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VMS 3010 > Diseases of the cardiovascular system III > Flashcards

Diseases of the cardiovascular system III Flashcards

1
Q

What is a cardiomyopathy?

A

Disease of the myocardium

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2
Q

What is a dilated cardiomyopathy?

A
  • Common in dogs
  • Characterised by ventricular dilation and thin hypomotile ventricular wall
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3
Q

What is hypertrophic cardiomyopathy?

A
  • Common in cats
  • characterised by hypertrophy of the ventricular wall and a restricted ventricular lumen
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4
Q

What is restrictive cardiomyopathy?

A

Characterised by a stiff ventrciular wall and marked dilation of the atrium feeding the ventricle

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5
Q

What is arrhythmogenic right ventricular cardiomyopathy?

A
  • Boxers
  • Fibrofatty infiltrate that preferentially affects the right ventricle
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6
Q

What diseases may be able to mimic a dilated cardiomyopathy?

A
  • Taurine deficiency in cats
  • L-carnitine deficiency in boxers
  • Toxins
  • Grain-free diets
  • Lamb based diets
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7
Q

What breeds are predisposed to dilated cardiomyopathy?

A
  • Medium to large breed dogs, e.g dobermans, great danes…
  • Doberman pinschers are autosomal dominant (splice-site mutation)
  • Great danes- appears to be familial, male dogs are over-represented suggesting X-linked inheritance
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8
Q

What is the clinical presentation of dilated cardiomyopathy?

A

Adult onset disease
* asympomatic/ occult phase = usually progressive
* Symptomatic phase = coughing, dyspnoea, ascites

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9
Q

What are the common physical findings of the occult phase of dilated cardiomyopathy?

A
  • soft sytolic heart murmur
  • Irregular heart rhythm
  • Pulse deficits
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10
Q

What are the occasional clinical signs of the occult phase of dilated cardiomyopathy?

A
  • Diastolic gallop
  • Weak pulse
  • Jugular vein distension
  • Decreased intensity of heart sounds
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11
Q

What are the overt clinical signs of dilated cardiomyopathy?

A
  • Moderate intensity
  • Irregular heart rhythm
  • Pulse deficits
  • Tachypnoea
  • Dyspnoea
  • Weakness
  • Increased bronchovesicular sounds
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12
Q

What are the less common clinical signs of dilated cardiomyopathy?

A
  • Jugular vein distension
  • Ascites
  • Hepatomegaly
  • Pale MM, hypothermia
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13
Q

What is the only reliable way to diagnose DCM?

A

Echocardiography

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14
Q

What echocardiography is recommended for adult dogs of at risk breeds (for DCM) ?

A

Annual two dimensional and M-Mode echocardiography
-ECG for signs of LV and LA enlargement

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15
Q

What are the cardiac biomarkers for dilated cardiomyopathy?

A

Troponin

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16
Q

What is hypertrophic cardiomyopathy?

A

primary myocardial disease that results in thickening of the left ventricular walls

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17
Q

What is the prevalence of HCM in the feline population?

A

Up to 20% in the general feline population

18
Q

What is the relationship between Hypertrophic cardiomyopathy and Maine Coons?

A
  • Causative mutation in A31P in the cardiac myosin Binding Protein C sarcomeric gene for inherited HCM, with autosomal domiannt inheritance
19
Q

What is the relationship between hypertrophic cardiomyopathy and ragdoll cats?

A
  • Substitution mutation in MYBPC3 associated with HCM was associated in 2007
20
Q

What are the clinical signs of HCM in cats?

A
  • Often asymptomatic- murmur or gallop is picked up at routinee examination
  • Heart murmurs can be absent in cats with HCM and heart failure
  • Best heard over the left apex or cranial sternum- often dynamic
21
Q

What are the cliniical signs of congestive heart failure?

A
  • Anorexia, Lethargy, Dyspnoea, Syncope, Pleural effusion/ pulmonary oedema
  • Feline aortic thromboembolism
22
Q

How might you diagnose Congestive Heart Disease?

A

Evaluate and test for diseases that cause secondary hypertrophy
* Important to do so before making a diagnosis

23
Q

What is the phenotype for echocardiography for felien HCM?

A
  • Papillary muscle hypertrophy
  • Increased LV wall thickness
  • Systolic anterior motion of the mitral valve
  • Left atrial enlargement
  • Spontaneous echo contrast
24
Q

What does a spontaneous echo contrast look like?

A

‘smoke sign’

25
Q

How might you treat congestive heart failure?

