet

**Tx deficiencies

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Q

DCM Prevention?

A

**Use Holter Monitor from >2yrs in susceptible breeds

***Genetic marker enzymes – 1 Doberman = pyruvate dehydrogenase kinase isoenzyme 4

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Q

What 2 drugs increase life expectancy with DCM?

A

ACE & Pimobendan (Pimo safe in cats too)

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Q

DCM in cats can cause what signs?

A

**Acute onset of paresis/paralysis due to thromboembolism

***Dyspnea, Anorexia, Lethargy, Vomiting

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Q

What is commonly found on Physical exam with DCM in cats?

A

***Bands of focal retinal degeneration

**Thromboembolism

**Pleural effusion

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Q

Secondary HCM causes in cats?

A

***Genetic mutations in Main Coon & Ragdoll (mutation w/ myosin binding protein C)

**HyperT4
**Systemic Hypertension
**Aortic Stenosis
**Dysplastic Mitral Valve ==> Pressure Overload = HCM

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Q

What is Hypertrophic obstructive cardiomyopathy (HOCM)?

A

**Hypertrophied intraventricular septum encroaches on the LV outflow tract ==> obstruction

HOCM = Big L atrium

**Enlarged septum can cause misalignment of the mitral valve ==> mitral valve obstructs LVOT during systole

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Q

What is a SAM?

A

**Systolic Anterior Motion of the anterior mitral leaflets ==> regurg & mitral insufficiency (also LA enlargement)

Q

Why does hypoxemia occur with HCM?

A

**Decrease capillary density

***Cells get bigger but capillaries do NOT increase ==> they get damaged from muscular force of enlarged cells

Q

HCM DX? (Lab, Rad)

A

Lab

**Biomarkers in blood = Increase cTn-1, Increase Pro-BNP, Increase CK, Increase K+
**Normal coagulation

Rad

**Valentine shaped heart
- -50%may just be big & round like DCM

***Left atrial enlargement – CONCENTRIC hypertrophy

Q

HCM TX before HF?

A

Slow heart w/ Beta Blockers (usually Atenolol)
* **Unless cat has asthma
ACE inhibitors if significant LA enlargement
Ca+ Channel Blockers – Diltiazem to slow heart
ACE inhibitors & low dose furosemide to prevent pulmonary edema
PLAVIX
LOW DOSE Aspirin (drops thromboxane)
Low MW heparin

Q

What does a “swirling smoke sign” indicate?

A

Predisposed to ATE

Q

Cats with HCM should you give fluids?

A

No heart failure – give fluids

Heart failure – no fluids

Q

HCM Tx once in HF?

A

FONS!
Traditional Additional Tx

**Beta Blocker for obstructed(HOCM)/Catecholamine release
**Non-obstructed = Diltiazem
Ace inhibitors

***Atenolol

***Spirolactone to block RAAS fibrosis & hypertrophy (can cause ulcerative facial dermatitis)

**Na restricted diet
**Reduce stress

Q

Method for initially trying to dx the cause of HCM in cats?

A

**Diagnosis by exclusion of other non-genetic causes of

hypertrophy such as hyperthyroidism and systemic hypertension

Q

HCM Clinical signs in cats?

A

–HF cats = bradycardia (give Dobutamine +inotrope)

*Sudden death – VPD
*Syncope
**Dyspnea
*Paresis from thromboembolism
*Steroid administration recently

**Signs of CHF
Murmurs – more predictive if they do NOT have murmurs
**Ventricular heaves
**Pulses (weak)**
**S4 gallop
*Vibration, can be normal in older cats

*Arrhythmias
*ATE – very painful

Q

What is the Gold standard for Dx HCM in cats and if they have CHF?

A

Thoracic Radiographs

■ Apparently healthy cats; screening with a generally very poor NPV
■ Dyspneic cats; gold standard but still some limitations associated
with the lack of pathopneumonic findings for CHF

Echocardiography

■ Apparently healthy cats with heart murmurs, gallops, or
arrhythmias; gold standard with high PPV and NPV
■ Dyspneic cats; will tell you if there is underlying heart disease
of the type and severity that could lead to CHF but does not
diagnose CHF

Q

Will a cat with asymmetric septal hypertrophy present with a murmur?

