Coughing with heart disease Flashcards
What is the association between increased LA size and cough?
Limited evidence of association (although some)
Similar breeds get MVD and tracheal collapse/ chronic bronchitis, bronchomalacia etc
There is a possible association between VHS increases and differentiating between a cardiac and non cardiac cough
What is the association between CHF and cough?
The actual pulmonary oedema unlikely to be associated with the cough, likely to be the other bits of the disease causing coughing
There are not cough receptors in the alveoli so unless the whole lungs are flooded you shouldn’t see a cough
What are the main ddx for collapse?
circulatory - haemorrhage/ anaemia, cardiovascular, hyperviscosity, reflex syncope, reduced vascular patency
Endocrine - addisons, phaeochromocytoma, low BG, low Ca
Respiratory - URT obstruction, severe laryngeal paralysis, thoracic wall/ pleural space disease, haemoglobin abnormalities
Neuromuscular - Exercise induced collapose, myopathies, MG, neuropathies
Neurological - spinal disease, brain disease, epilepsy, hepatic encephalopathy, narcolepsy/ cataplexy
What is syncope?
Syncope: sudden transient loss of consciousness associated with loss of postural tone (collapse)
• Collapse into lateral recumbency (faint)
• +/‐ limb rigidity, opisthotonus,
• micturition, vocalisation
• Profound hypotension/ asystole – “hypoxic seizure” preceded by loss of muscle tone
• Presyncope – transient ataxia/weakness, esp HLs
• Rapid recovery
How can you identify a seizure?
• preceded by atypical limb/facial movement, staring,
prodromal “aura”
• persistent tonic/clonic motion, defecation,
• Post‐ictal aura/dementia, neurologic deficits
• Usually at rest
• Seizures during exercise/ excitement extremely rare
but reported occasionally
Outline reflex syncope
• Neurocardiogenic (vaso‐vagal)
Most common in small brachycephalic dogs, stimulated by excitement - get a reflex bradycardia and faint
• Situational – cough/ micturition/ vomit
• small breed dogs with DMVD (cough/ excitement),
• phaeochromocytoma, altered autonomic tone (GI
disease)
• Anaemia (viscosity?)
What are the standard ix done with collapse?
• CBC, biochem, urinalysis • SBP +/‐ endocrine tests. • ECG – especially if arrhythmia present • Echo – r/o cardiac structural disease • Ambulatory ECG (Holter monitoring) +/‐ event recording • ? Rectal temperature test • Consider internal medicine/ neurology input!
What are the cardiac causes of collapse?
- Arrhythmias – tachy/brady DCM, ARVC
- Reduced cardiac output: DCM, DMVD, hypovolaemic
shock - Reduced cardiac filling – HCM, PE , cardiac neoplasia
- Cardiac outflow obstruction – SAS, PS, neoplasia/ thrombus, PHT, PTE, HOCM (cats), dynamic LVOT obstruction in young dogs (rare)
- Cyanotic disease (R‐L shunts) – R‐PDA, ToF, Eisenmengers
What are the componenets of BOAS?
combinations of stenotic nares, an overlong soft
palate, laryngeal or tracheal hypoplasia and eversion of the laryngeal saccules
What is suggestive of CO poisoning?
brick red mucous membranes
Outline methaemoglobinaemia
Methaemoglobin is formed as a result of oxidative damage to the haemoglobin caused by toxic oxidants such as nitrates, topical anaesthetics, and raw or cooked onions (and paracetamol in the cat). Mucous membranes may be cyanosed or tinged brown, but the presence of brown discoloration of blood spots collected on white filter paper is highly suggestive of methaemoglobinaemia
What can abruptly reduced cardiac output?
■ Obstructive lesions within the vasculature returning
blood to the right side of the heart;
■ Decreased right ventricular filling due to cardiac tamponade (usually caused by pericardial effusion);
■ Restrictive ventricular filling (eg, due to constrictive
pericarditis, constrictive myocardial disease);
■ Tricuspid stenosis;
■ Intracardiac neoplasia;
■ Heartworm disease;
■ Thromboembolism.
What suggests pericardial effusion?
Pericardial effusion may be suspected because of
poor peripheral pulse quality, muffled heart sounds on
auscultation, ascites, jugular venous distension and a
globoid cardiac silhouette on radiography, and can usually be diagnosed quite easily using two-dimensional ultrasound.
What are the most common arrhythmias causing collapse?
in dogs are sustained ventricular tachyarrhythmias, high grade second degree and third degree atrioventricular block, and periods of sinus arrest/asystole resulting from the ‘sick sinus’ syndrome
What are ventricular tachyarrhytmias associated with?
systemic disease states, electrolyte abnormalities, acidbase disturbances, hypoxaemia, severe abdominal disease (especially pancreatic and splenic) and neurological disease, or may be due to primary myocardial disease.
