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RUSVM SAM 1 > Degenerative Valve Disease > Flashcards

Degenerative Valve Disease Flashcards

1
Q

What is the most common acquired heart disease in dogs?

A

Degenerative valve disease

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

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2
Q

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

A

King Charles spaniel

-increased serotonin May contribute to valve remodeling

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3
Q

What pathology occurs in affected valves during DMVD?

A

Accumulation of glycosaminoglycans, fibrosis, and loss of collagen

Grossly leaflets are thickened, nodular, and shortened/curled

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4
Q

How does DMVD affect blood flow?

A

Malformed leaflets result in inadequate coaptation and valvular regurgitation

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5
Q

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

A

Volume

Atrial and ventricular dilation
Eccentric hypertrophy

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6
Q

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

A

Congestive heart failure

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7
Q

What is stage A of DMVD?

A

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

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8
Q

What is stage B of DMVD?

A

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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9
Q

What is stage B1 of DMVD?

A

Structural heart disease present but asymptomatic

—> no radiographic or echocardiography evidence of cardiac remodeling

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10
Q

What is stage B2 of DMVD?

A

Asymptomatic patients that have hemodynamically significant valve regurg

—> radiographic and echo with left sided heart enlargement

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11
Q

What is stage C DMVD?

A

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

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12
Q

What is stage D DMVD?

A

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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13
Q

What is the signalment of DMVD?

A

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

Male>female

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14
Q

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

A

Left apical systolic murmur

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

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15
Q

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

A

True

  • lung sounds will also be normal unless there is concurrent respiratory disease
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16
Q

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

A

True

17
Q

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

A

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

18
Q

What radiographic signs can point to an enlarged left atrium?

A

Lateral view - dorsal deviation of the trachea

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

19
Q

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

A

Thoracic radiographs

20
Q

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

A

False

Thoracic radiographs

21
Q

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

A

LEFT sided cardiomegaly with mod/severe atrial enlargement

Intersitial +/- alveolar pulmonary infiltrates

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

22
Q

What is the typical presentation of stage C DMVD ??

A

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

23
Q

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

A

Dorsoventral

Heart falls forward, good contrast in lungs

24
Q

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

A

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

25
Q

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

A

1500

26
Q

How do you treat stage A DMVD?

A

No clinical disease or structural heart disease

Monitor for murmur/click annually or biannually

27
Q

How do you treat stage B1 DMVD?

A

No drugs/dietary therapy

Monitor murmur, echo, radiographs annually or biannually

28
Q

How do you treat B2 DMVD?

A

ACE inhibitor
Pimobendan

—> both shown to increase time before developing CHF

Can recommend both drugs in dogs with moderate/severe LAE and LV remodeling

29
Q

How is acute stage C DMVD treated?

A

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

30
Q

How is chronic stage C DMVD treated>

A

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

31
Q

What is the prognosis for dogs with DMVD?

A

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

32
Q

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?

A

> 30br/min

Animals in stage C should be monitored daily
B2 patients should be monitored weekly

33
Q

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

A

Abdominal distention

Tachypnea/dyspnea/cough if there is large amount of pleural effusion

Exercise intolerance

34
Q

A right apical systolic murmur
High normal heart rate or tachycardia

What valvular disease is this characteristic of?

A

Degenerative tricuspid valve disease

35
Q

Degenerative valve disease is usually seen in what cats?

A

Middle age to older cats

Less common than in dogs

36
Q

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

A

Drug therapy and monitoring as per dog

+ anticoagulant
+ thoracocentesis

RUSVM SAM 1 (26 decks)

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