A

**Will present with murmur if cat has a HOCM ==> obstruction leading to mitral insufficiency ==> regurg back into L atrium during systole (Systolic Anterior Motion of the anterior mitral leaflets) = murmur

**No murmur if no obstruction present in LVOT, (no turbulance or increased peak flow velocity = no murmur) but still Diastolic filling problem

Q

What is the key prognastic factor with cats in heart failure?

A

Left atrium size (>20mm = very poor prognosis)

Q

What are the 3 forms of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

A

Concealed form (VPDs)
Overt form
==>Syncope, exercise intolerance, weakness, SUDDEN DEATH
Myocardial dysfunction form
Go into R CHF (less common)

Q

Pathophysiology of Boxer Cardiomyopathy – familial Ventricular Arrhythmia (FVA)

A

Genetic in boxers

Response to dz

**Connection 43 protein in gap junctions
**Calstabin protein in endoplastic reticulum

Gene causing dz
***Striatin gene

Q

ARVC Dx in Boxers?

A

***Post mortem to Dx – histo to see fatty infiltration

***Live animal = Halter Monitor - GOLD STD for Dx

**Heart generally looks normal

***Proteins in serum
cTn-1 levels in serum are higher in affected animals & directly proportional to the # VPCs/24 hours

Q

When to Tx ARVC and what to Tx with?

A

Asymptomatic w/ > 1000 VPDs, VT, or R on T phenomenon
Sotalol (want to see at least 80% improvement) Or combo w/Mexillitene & Atenolol
Evaluate Tx w/Holter Monitor

Carnitine can help with Boxers

Q

ARVC in cats

A

**Fibrofatty infiltrate into the right ventricle leads to marked ventricular enlargement & failure

**Syncope because of Arrhythmias

Sotolol helps

Q

What is Myxomatous AV Valvular degeneration?

A

Degenerative disorder of the Mitral valve or tricuspid valve
75% of all CV Dz cases

***Thickening of the valve causes regurgitation of blood to the atrium during systole

***Chordae tendonae may become thickened & rupture causing prolapse of the valve during systole

Q

How does the heart compensate in MAVVD w little regurg?

A

Increase sympathetic tone

Q

When is RAAS activated in MAVVD?

A

When the dz is severe & animals is on diuretics (Furosemide)

Q

What type of hypertrophy is associated w/ MAVVD?

A

Eccentric hypertrophy of L ventricle – Volume Overload

Q

What do jet lesions cause?

A

Rupture of L atrium & cardiac tamponade

Q

How do dogs w/ MAVVD present?

A

Asymptomatic murmur (louder = more regurg/ worse prognosis)
Large airway compression = Syncope
L atrial rupture & cardiac tamponade

Acute heart failure
Chronic CHF

Q

If a small dog comes in coughing – What is your DDx?

A

Small airway dz
Collapsing trachea
Compression of bronchus from MAVVD
MAVVD CHF

Q

What is an early sign of MAVVD?

A

Systolic click

**Occurs when elongated chordaete tendonae snap tight as the degenerative valve protrudes into the L atrium in mod systole

Q

How does MAVVD appear radiographically?

A

L atrial enlargement ===> May not see in acute onset due to blown chordae tendinae
Lung edema
Enlarged heart (fills 3 ribs spaces)

Q

How does MAVVD appear on echo?

A

*Function is normal

*LA is enlarged
*Valves look thickened & club shaped

Q

When murmur is detected in asymptomatic dog what is the most likely cause?

A

MAVVD

Q

How do you tx MAVVD dogs w/ a cough but not HF?

A

**Arteriodilators (Hydralazine, ACE inhibitors)

**bronchodilators

Q

How do you tx MAVVD dogs w/ mild to moderate HF?

