Degenerative Valve Disease Flashcards by Corinne Perra

What is the most common acquired heart disease in dogs?

Degenerative valve disease

—> mitral valve disease (most common)
—> tricuspid valve disease

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What breed of dog is most commonly seen with degenerative mitral valve disease?

King Charles spaniel

-increased serotonin May contribute to valve remodeling

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What pathology occurs in affected valves during DMVD?

Accumulation of glycosaminoglycans, fibrosis, and loss of collagen

Grossly leaflets are thickened, nodular, and shortened/curled

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How does DMVD affect blood flow?

Malformed leaflets result in inadequate coaptation and valvular regurgitation

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DMVD can lead to _________ overload and result in what changes to the heart?

Volume

Atrial and ventricular dilation
Eccentric hypertrophy

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What happens if DMVD worsens past the limits that the atria/ventricles can comply?

Congestive heart failure

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What is stage A of DMVD?

High risk patient that currently has no structural disorder of the heart (eg every King Charles Spaniel)

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What is stage B of DMVD?

Patient with structural heart disease (murmur of mitral valve regurg is present) but have not developed clinical signs caused by heart failure

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What is stage B1 of DMVD?

Structural heart disease present but asymptomatic

—> no radiographic or echocardiography evidence of cardiac remodeling

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What is stage B2 of DMVD?

Asymptomatic patients that have hemodynamically significant valve regurg

—> radiographic and echo with left sided heart enlargement

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What is stage C DMVD?

Patients with past or current clinical signs of heart failure associated with structural heart disease

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What is stage D DMVD?

Patient with end-stage disease
Clinical signs of heart failure caused by degenerative valve disease that are “refractory” to standard therapy

-furosemide dose >12mg/kg/day required to maintain patient comfort

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What is the signalment of DMVD?

Small and med breed
Middle age to older
-King Charles spaniel can have this as young adults

Male>female

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Where do you heart a murmur that you would associate with DMVD?

Left apical systolic murmur

Some have a mild systolic click with or without murmur (prolapsing valve)

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T/F: dogs with stage B1/2 DMVD should have normal heart rate, respiratory rate, and normal femoral pulse

True

lung sounds will also be normal unless there is concurrent respiratory disease

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T/F: dogs with stage B2 DMVDdo not have any clinical signs

True

You hear a left apical systolic murmur in an older dog, what diagnostics should you do to follow. Up?

Thoracic radiographs to evaluate cardiomegaly and baseline of lungs and vasculature e

BP for systemic hypertension

CBC, biochem, UA
-asses cardiac vs non cardiac, co-morbidities, baseline values

Echocardiography (gold standard)-definitive diagnosis and staging

What radiographic signs can point to an enlarged left atrium?

Lateral view - dorsal deviation of the trachea

DV- cowboy sign (branching of mainstem bronchi around the LA)

If any cardiopulmonary signs are present (ie cough, increase RR, collapse/syncope, abnormal lung sounds) what should be your first diagnostic test?

Thoracic radiographs

T/F: echocardiography is the gold standard for the diagnosis of L-sided CHF

False

Thoracic radiographs

What is the criteria for diagnosis of L-sided CHF on thoracic radiographs?

LEFT sided cardiomegaly with mod/severe atrial enlargement

Intersitial +/- alveolar pulmonary infiltrates

Enlargement of the cranial or caudal pulmonary veins (not always seen)

What is the typical presentation of stage C DMVD ??

History of .. increased resp rate/ cough/ collaspse/syncope/ exercise intolerance

Left apical systolic murmur ALWAYS present, often high grade

Normal heart rate or tachycardia

Tachypnea
+/- Dyspnea and cyanosis

Normotensive and normothermic

What is the best radiographic view to view the caudal vessels of the heart?

Dorsoventral

Heart falls forward, good contrast in lungs

What are the cardiac biomarkers ? What is most commonly measured in DMVD?

B-type natriuretic peptide (BNP) - most commonly used

Atrial natriuretic peptide

Cardiac troponin

—>not a stand alone test, not specific for certain heart diseases
—> asses risk of developing CHF

A NT-proBNP > __________ suggests high risk of developing CHF within 6-12months

1500

How do you treat stage A DMVD?

No clinical disease or structural heart disease Monitor for murmur/click annually or biannually

How do you treat stage B1 DMVD?

No drugs/dietary therapy Monitor murmur, echo, radiographs annually or biannually

How do you treat B2 DMVD?

ACE inhibitor Pimobendan —> both shown to increase time before developing CHF Can recommend both drugs in dogs with moderate/severe LAE and LV remodeling

How is acute stage C DMVD treated?

Management should involve cardiologist Parenteral furosemide (IM or IV) Pimobendan O2 as needed +/- topical nitroglycerin —> ICU for severe pulmonary edema= nitroprusside CRI, dobutamine if systolic dysfunction

How is chronic stage C DMVD treated>

Oral furosemide Pimobendan ACEi once patient is eating normally Spironolactone a few weeks later

What is the prognosis for dogs with DMVD?

Stage b1- good >5yrs Stage B2- fair 2-5+years Stage C- poor (6-8months) stage D- poor (<3months) —death is usually due to euthanasia due to poor quality of life

Sleeping/resting respiratory rate is a reliable indicator of L-sided CHF in dogs. What respiratory rate can indicate that the patient should be evaluated for CHF?

>30br/min Animals in stage C should be monitored daily B2 patients should be monitored weekly

What are the clinical signs seen in degenerative tricuspid valve disease?

Abdominal distention Tachypnea/dyspnea/cough if there is large amount of pleural effusion Exercise intolerance

A right apical systolic murmur High normal heart rate or tachycardia What valvular disease is this characteristic of?

Degenerative tricuspid valve disease

Degenerative valve disease is usually seen in what cats?

Middle age to older cats Less common than in dogs

For cats with degenerative valve disease, how does treatment differ than dogs?

Drug therapy and monitoring as per dog + anticoagulant + thoracocentesis