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SA DX & TX I > Exam 4 - Canine Chronic Valvular Disease > Flashcards

Exam 4 - Canine Chronic Valvular Disease Flashcards

1
Q

T/F: approximately 10% of dogs have heart disease & approximately 30% will develop heart failure

A

true

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2
Q

what is the number one cause of canine heart disease?

A

myxomatous mitral valve disease - canine chronic valvular disease

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3
Q

what breed is predisposed to develop mmvd?

A

cavaliers

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4
Q

what is the pathophysiology of canine cvd?

A

degeneration of the av valves & chordae tendinae - mitral & tricuspid valves (endocardiosis) with the left av valve being most commonly affected

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5
Q

why does cardiac remodeling occur in dogs with mmvd? what changes are seen?

A

occurs secondary to progressive mitral/tricuspid regurgitation

left atrial & ventricular chamber dilation & left systolic dysfunction

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6
Q

what is a common sequelae to mmvd? what is a rare one?

A

pulmonary hypertension

rare - clinically significant arrhythmias are uncommon

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7
Q

what is the median time to developing CHF in stage B2 for an animal on pimobendan?

A

42 months

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8
Q

what is the preclinical/asymptomatic stage of CHF?

A

ACVIM stage B1 & B2

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9
Q

how is stage B1 & B2 of CHF diagnosed?

A

easy to diagnose - characteristic mitral heart murmur heard in small, older breed dogs

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10
Q

what is the clinical stage of CHF?

A

ACVIM stage C & D

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11
Q

what are the clinical signs attributed to in CHF stage C & D?

A

left sided CHF with pulmonary edema

left mainstem bronchus compression secondary to marked left atrial enlargement

pulmonary hypertension

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12
Q

what is stage A according to the ACVIM classification of heart failure?

A

at risk for heart failure - apparently healthy animal, but high risk for developing CVD or DCM

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13
Q

what is stage B according to the ACVIM classification of heart failure?

A

animal at risk for heart failure - dogs with CVD or DCM that have never had clinical signs of CHF attributable to CVD or DCM

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14
Q

what are stages C & D in regards to the ACVIM classification of heart failure?

A

stage C - past or current signs/symptoms of CHF

stage D - end stage CHF, refractory to standard treatment

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15
Q

what is the classification of stage B1?

A

asymptomatic dogs with CVD or DCM that is not severe enough to meet criteria used to trigger the use of medical treatment to delay the onset of heart failure

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16
Q

what is the classification of stage B2?

A

asymptomatic CVD or DCM that is severe enough to result in cardiac remodeling (left atrial & left ventricular enlargement) sufficient to recommend treatment before the onset of clinical signs

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17
Q

what is the current recommendation for CVD/DCM in a dog in stage A?

A

annual auscultation

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18
Q

what is the current recommendation for CVD/DCM in a dog in stage B1?

A

diagnostic tests for staging, scheduled follow-up & client education - no therapy recommended

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19
Q

what is the current recommendation for CVD/DCM in a dog in stage B2?

A

diagnostic tests for staging, scheduled follow-up & client education - pimobendan recommended

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20
Q

what is the current recommendation for CVD/DCM in a dog in stage C?

A

therapy required - furosemide, pimobendan, ACEi, spironolactone

scheduled follow-up & client education

21
Q

what is the current recommendation for CVD/DCM in a dog in stage D?

A

therapy required - symptom specific recommendations

scheduled follow-up & client education

22
Q

what are the EPIC conclusions in regards to time to onset of CHF or cardiac death?

A

extends symptom free survival

60% = 15 months (10% increase in your dogs health-span)

1/3 decreased risk of CHF every day for the rest of the dog’s life - majority of benefit attributable to delay onset of CHF

*extends overall survival
*safe & well tolerated
*results are of clinical relevance

23
Q

what are the 4 possible diagnostic criteria for stage B2 of CVD?

A

documentation of ‘sufficient cardiomegaly’

(echocardiogram)
1. left atrial/ventricular chamber dilation

(thoracic rads)
2. increased vertebral heart size (> 11.5)
3. increased vertebral left atrial size (> 3.0) - progressive radiographic cardiac enlargement
4. > 0.5 increase in VHS over 6 months or increase > 0.08 in a month

24
Q

what is the typical murmur heard in a dog with stage B2 CHF?

A

mitral regurgitation murmur - left systolic apical, typically grade 3/6

25
Q

what criteria must be met to diagnose an asymptomatic older small breed dog with a mitral valve murmur in stage B2 CHF?

A

must meet or exceed any one of the following 4 criteria!!!!!

(echocardiogram)
1. left atrial/ventricular chamber dilation

(thoracic rads)
2. increased vertebral heart size (> 11.5)
3. increased vertebral left atrial size (> 3.0) - progressive radiographic cardiac enlargement
4. > 0.5 increase in VHS over 6 months or increase > 0.08 in a month

26
Q

what is the highest priority test to diagnose CVD? why?