A

**Medical tx @ home

Furosemide to control pulmonary edema
ACE inhibitors (enalapril)
Na restricted diet & limit exercise

Q

How do you tx MAVVD dogs in severe HF?

A

***Tx in hospital

**Supplemental O2

**IV furosemide until RR has decreased by 10 breathes/min

*Nitroprusside
*ACE inhibitors
*Spironlactone
*Pimobendan

**Hydralazine

**Amlodipine (Ca channel blocker)

Q

When should you not Tx with Pimobendan?

A

Do not use until onset of clnical signs because can be deleterious

Q

What can pulmonary hypertension associated w/ MAVVD cause?

A

R heart failure

Q

What is stage A of chronic valvular heart disease?

A

Normal dogs @ high risk
Cavelier king charles spaniel & small breeds
**Should have a yearly check up
**If there is a murmur, do NOT breed

Does not require drugs or diet therapy

Q

What is stage B1 of chronic valvular heart dz?

A

***Structureal heart dz, but no signs of CHF

***Have no radiographic or echo signs of remodeling

**Recheck every year
Does NOT require Tx

Q

What is stage B2 of chronic valvular dz?

A

***Have structural heart dz, but no clinical signs

***Do have radiographic & echo signs of L heart enlargement

Can tx w/ ACE inhibitors, beta blockers or mild Na restriction

Q

What is stage C of chronic valvular dz?

A

***Have past or current signs of HF

***@ home Tx = furosemide, ACE inhibitors, Pimobendan, spirolactone, beta blockers, diet changes

In hospital = FONS

Q

What is stage D of chronic valvular dz?

A

***End stage HF
**Max furosemide dose

Free access to water
Remove body cavity fluid

***Nitroprusside + Ace inhibitor + Pimobendan

Diet change
**No Beta Blocker

Q

Endocarditis commonly occurs in what part of the heart?

A

Normally develops in aortic & mitral valves

Q

Endocarditis infection leads to?

A

*Dysrhythmias
*VPDs
*Tachycardia
*Heart block
*Septic emboli
**Glomerulonephritis & arthritis from immune response

Q

What Hx is associated w/ dogs w/ endocarditis?

A

**Invasive Dx or Sx procedure

**Urinary, skin, or oral infection

Usually reports signs of systemic infection

Q

How does endocarditis present on PE?

A

**Fever + heart murmur

**Bounding pulses

**Aortic insufficiency

May see pneumonia, renal or neuro signs caused by emboli

Q

What so you see on lab work w/ endocarditis?

A

Neutrophilic leukocytosis w/ L shift
Anemia, thrombocytopenia
elevated BUN, creatinine & liver enzymes

Q

How does endocarditis appear on echo?

A

Appear has vegetations on the mitral/aortic valve

Affected valves are hyperchoic, thickened & irregular

Q

How do you treat endocarditis?

A

Tx arrythmias & HF

Parenteral bactericidal ABX for @ least 1-2 weeks

Followed by oral ABX for 2-4 months

Q

What ABX are used initially to Tx endocarditis?

A

Clindamycin

Enrofoxacin

Q

What cardiac dz may predispose dogs to endocarditis?

A

Subvalvular aortic stenosis

Q

What are the guidelines for prevention of endocarditis in heart sx?

A

Ampicillin or amoxicillin

1 hour before procedure & 2-3 days after

Q

What are the causes of pericardial effusion?

A

CHF
Hypoalbuminemia
Pericarditis
Hemorrhage
Neoplasia
Idiopathic

Q

What tumors cause pericardial effusion?

A

Hemangiosarcoma
Heart base tumor-parpganglioma
Lymphosarcoma
mesothelioma

Q

How do dogs w/ pericardial effusion present on PE?

A

Pale mm
Slow CRT
Muffled heart sounds
Poor pulses
Jugular distension 
Ascites
No heart murmur

Q

What is the predilection site for hemangiosarcoma?

A

R auricle & atrium

Q

What is the predilection site for paragangliomas?

