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RUSVM SAM 1 > Endocarditis/Myocarditis and Heartworm > Flashcards

Endocarditis/Myocarditis and Heartworm Flashcards

1
Q

What is infective endocarditis?

A

Invasion of valvular endothelium by microorganisms —> proliferative or erosive lesions

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2
Q

T/F: Infective endocarditis is a disease localized only to heart tissue

A

False

Produces systemic dense affecting multiple organs like the kidney and joints

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3
Q

What valves are most commonly affected in infective endocarditis ?

A

Mitral and aortic

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4
Q

What are risk factors for infectious endocarditis?

A

Bacteremia of any cause

Subaortic stenosis

Immunosuppressive/corticosteroid therapy

Periodontal disease/fetal procedure

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5
Q

T/F: DMVD is a risk factor for endocarditis?

A

False

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6
Q

What syndromes can cause endocarditis?

A

Immune mediated disease —> Ag-AB formation and deposition

Congestive heart failure —> destruction and necrosis of value resulting in regurgitation

Thromboembolic Disease

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7
Q

What is the signalment of infectous endocarditis?

A

Middle aged to older

Medium to large breed dogs

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8
Q

What is the most common presenting complaint due to infectious endocarditis?

A

LAMENESS

Other common signs: lethargy, hyporexia, tachypnea, cough, dyspnea, weakness, fever

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9
Q

T/F: most dogs with infectious endocarditis have a heart murmur

A

True

Mitral: left apical systolic
Aortic: left basilar diastolic+bounding femoral pulse

*absence of murmur does not rule out IE

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10
Q

T/F: Fever and arrhythmias are common findings in infectious endocarditis?

A

True

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11
Q

What are common CBC abnormalities seen with IE?

A 
Leukocytosis 
Neutorphilia 
Monocytotosi 
Thrombocytopenia 
Mild anemia
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12
Q

What are common biochem changes seen with IE?

A 
Hypoalbuminemia 
Azotemia 
Elevated liver enzymes 
Proteinuria 
Hematuria 
Pyruria 
Hemoglobinuria 
Bacteruria
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13
Q

If IE causes glomerular disease, what protein can be lost (besides albumin) that can lead to one of the primary clinical syndromes?

A

Antithrombin III —> thromboembolism

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14
Q

Do you do a urine culture in IE patients?

A

Yes.. can provide an causative organism

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15
Q

How should you collect samples for blood culture of IE?

A

Prior to antibiotic therapy

3-4blood samples should be collected aspetically from different venous sites —> aerobic and anaerobic cluture

Bartonella : 2ml of EDTA blood frozen

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16
Q

What may you see on an echo of a dog with IE?

A

Vegetative lesions on the mitral/aortic valves

mitral/aortic regurgitation,

LA/LV dilation

erosive lesions, and abscess

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17
Q

What bacteria are common causes of IE?

A 
Strep intermedius/canis 
Staph aureus 
E.coli 
Pseudomonas 
Bartonella
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18
Q

What is the therapy for IE?

A

Long term bactericidal antibiotics
1-2weeks IV is possible followed by 6-8weeks of oral

CHF therapy

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19
Q

What is the prognosis for IE?

A

Valve damage is often permanent

Aortic IE is usually grave prognosis
Only mitral involvement, better prognosis, may live >1year

Depends on other factors: gram neg infection, refractory CHF, renal failure, thromboembolic , hypoalbuminemia,.. etc

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20
Q

How can you prevent IE?

A

Peri procedural antibiotics in dogs with congenital heart disease esp subaortic stenosis

Antibiotics in these patients if immmunosuppressed

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21
Q

What is myocarditis?

A

Myocardial inflammation, in absence of ischemia, resulting in myocyte damage and cardiac dysfunction

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22
Q

What can be predisposing factors to myocarditis?

A 
Respiratory or GI infection 
Vaccination 
Surgery 
Trauma
Drug exposure
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23
Q

Clinical signs associated with myocarditis?

