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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
Q

What is the treatment for myocarditis?

A

Anti-arrhythmic drugs and supportive care

Specific treatment of underlying cause if there is one

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26
Q

What is a common cause of myocarditis in dogs in Texas/other parts of southern US?

A

Trypanosoma cruzi (Chagas’ disease)

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27
Q

What are the acute and chronic stages of Chagas’ disease?

A

Acute: lethargy, generalized lymphadenopathy, pallor, hepatospenomegaly, sudden death

Chronic: progressive Rsided dysfunction, often CHF

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28
Q

How do you diagnose Chagas’ disease?

A

Serology

Traomastigotes on blood smear

29
Q

What is the lifecycle of Diroflilaria immitus in dogs?

A

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
Q

What are the features of HWD?

A

Pulmonary artery and pulmonary parenchyma injury

Pulmonary hypertension
Rsided cardiac dysfunction

Glomerulonephritis
Anemia
Thrombocytopenia

Caval syndrome
DIC

31
Q

What is the primary location of adult heartworms?

A

Caudal pulmonary artery

32
Q

What damage do heartworms cause within the pulmonary artery?

A 
Inflammation 
Endothelial damage
Myointimal proliferation 
Disruption of vascular integrity 
Fibrosis
Pulmonary hypertension

Can cause mechanical obstruction in the aa.

Dead worms induce thrombosis

33
Q

Structural changes of the lumen and narrowing of the pulmonary arteries has what effect on afterload? And pulmonary vascular resistance?

A

Increases afterload of the right ventricle

Increased pulmonary vascular resistance

34
Q

Increased pulmonary arterial pressure has what effects on the heart?

A

RV hypertrophy

Increases RV and RA pressure
Tricuspid regurgitation

—> increased systemic pressure and R-sided CHF

35
Q

Because of the increased afterload caused by narrowing and increased resistance of pulmonary arteries, what are consequences of decreased CO?

A

Decreased pulmonary arterial flow

  • > thrombosis
  • > hypoxemia
  • > decreased preload to LA and LV
36
Q

What is Wolbachia? How does it interact with Drofliaria immitus?

A

Intracellular, gram neg bacteria

Symbiotic with Drofliaria
Endotoxins and surface proteins

37
Q

What is effective at reducing or eliminating Wolbachia?

A

Doxycycline

38
Q

Why can a glomerulonephritis result from heartworm infection?

A

Secondary to antigen-antibody deposition

Results in albuminuria

39
Q

What is caval syndrome?

A

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
Q

What are clinical signs of heartworm ?

A

Majority are asymptomatic

Exercise intolerance 
Weight loss
Lethargy 
Cough, tachypnea, dyspnea, hemoptysis 
Abdominal distention 
Syncope or collapse 
Hematuria (hemoglobinuria)
41
Q

PE findings with heartworm?

A

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
Q

What are your next diagnostic steps if your heartworm antigen test is positive?

A

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
Q

What are CBC abnormalities that can be associated with HWD?

A

Neutrophilia, eosinophilic, basophilia, anemia, thrombocytopenia

44
Q

What radiographic signs would be suggestive of pulmonary hypertension?

A

Pulmonary artery > pulmonary veins

Right sided cardiomegaly —> backwards D shaped

Bulge at 1-2:00 —>MPA

Tortuous pulmonary artery

45
Q

What is part of the treatment plant to reduce risk of thromboembolism

A

Exercise restriction

46
Q

What do you use to reduce/eliminate microfilaria and destroy developing L3/L4?

A

Macrocyclic lactose

47
Q

When is macrocyclic lactose treatment started?

A

The day HW is diagnosed

Or delay a day if microfilaria are detected —> pre treatment with glucocorticoids and antihistamine

48
Q

What are some of the macrocyclic lactose preventative?

A

Ivermectin
Selamectin
Moxidectin
Milbemycin oxime

49
Q

When is milbemycin contradincated?

A

Potent microfilaria I’ve

Microfilarermic dogs —> cause anaphylactic rxn

50
Q

What is the adulticide therapy for HW?

A

Melarsomine dihydrochloride

51
Q

What are the protocols for adulticide therapies with melarsomine?

A

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
Q

Can macrocyclic lactose be used to treat adult stages of HW?

A

Yes “slow-kill” method

Not recommended
Takes 2+ years for all adult worms to be killed

53
Q

What are common drugs used for melarsomine injections?

A

Opioids, corticosteroid or NSAID

Caution using NSAIDS: corticosteroid therapy is the primary treatment for pulmonary complications of HWD

54
Q

What is the purpose of corticosteroids in HWI?

A

Prevent and treat adverse rxn to microfilaricides

Treat pneumonitis, pulmonary granuloma, pulmonary thromboembolism

Analgesia for melarsomine injections

55
Q

When are melarsomine injections administered?

A

Day 60

Day 90
Day 91

56
Q

What are complications of hearworm treatment?

A

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
Q

What is the prognosis for HW?

A

Asymptomatic -> good

Mild-moderate disease -> generally good but possible complication (guarded)

58
Q

What are the differences in dirofilaria immitis life cycle in cats?

A

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
Q

What is heartworm associated respiratory disease (HARD) ?

A

Inflammatory and proliferative disease of pulmonary arteries, bronchioles, and pulmonary parenchyma in cats WITHOUT mature infections

60
Q

_____% of cats with immature HW infections develop HARD

A

50

61
Q

What contributes to the profound inflammatory rxn to immature (S5) and dead worms in HARD?

A

Pulmonary intravascular macrophages (PIMs)

62
Q

Symptoms of HARD are similar to what other feline disease?

A

Asthma

  • coughing, wheezing
  • dyspnea
  • lethargy
  • hyporexia, weight loss
  • exercise intolerance
  • vomiting
  • Rsided CHF
63
Q

Current antigen tests for heartworm detect what? When can you get false negatives?

A

Antigens produced in the reproductive tract of adult females

False negs

  • > not fully mature worms
  • > only males
  • > only 1 female
64
Q

What does the the antibody test for heartworm detect?

A

Can develop L4 larvae

If Ab test is positive -> need to do Ag test

65
Q

When can you have false negative Antibody heartworm tests?

A

Too early in infection to detect (<6-90 days post transmission)

66
Q

What pattern do you usually see in cats with HARD?

A

Mostly parenchymal inflammation

Diffuse/ patchy bronchointerstitial pattern

67
Q

Why is adulticide therapy not recommended in cats?

A

High risk of morbidity and mortality

68
Q

What is the treatment for heartworm in cats?

A

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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