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RUSVM SAM 1 > Dilated Cardiomyopathy and Arrythmogenic Right Ventricular Cardiomyopathy > Flashcards

Dilated Cardiomyopathy and Arrythmogenic Right Ventricular Cardiomyopathy Flashcards

1
Q

What is the second most common acquired heart disease in dogs?

A

Dilated cardiomyopathy (DCM)

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2
Q

What dogs primarily get DCM?

A

Large and giant breed dogs

Plus cocker spaniels, Portuguese Water Dog, toy Manchester terrier

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3
Q

DCM is a myocardial disease characterized by ??

A

Ventricular systolic dysfunction

—> impaired contractility, dilation occurs secondary to the systolic dysfunction

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4
Q

What breed has a familial predisposition to DCM?

A

Doberman pinscher
-2 genetic mutations identified (pyruvate dehydrogenase kinase 4 and NCSU DCM 2)

Also.. Great Dane, Irish wolfhound, Newfoundland, Portuguese Water Dog, toy Manchester terrier

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5
Q

What would you see on histopathology of a dog with DCM?

A 
Attenuated wavy myofibers 
Myocytolysis 
Vacuolization of myocytes 
Necrosis 
Fibrosis 
Some fatty infiltration
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6
Q

How does DCM affect blood flow?

A

Decreased contractility —> decreased stroke volume —> low cardiac output

Compensatory RAAS activation (increases preload) —> volume overload —> eccentric hypertrophy

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7
Q

________________ can occur as a result of increased diastolic pressure and functional mitral regurgitation

A

Atrial dilation

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8
Q

What type of arrhythmias are most common in DCM?

A

Atrial fibrillation
VPC/VT

—> tachycardia and loss of synchrony will lead to worsening CO

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9
Q

At what age do you usually see DCM?

A

Adult (4-9yrs)

Male>female

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10
Q

What are the two stages of DCM?

A

Occult (asymptomatic)
Overt (symptomatic)

—> most dogs progress to symptomatic stage but it takes years

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11
Q

Sudden death can result due to __________ in Dobermans with DCM

A

Ventricular arrhythmia

  • 30% in the occult phase
  • 50% once in HF
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12
Q

What would you see on physical exam of a dog with DCM ?

A

Low grade apical systolic murmur may be present

S3 gallop (gallops are diastolic sounds)

Arrhythmia may be present
Femoral pulse may be weak

CHF or low output HF are possible

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13
Q

What is the diagnostic approach to DCM?

A 
History (asymptomatic vs symptomatic) 
PE
Client desire 
Client finances 
Other patient factors 
Availability of testing/treatment
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14
Q

T/F: genetic screening/testing should be done in breeding animals

A

True

-for PDK4 and NCSU DCM2 mutations

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15
Q

You auscultation a murmur in a Doberman pincher dog, on ECG you see an..
irregularly irregular pattern (R-R interval)
P waves absent
QRS are narrow

What arrhythmia is this?

A

Atrial fibrillation

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16
Q

Why might you want to do a 24hr holter monitor in Dobermans ?

A

Arrhythmias can be intermittent

—>screen for possible DCM

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17
Q

What nutritional deficiency can cause DCM in cats and dogs? Can measure blood levels of this nutrient in atypical breeds with DCM

A

Taurine

—> esp in dogs receiving diets that do not meet AAFCOs minimum nutrient requirements or dogs on homemade diets

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18
Q

What cardiac biomarker can help determine between cardiac and non-cardiac causes of DCM?

A

NT-proBNP

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19
Q

What is the treatment for DCM?

A

No curative treatment

Drug therapy
-benazepril /pimobendan have shown to slow progression

Afib

  • diltiazem +/-digoxin
  • electrical cardioversion

Ventricular arrhythmias

  • mexiletine or sotalol
  • amiodarone for refractory VT
20
Q

What is the prognosis for dogs in the occult phase of DCM?

A

Fair to guarded

  • most dogs progress to HF
  • some can have sudden death
21
Q

What diseases must you rule out before contributing systolic dysfunction to DCM?

A

Tachycardia induced

Nutritional -taurine

Doxorubicin-induced

Inflammatory/infectious (myocarditis)

Hypothyroidism

22
Q

What are the causes of DCM in cats?