A 
Fever
Lethargy
Hyporexia
Respiratory signs (cough, tacypnea, dyspnea) 
Syncope
Muscle pain 
Diarrhea
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24
Q

What diagnostics can be used to determine myocarditis?

A

ECG- ventricular premature complexes are common

Thoracic radiographs -unremarkable —> CHF or pulmonary infection

Echo- rules out other disease

Cardiac troponin —> often increased with acute myocarditis

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25
What is the treatment for myocarditis?
Anti-arrhythmic drugs and supportive care Specific treatment of underlying cause if there is one
26
What is a common cause of myocarditis in dogs in Texas/other parts of southern US?
Trypanosoma cruzi (Chagas’ disease)
27
What are the acute and chronic stages of Chagas’ disease?
Acute: lethargy, generalized lymphadenopathy, pallor, hepatospenomegaly, sudden death Chronic: progressive Rsided dysfunction, often CHF
28
How do you diagnose Chagas’ disease?
Serology | Traomastigotes on blood smear
29
What is the lifecycle of Diroflilaria immitus in dogs?
180-210days Adult in pulmonary aa —> females release microfilaria into circulation —> mosquito and develop to L1 larvae —>develop to L3 over 8-17days —> L3 transmitted to dog —> L3 and L4 in tissue for 1-12days —> L5 migrates into tissue and migrates of vascular system and PA
30
What are the features of HWD?
Pulmonary artery and pulmonary parenchyma injury Pulmonary hypertension Rsided cardiac dysfunction Glomerulonephritis Anemia Thrombocytopenia Caval syndrome DIC
31
What is the primary location of adult heartworms?
Caudal pulmonary artery
32
What damage do heartworms cause within the pulmonary artery?
``` Inflammation Endothelial damage Myointimal proliferation Disruption of vascular integrity Fibrosis Pulmonary hypertension ``` Can cause mechanical obstruction in the aa. Dead worms induce thrombosis
33
Structural changes of the lumen and narrowing of the pulmonary arteries has what effect on afterload? And pulmonary vascular resistance?
Increases afterload of the right ventricle Increased pulmonary vascular resistance
34
Increased pulmonary arterial pressure has what effects on the heart?
RV hypertrophy Increases RV and RA pressure Tricuspid regurgitation —> increased systemic pressure and R-sided CHF
35
Because of the increased afterload caused by narrowing and increased resistance of pulmonary arteries, what are consequences of decreased CO?
Decreased pulmonary arterial flow - > thrombosis - > hypoxemia - > decreased preload to LA and LV
36
What is Wolbachia? How does it interact with Drofliaria immitus?
Intracellular, gram neg bacteria Symbiotic with Drofliaria Endotoxins and surface proteins
37
What is effective at reducing or eliminating Wolbachia?
Doxycycline
38
Why can a glomerulonephritis result from heartworm infection?
Secondary to antigen-antibody deposition Results in albuminuria
39
What is caval syndrome?
Mechanical obstruction of blood flow in the Rside of the heart and vena cava Only occurs if worm burden is heavy Can result in hemolytic anemia and cardiogenic shock
40
What are clinical signs of heartworm ?
Majority are asymptomatic ``` Exercise intolerance Weight loss Lethargy Cough, tachypnea, dyspnea, hemoptysis Abdominal distention Syncope or collapse Hematuria (hemoglobinuria) ```
41
PE findings with heartworm?
Weight loss/poor body condition Split S2 Murmur due to tricuspid regurgitation (right apical systolic) Gallop Abnormal lung sounds Tachypnea, dyspnea Right-sided CHF: hepatomegaly, ascites, jugular venous distention/pulsation
42
What are your next diagnostic steps if your heartworm antigen test is positive?
Heartworm infection is present -> run a modified Knott or filter test (evaluate for microfilaria) ``` CBC Biochem and UA Thoracic radiographs Preventative Doxycycline Melarsomine in 2 months ``` If positive for microfilaria —> pretreat with antihistamine and glucocorticoids
43
What are CBC abnormalities that can be associated with HWD?
Neutrophilia, eosinophilic, basophilia, anemia, thrombocytopenia
