Endocarditis, Myocarditis, Pericardial Disorders, and Cardiac Neoplasia Flashcards
True or False: DMVD has been shown to be a risk factor for infectious endocarditis
FALSE
subaortic stenosis is a risk factor for endocarditis
What is the most common presenting complaint for a patient with infectious endocarditis?
LAMENESS
(+ fever)
What are the non-cardiac complications that occur with infectious endocarditis?
- Polyarthritis
- Glomerulonephritis
- Thromboembolic disease (due to loss of AT3)
- CHF + arrhythmias
What type of murmur would you expect to hear in a patient with endocarditis and vegetative lesions on the mitral valve?
Left apical systolic murmur (due to mitral regurg)
What type of murmur would you expect to hear in a patient with infectious endocarditis and vegetative lesions on the aortic valve?
Left basilar diastolic murmur (due to aorta regurg) + bounding femoral pulses
Infectious endocarditis that has progressed to CHF is usually _____ sided
left
List the most common causative agents associated with infectious endocarditis
- Staph intermedius
- Staph aureus
- Strep canis
- E. coli
- Pseudomonas
- Bartonella
What is the antibiotic therapy protocol for endocarditis?
Long-term bactericidal Abx
- Beta lactam + Enrofloxacin
- Given IV for 1-2 weeks, then PO for 6-8 weeks
(+ CHF meds if present)
True or False: Fluid therapy, such as SQ fluids, should be given to a patient in CHF
FALSE FALSE FALSE contraindicated
(already have volume overload/too much preload to the heart, this would make it worse)
What is the prognosis of a pet with infectious endocarditis?
- Permanent valve damage (regurg) despite resolution
- Grave prognosis with aortic IE (days)
- Better outcome if mitral valve IE (> 1 yr)
- Worse prognosis if: refractory CHF, thromboembolism, or renal failure
An owner brings in a golden retriever with infectious endocarditis and is told by the vet that the prognosis is guarded, the pet may live just days longer. Which valve is likely affected?
Aortic valve - grave prognosis
Myocarditis can result in ________ dysfunction and heart failure
systolic
________ is a cardiac biomarker that is used in the diagnosis of myocarditis
Cardiac troponin I
If you’re a practicing veterinarian in the southern US, ____________ should always be on your list of differentials when suspect of myocarditis
Chagas disease - Trypanosoma cruzi
What is the most common cause of acquired pericardial effusion in dogs?
A. Neoplasia
B. Idiopathic
C. Infectious
D. CHF
A. Neoplasia
What is the most common cause of acquired pericardial effusion in cats?
A. Neoplasia
B. Idiopathic
C. Infectious
D. CHF
D. CHF
How can pericardial effusion lead to cardiac tamponade?
When IPP exceeds ICP
Heart can’t expand, diastolic filling decreases (preload decreases), then SV decreases and then CO
Age, breed, and sex predilection associated with pericardial effusion in dogs?
- Middle to older
- Medium to large breeds (GSD, Goldens, Labs, brachycephalic breeds)
- Males > females
How do dogs with acute pericardial effusion present?
On an ER bases for collapse or weakness, +/- acute vomiting
How do dogs with chronic pericardial effusion typically present?
- Vague CS
- Lethargic, exercise intolerance, ABD distension
- Coughing, panting, tachypnea/dyspnea
Pulsus paradoxus is when the arterial pulse pressure decreases during inspiration. This occurs with what heart condition?
Pericardial effusion
What would you expect to hear during your cardiac and respiratory portion of a PE on a dog with pericardial effusion?
- Muffled heart sounds if large amount of pericardial effusion
- Lung sounds decreased if pleural effusion
- Jug distension
- Tachypnea/Dyspnea
- If cardiac tamponade: low BP
Explain the fluid you would expect to see after performing a pericardiocentesis on a dog with pericardial effusion?
Sanguineous (hemorrhagic)
CHF due to pericardial effusion is usually _______ sided
Right
What valves are most commonly affected by infectious endocarditis?
Mitral and aortic valves (L side of heart)
What are the risk factors for developing infectious endocarditis?
- Bacteremia due to any cause (UTI, pneumonia, pyoderma, infected wound, etc)
- Subaortic stenosis
- Immunosupression
- Dental procedure
DDx for a dog presenting with a heart murmur and fever? (cardiac causes)
Infectious endocarditis or myocarditis
(NO OTHER HEART DZ CAUSES FEVER)
How can infectious endocarditis lead to thromboembolic disease?
Glomerulonephritis causes AT3 to be lost with Albumin
Loss of AT3 causes hypercoaguable state and thrombus formation
_________ may develop after a respiratory or GI infection, vaccination, surgery, trauma, or drug exposure
A. Endocarditis
B. Myocarditis
C. Pericardial effusion
B. Myocarditis
How does Chagas disease typically present in a dog?
- Fever
- Enlarged LN
- Arrhythmias
- Myocardial dysfunction
- CHF
Most common locations for hermangiosarcoma?
- Right atrium / Right auricle
- Spleen
- Lungs
What is the treatment protocol for a patient with a heart base tumor?
(Chemodectoma)
- Pericardiectomy
List all the heart conditions resulting in sudden death in dogs and cats
Cats > dogs
1. AVSD
2. HCM
3. RCM
Dogs > cats
4. DCM
5. ARVC
6. Subaortic stenosis
Which of the following could result in a globoid cardiac silhouette on thoracic radiographs?
A. Myocarditis
B. Endocarditis
C. Pericardial effusion
C. Pericardial effusion
Which drug is contraindicated in a patient with cardiac tamponade?
Diuretics (Furosemide)
- Already low preload, CO and SV
- Dont won’t to loose more fluid vol.. will make it worse
What is the prognosis for a patient with hermangiosarcoma on the right auricle resulting in pericardial effusion and cardiac tamponade?
Pericardiocentesis + If just on auricle - can be surgically resected
Chemo + surgery gives then ~6 months
What is the prognosis for a patient with hermangiosarcoma of the right atrium resulting in pericardial effusion and cardiac tamponade?
- Pericardiocentesis
- Can’t be surgically resected
- Tx with doxorubicin gives them ~ 3-4 months
Owner usually elects for euthanasia due to poor prognosis
Most common breed associated with chemodectomas?
Brachycephalics
What disease resolves in 50% of dogs after initial pericardiocentesis?
Idiopathic pericarditis
What is a congenital pericardial disease that can be seen in cats?
Perineopericardial Diaphragmatic hernia (PPDH)
What is the treatment protocol for a patient with perineopericardial Diaphragmatic hernia (PPDH)
If asymp - no tx needed
If symp - surgical correction
What is PPDH?
Abnormal opening between the pericardial sac and peritoneal cavity resulting in herniation of the liver, gall bladder, diaphragm, etc
