Endocardial disease in small animals Flashcards
What is endocardial disease
disease on the endocardium
primarily valvular disease
describe the pathology of chronic degenerative valvular disease
thickening and redundancy of heart valve leaflets
is degeneration of mitral and/or tricuspid valve (tricuspid on its own is rare)
area becomes thickened
Describe the pathophysiology of chronic degenerative valve disease
as the valve gets thicker, it doesn’t shut adequately
blood regurg from ventricles to atrium
end diastolic volume bigger than normal
stroke volume increases, forward output falls
atrium has to deal with regurge vol and bigger venous return
atria gets bigger
flow through aorta will go down, less blood going out of aorta
large end diastolic vol
cardiomyocytes stretch-increase in heart size over time
What is the signalment for chronic valve degeneration disease
middle –> older age
small breeds
cavalier king Charles spaniels, poodles, chihuahua
What is the rule of thumb when it comes to heart conditions in dogs?
small breed dogs- chronic degenerative valve disease
large breed dogs - Dilated cardio myopathy
Describe how an animal with chronic degenerative valve disease present
typical congestive heart failure history
increased resp rate and effort
coughing
decreased appetite
Describe how you would decide if a murmur is a sign of significant disease
grade 3 murmur or louder
heart rate>120
loss of sinus arrhythmia
precordial thrill
dysrhythmia pulse deficits
How do you investigate chronic degenerative valvular disease
if stable:
echocardiography
thoracic radiographs
ECG
biochemistry
BP
what do you tend to see on thoracic radiographs with chronic degenerative valvular disease
enlarged heart
elevated trachea
clear lung fields
Bulge on cardiac silhouette at 2-3 o’clock in DV = L atrial appendage
How do we use echocardiograms to diagnose chronic degenerative valvular disease
tachycardia
arrhythmia-APCs, atrial fibrillation
changes in complex morphology
What is the most common cause of heart failure in dogs
valvular disease
What are the two types of endocardial disease
acquired form
OR
congenital form
List 3 examples of acquired form of endocardial disease
Chronic degenerative valvular disease (CDVD)
endocarditis
traumatic injury
How many classes of CDVD are there
4 classes
Describe class 1 CDVD
small discrete nodules along the edge of the valve
Describe class 2 CDVD
thickened free edges and irregular
Describe class 3 CDVD
valve edges are grossly thickened and nodular with extension of lesions to the base of the CT
Describe class 4 CDVD
further severity of class 3 lesions
why do jet lesions occur in CDVD
regurgitant jet of blood moves into the atrium
why does the atria enlarge in CDVD
due to blood regurgitating from the ventricles into the atrium and normal venous return entering the atrium - leads to there being an abnormal amount of blood within the atria
Describe the clinical presentation of a dog with CDVD
increased respiratory rate and effort
coughing
exercise intolerance
decreased appetite / weight loss
What are the 3 types of heart murmurs
pathological, innocent and physiological
how many grades of heart murmur are there
6
Describe a grade 1 heart murmur
quiet, only heard after a few minutes in a quiet room
Describe a grade 2 heart murmur
quiet but easily audible
Describe a grade 3 heart murmur
same intensity as the heart sounds
Describe a grade 4 heart murmur
a murmur louder than the heart sounds but no precordial thrill heard
Describe a grade 5 heart murmur
very loud murmur and precordial thrill present
Describe a grade 6 heart murmur
murmur audible when stethoscope removed from the chest wall
where is a murmurs PMI for a mitral insufficiency
over the left apex
what radiographic abnormalities are seen in a dog with CHF
elevation of distal trachea
increased cardiac silhouette height
straightening of the caudal border of the heart and loss of the cardiac waist
tenting of the LA
bulge on cardiac silhoette in DV
why is echocardiography not useful for CHF
because you can’t diagnose CHF or the extent of the problems from looking at the heart on ultrasound
what is often blamed for endocarditis
dental disease
what type of murmur will an animal with endocarditis have
a variable murmur