A

Uncommon in cats

-most idiopathic, some due to viral myocarditis

23
Q

What is the most common adult-onset heart disease in Boxers?

A

Arrythmogenic right ventricular cardiomyopathy (ARVC)

24
Q

What are the 3 types of ARVC?

A

Asymptomatic with VPCs

Symptomatic with VPCs

Ventricular dilation, systolic dysfunction, and SVT and VT

25
Q

What is the etiology of arrhythmogenic right ventricular cardiomyopathy ?

A

Deletion mutation in the straitin gene

-autosomal dominant with incomplete penetrance

26
Q

How do the hearts of dogs affected with ARVC appear?

A

Normal except dogs in the 3rd stage with ventricular/atrial dilation

27
Q

On histopathology how does ARVC appear?

A

Fatty infiltration
Myocyte vacuolization
Myocyte loss

28
Q

How does ARVC affect blood flow?

A

Ventricular tachycardia reduces cardiac output by limiting diastolic filling time

Boxers with type III have poor CO due to systolic dysfunction and these dogs can develop CHF due to chronic volume overload

29
Q

What is the signalment of ARVC?

A

Boxers usually 5-7yrs
-up to 40% have striatin mutation

Disease frequency and severity increases with age

30
Q

What are the most common signs/presenting complaint in dogs with ARVC?

A

Syncope and exercise intolerance

31
Q

T/F: the right ventricle is ALWAYS involved in ARVC, but it can also affect the left ventricle

A

True

32
Q

What are possible findings on a physical exam of a dog with ARVC?

A

Can be normal
Premature beats, brief pauses, tachycardia

Murmurs (uncommon)

L or R sided CHF (tachypnea, tachycardia, abnormal lung sounds, jugular venous distention

33
Q

T/F: genetic screening for striatin mutation, if negative, rules out development of ARVC

A

False

Boxers with a negative test have a decreased risk compared to positive animals

34
Q

What diagnostics can be done in a boxer with suspected ARVC?

A

Generic screening
Electrocardiogram/ 24hr Holter
BP
Echo- will be normal in type I and II

Radiograph if CHF is suspected

35
Q

In an echo, VPCs originating from the Right ventricle are ___________ in lead II

A

Upright (positive)

36
Q

When is treatment indicated for ARVC?

A

Anti-arrhythmic therapy initiated in dogs with …
—> >1000 VPC/day
—> ventricular tachycardia
—> R on T

37
Q

What drug is used to treat ARVC and what is its MOA?

A

Sotalol

Mainly and potassium channel blocker, has some B blocker effect

38
Q

What can you use to treat ARVC in cases that are not responsive to sotalol ?

A

Mexiletine

Causes more GI upset than sotalol

39
Q

How would you treat a refractory ventricular tachycardia with ARVC?

A

Combination of antiarrhythmic (sotalol +mexiletine)

OR

Amiodarone —> mainly a potassium channel blocker but has activity in all classes ( can cause liver toxicity)

40
Q

What would you add onto your ARVC therapy of sotalol if the Boxer also had systolic dysfunction (type III) ?

A

ACE inhibitor and pimobendan

41
Q

T/F: ARVC can lead to sudden death

A

True

Important to inform clients

42
Q

What is the prognosis for ARVC?

A

Good to guarded (sudden death risk) in type I and type II

Poor for type III if in CHF

43
Q

What is R on T phenomenon? Why would this be an indicator to begin antiarrhythmic therapy?

A

When ventricular depolarization is initiated before the ventricle has fully repolarized

Very disruptive can lead to VT or Vfib

44
Q

What are causes other than ARVC that can cause syncope in boxer dogs?

A

Bradyarrhythmia

Non cardiac —> metabolic, hematologist, neoplastic, or musculoskeletal disorders

Neurological disease can resemble syncope

45
Q

T/F: ARVC can occur in cats

A

True

Uncommon

46
Q

What are the most common symptoms seen in cats due to ARVC?

A

Symptoms related to R-sided CHF

Tachypnea/dyspnea
Abdominal distention
Lethargy
Syncope or pre-syncope

RUSVM SAM 1 (26 decks)

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