A

Beta blockers or calcium channel antagonists - act as negative chronotropes and negative inotropes to improve diastolic filling
* Can be controversial if SAM present – sleep more effective than beta-blockade and diltiazem has
questionable long term effect on survival

26
Q

What is restrictive cardiomyopathy?

A

Second most common primary cardiomyopathy in the cat
» Characterised by a diastolic dysfunction, with impaired ventricular
filling due to increased myocardial stiffness (reduced ventricular
compliance

27
Q

What are the clinical signs of restrictive cardiomyopathy?

A

most cats will present in CHF
* Dyspnoea (89%), followed by non-specific signs (lethargy,
weakness, hypothermia, anorexia), ascites (14%), and
paresis/paralysis related to ATE (6%)) * Heart murmur (81%) (left apical systolic in 77% of murmurs) and
gallop rhythm (31%) of RCM cats

28
Q

What is Arrhythmogenic Right ventricular cardiomyopathy?

A

» AKA Box cardiomyopathy (but Boxers can also develop DCM!)
» Inherited as an autosomal dominant trait, variable penetrance
» Most commonly characterised by ventricular arrhythmias,
syncope, and sudden death – but can also be asymptomatic

29
Q

What are the clinical signs and prognosis of Arrhythmogenic right ventrciular cardiomyopathy?

A
  • 1) asymptomatic dogs with ventricular tachyarrhythmia
  • 2) dogs with normal heart size and LV function, but with syncope or
    weakness from paroxysmal or sustained ventricular tachycardia
  • 3) Boxers with poor myocardial function and CHF, as well as ventricular
    arrhythmias. The prognosis is especially poor in the last category.
30
Q

What is the histology of Arrhythmogenic right ventricular cardiomyopathy?

A

multifocal myocyte vacuolisation, myocyte loss, and significant fatty infiltration

31
Q

What is the diagnosis for arrhythmogenic right ventrciular cardiomyopathy?

A

can have normal physical exam, or; tachyarrhythmia, pulse deficits, systolic murmur –may require 24-hour Holter monitor * Note: many Boxers have a soft basilar systolic murmur due to SAS or may be physiological and NOT necessarily due to ARVC
* Likely to be multiple factors that may influence which dogs develop overt clinical signs of the disease

32
Q

How might you treat arrhythmogenic right ventricular cardiomyopathy?

A
  • Sotalol (β-blocker) 1.5-3.5 mg/kg PO q 12hr, or mexiletine (VG Na+
    blocker) 5-6 mg/kg PO q 8hr * +/- fish oils (780 mg EPA and 497 mg DHA PO per day)
33
Q

What is Myxomatous Mitral Valve Disease?

A

a condition that causes the mitral valve leaflets to become loose and floppy, which can lead to blood leaking backward into the heart or lungs

34
Q

What breeds are predisposed to MMVD?

A
  • Prevalence higher in small breed dogs <20 kg (CKCS,
    Chihuahua, Dachshund, Poodle, Pomeranian, Papillons etc.) * Large breeds can be affected, usually more severe and
    progresses quickly
35
Q

What valve does MMVD primarily effect?

A

» Primarily affects the left AV valve but 30% of dogs have an
affected tricuspid valve
» Cause remains unknown, however there is an inherited
component in some breeds. Severity may also have a
genetic component

36
Q

What is the pathophysiology of MMVD?

A
  • Deformation of valve leaflets (expansion of ECM – extra
    cellular matrix - with proteoglycans and GAGs, fibrosis,
    degradation of endothelium) * Regurgitation of blood into LA
  • Increased cardiac workload on LV due to volume overload
  • Eccentric hypertrophy of LV
  • Severe MR > CHF
37
Q

What are the differentials for MMVD?

A
  • Dilated cardiomyopathy
  • Bacterial endocarditis of mitral valve
  • Previously undetected congenital heart disease
    (e.g. mitral valve dysplasia, or PDA)
38
Q

What are the diagnostics for MMVD?

A
  • Ausculatation
  • Blood Pressure
  • Thoracic radiography
39
Q

How might you potentially treat MMVD?

A

Depends on the stage
* Stage B2: Murmur intensity ≥ 3/6,
remodelling of LA and LV, breed adjusted
VHS > 10.5
* If echo is not available then VHS > 11.7,
serially increasing VHS, VLAS > 3

40
Q

What is the ratio for MMVD?

A

LA:Ao ratio ≥ 1.6

VMS 3010 (102 decks)

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