44
What radiographic signs would be suggestive of pulmonary hypertension?
Pulmonary artery > pulmonary veins Right sided cardiomegaly —> backwards D shaped Bulge at 1-2:00 —>MPA Tortuous pulmonary artery
45
What is part of the treatment plant to reduce risk of thromboembolism
Exercise restriction
46
What do you use to reduce/eliminate microfilaria and destroy developing L3/L4?
Macrocyclic lactose
47
When is macrocyclic lactose treatment started?
The day HW is diagnosed Or delay a day if microfilaria are detected —> pre treatment with glucocorticoids and antihistamine
48
What are some of the macrocyclic lactose preventative?
Ivermectin Selamectin Moxidectin Milbemycin oxime
49
When is milbemycin contradincated?
Potent microfilaria I’ve Microfilarermic dogs —> cause anaphylactic rxn
50
What is the adulticide therapy for HW?
Melarsomine dihydrochloride
51
What are the protocols for adulticide therapies with melarsomine?
Usually delayed for 1-2months to allow immature worms to become adults, and for Wolbachia to be cleared 3 dose (split dose) -> effective at removing adult worms and reduces the risk of PTE
52
Can macrocyclic lactose be used to treat adult stages of HW?
Yes “slow-kill” method Not recommended Takes 2+ years for all adult worms to be killed
53
What are common drugs used for melarsomine injections?
Opioids, corticosteroid or NSAID Caution using NSAIDS: corticosteroid therapy is the primary treatment for pulmonary complications of HWD
54
What is the purpose of corticosteroids in HWI?
Prevent and treat adverse rxn to microfilaricides Treat pneumonitis, pulmonary granuloma, pulmonary thromboembolism Analgesia for melarsomine injections
55
When are melarsomine injections administered?
Day 60 Day 90 Day 91
56
What are complications of hearworm treatment?
Anaphylaxis -microfilaria -> pretreat with diphenhydramine and glucocorticoids, avoid milbemycin Eosinophilic penumonitits/granulomatosis -corticosteroids Pulmonary thrombosis/thromboembolism - corticosteroids Pulmonary hypertension - sildenafil CHF- furosemide, sildenafil, and and abdominocentitis Caval syndrome- emergency surgery to remove worms
57
What is the prognosis for HW?
Asymptomatic -> good Mild-moderate disease -> generally good but possible complication (guarded)
58
What are the differences in dirofilaria immitis life cycle in cats?
Cats are not a preferred target for mosquitos Have to feed on infected dog first Unnatural host -> none to few adults Longer life cycle: 7-8months Aberrant migration more common
59
What is heartworm associated respiratory disease (HARD) ?
Inflammatory and proliferative disease of pulmonary arteries, bronchioles, and pulmonary parenchyma in cats WITHOUT mature infections
60
_____% of cats with immature HW infections develop HARD
50
61
What contributes to the profound inflammatory rxn to immature (S5) and dead worms in HARD?
Pulmonary intravascular macrophages (PIMs)
62
Symptoms of HARD are similar to what other feline disease?
Asthma - coughing, wheezing - dyspnea - lethargy - hyporexia, weight loss - exercise intolerance - vomiting - Rsided CHF
63
Current antigen tests for heartworm detect what? When can you get false negatives?
Antigens produced in the reproductive tract of adult females False negs - > not fully mature worms - > only males - > only 1 female
64
What does the the antibody test for heartworm detect?
Can develop L4 larvae If Ab test is positive -> need to do Ag test
65
When can you have false negative Antibody heartworm tests?
Too early in infection to detect (<6-90 days post transmission)
66
What pattern do you usually see in cats with HARD?
Mostly parenchymal inflammation Diffuse/ patchy bronchointerstitial pattern
67
Why is adulticide therapy not recommended in cats?
High risk of morbidity and mortality
68
What is the treatment for heartworm in cats?
Short term corticosteroids in cats with respiratory signs Embolic/anaphylactic emergency: o2, corticosteroid, and bronchodilator Doxycycline and clopidogrel

RUSVM SAM 1 (26 decks)

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