A

echocardiography - it is the most sensitive & specific method to diagnose & stage CVD making it the priority test

27
Q

what should you do when evaluating chest rads that weren’t taken at a 6 month interval?

A

divide the difference in VHS by the number of months between the visits - a change per month that is > 0.08 also represents progressive cardiomegaly in dogs with stage B CVD

28
Q

what are the differences in follow-up care in dogs with stage B1 versus stage B2 CVD?

A

stage B1 - no treatment, follow up every 6-12 months, weekly monitoring of home respiration rates, & modest dietary sodium restriction

stage B2 - pimobendan (0.23-0.3 mg/kg every 12 hours), recheck every 4-8 months, daily monitoring of home respiration rates, & modest dietary sodium restriction

29
Q

if you have a dog in stage C CVD with no significant arrhythmias, what treatment is recommended?

A
  1. pimobendan & furosemide
  2. ACEi
  3. spironolactone
30
Q

if you have a dog in stage C CVD with significant ventricular arrhythmias, what treatment is recommended?

A
  1. pimobendan & furosemide
  2. ACEi & sotalol
  3. spironolactone
31
Q

if you have a dog in stage C CVD with atrial fibrillation, what treatment is recommended?

A
  1. pimobendan & furosemide
  2. ACEi & diltiazem
  3. spironolactone +/- digoxin
32
Q

after the initial diagnosis of L-CHF secondary to mmvd is made, what should be done?

A

follow-up in 10-14 days & scheduled follow-ups every 2-4 months or sooner if signs of decompensation develop or after a significant change in meds

33
Q

what is heart failure?

A

inability of the heart to meet tissue perfusion needs with normal filling pressures

34
Q

what is backward heart failure?

A

‘wet’ heart failure

left sided CHF - cardiogenic pulmonary edema
right sided CHF - ascites +/- pleural effusion
left & right sided - biventricular failure

35
Q

what is forward heart failure?

A

‘cold’ - poor peripheral perfusion

36
Q

what diagnostic tests should be performed if you suspect forward heart failure?

A

blood pressure - low
pre-renal azotemia
venous O2 < 24mmHg
increased blood lactate

37
Q

what is the typical history & physical exam findings of a dog with suspected ‘forward’ heart failure?

A

lethargic, dull/depressed, exercise intolerance, weakness, collapse, syncope

+/- murmur, relative tachycardia, cool extremities, weak pulses, increased CRT, cyanosis, & low body temperature

38
Q

what is the typical history & physical exam findings of a dog with suspected ‘backward’ right-sided heart failure?

A

pot belly/abdominal distension, diarrhea, dyspnea, tachypnea

+/- murmur/relative tachycardia, ascites with jugular distension & positive hepatojugular reflex, pleural effusion - muffled lung and/or heart sounds

39
Q

what diagnostic tests should be performed if you suspect right-sided backward heart failure?

A

echocardiogram, abdominal ultrasound, thoracic radiographs, abdominocentesis, & pleurocentesis

40
Q

what is seen on rads in a dog with left sided backward heart failure?

A

cardiogenic pulmonary edema

41
Q

what diagnostic tests should be performed if you suspect left-sided backward heart failure?

A

thoracic rads, therapeutic challenge, blood biomarkers - n-terminal pro b type naturetic peptide

42
Q

what is the typical history & physical exam findings of a dog with suspected ‘backward’ left-sided heart failure?

A

cough, tachypnea, dyspnea, acute history, depressed, anorexia, weight loss, orthopnea

+/- murmur, relative tachycardia, normal lung sounds, crackles, wheezes, & increased bronchovesicular sounds

43
Q

why do dogs get a cough with CVD?

A

there is compression of the left mainstem bronchus secondary to left atrial enlargement & primary airway disease complicated by heart enlargement

can mimic primary respiratory disease - can occur alone or in combination with CHF, small (chronic bronchitis) & large airway (collapsing trachea) disease

44
Q

what is the therapy for a cough in a dog with cvd?

A

therapy is palliative not curative - therapy targets underlying airway disease & CVD

45
Q

what are some signs that don’t support a diagnosis of CHF?

A

slow heart rate, sinus arrhythmia, no gallop sounds, normal pulses, loud lung crackles, normal VHS, no pulmonary infiltrate

46
Q

what are some surgical options for CVD?

A

open surgical repair on cardiopulmonary bypass & transcatheter edge to edge repair (v-clip)

47
Q

what is the 4th most common reported cause of canine death?

A

CVD

48
Q

T/F: CVD is rare before 5 years of age

A

true

49
Q

T/F: 30% of stage B2 dogs will develop CHF

A

true

SA DX & TX I (59 decks)

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