A

Base of aorta

Q

Why are diuretics contraindicated in pericardial effusion?

A

They decrease blood volume & cause further collapse of the cardiac chambers

Q

How do you Tx pericardial effusion?

A

Immediate percardiocentesis

Q

What heart problems are seen in Boxers?

A

Boxer Cardiomyopathy (ARVCM)
Dilated Cardiomyopathy (DCM) – Fibro-Fatty Type
Aortic Stenosis
Atrial Septal Defect
Supraventricular Tachycardia
VPD’s ==> Bigeminy, Trigeminy 
Endocarditis
Carnitine deficiency

Q

What heart problems are specific to Doberman’s?

A

Dilated Cardiomyopathy – Fibro-fatty Type & Familial

Q

What heart problems are specific to bulldogs?

A

Pulmonic Stenosis

Ventricular Septal Defect

Q

What heart problems are found in Giant/Large breeds?

A

Dilated Cardiomyopathy – Wavy Type

AV-Valve Insufficiency

Endocarditis

Q

What heart problems are specific to German shepards?

A

Inherited Ventricular Arrhythmias (puppies)

PDA (F3:M1)

Endocarditis

Pericardial Effusion (Hemangiosarcoma)

Q

What heart problems are found in Brachycephalic breeds?

A

Pericardial effusion - paraganglioma

Q

What heart problems are found in cats?

A

Hypertrophic Cardiomyopathy (HCM)
Ventricular Septal Defect
Tetrology of Fallot
AV Valve insufficiency 
PRAA – 4th in kittens &amp; Megaesphagus

Q

What heart problems are found in Asian cats?

A

Endocardial Fibroelastosis

Q

What are some diuretics that inactivate the RAAS system and are useful when furosemide dose has gotten too high in conjunction with ACE Inhibitors?

A

**Thiazides (synergistic effect w/ furosemide)

**Spironolactone (aldosterone antagonist)

Q

Why are ACE inhibitors so useful in slowing the progression of HF?

A

**They allow the dose of furosemide to be reduced which helps prevent azotemia from occuring.

**Block potent vasoconstrictor effects of angiotensin II & myocardial remodeling effects and fibrosis induced by aldosterone

Q

Why do we try to maximize ACE inhibitor dose and minimize furosemide dose?

A

Want to increase volume in animal to increase CO ==> increased GFR and less chance of causing dehydration, azotemia, and electrolyte imbalances

Q

PDA murmur type, sound, pulse type?

A

L==>R shunt
* Systolic and Diastolic murmur
* Machinery murmur
* waterhammer pulse
R==>L shunt
* Systolic to absent murmur

Q

Will an EKG detect a PDA?

A

NOOOOO

Q

Only way to directly cause vasodilation of pulmonary artery?

A

Oxygen and Sildenafil (useful for reducing amount needed to shunt in PDA)

Q

Aortic Stenosis type of murmur and pulse?

A

**Systolic & Diastolic murmur

**Weak peripheral pulse but very strong at apex

Holosystolic (still hear heart sounds)

Q

When the aorta outflow is obstructed what happens?

A

Pressure overload = CONCENTRIC hypertrophy

Q

3 main conditions almost always occur with Aortic Stenosis?

A

Synchope
Weakness
Sudden death

Q

Why do dogs rarely develop signs of LCHF with aortic stenosis?

A

Few make it to LHF because DECREASED CO from lack of peripheral blood flow + arrhythmias (VPD & VTach) = sudden death

Q

In Pulmonary Stenotic dogs where sx is not possible, what drug may improve Diastolic fxn and arrhythmias?

A

Atenolol b/c it is B1 selective and has less effect on the lungs

Q

ASD murmur type?

A

May be murmur over base of heart due to relative pulmonic stenosis (systolic murmur),

relative tricuspid stenosis (diastolic murmur), and maybe splitting of S2

Q

How can you determine the difference between Aortic Stenosis and ASD?

A

Only way is ultrasound

Q

A bounding hyperkinetic pulse is indicative of what?

A

Aortic insufficiency