Exam 4 - Feline Cardiac Disease

Question 1

T/F: approximately 15% of apparently healthy cats have cardiomyopathy

Answer 1

true

Question 2

what is a murmur?

Answer 2

audible sound of turbulent blood flow

Question 3

what causes a murmur?

Answer 3

valve regurgitation

outflow tract obstruction

congenital lesions - septal defects

Question 4

why are murmurs an insensitive diagnostic test for detecting heart disease in a cat?

Answer 4

cats can have a murmur that is unrelated to heart disease

or a cat can have heart disease with no audible murmur

Question 5

in cats a ______ is not always present with heart disease & and ______ is not always caused by heart disease

Answer 5

murmur

Question 6

what do you do to diagnose a cat with heart disease?

Answer 6

detection of a murmur, gallop sound, arrhythmia on physical exam

arrhythmia on ECG

cardiomegaly on thoracic rads

echo - required to diagnose type of heart disease

Question 7

what is the best test for detecting heart disease in a cat?

Answer 7

echo!!!

cardiomegaly on rads, arrhythmia on ECG, elevated NTproBNP in a cat with murmur/gallop/respiratory signs

Question 8

what are some examples of things that can cause a heart murmur?

Answer 8

heart disease, hypertension, hyperthyroidism, age related, stress, anxiety, anemia, dehydration

Question 9

when looking at a cat with suspected heart disease with an arrhythmia on ecg, what signs may indicate that is clinically significant?

Answer 9

tachycardia, weakness, collapse, pale mucus membranes, poor pulse quality, & systemic hypotension

need to rule out hyperthyroidism & electrolyte abnormalities

Question 10

what medications can be used for a cat with ventricular arrhythmias?

Answer 10

atenolol - 6.25 mg/cat PO every 12 hours

sotalol - 10mg/cat PO every 12 hours

Question 11

why do you need an echo in a cat with suspected cardiac disease?

Answer 11

investigate the cause of a murmur, assess ventricular systolic & diastolic function, look for atrial enlargement, & thrombus/stroke/assess embolic risk

Question 12

what is a biomarker?

Answer 12

substance that is specific to the organ or tissue under study that is released in proportion to injury or disease

Question 13

what is BNP?

Answer 13

b-type natriuretic peptide that is released by cardiac myocytes primarily in the ventricle in response to stretch

it is cleaved into 2 parts - inactive has a longer 1/2 life that can be measured in plasma or serum

Question 14

why use a BNP assay on a cat?

Answer 14

species specific - useful for assessing dyspneic cats

Question 15

what does a negative BNP test indicate?

Answer 15

high likelihood heart disease is not present

Question 16

what can a false positive test for BNP indicate?

Answer 16

hypertension, hyperthyroidism, & renal disease

Question 17

what are the different stages of heart disease in cats?

Answer 17

stage a - predisposed

stage b1 - low risk, subclinical with normal or mild atrial enlargement

stage b2 - higher risk, subclinical stage, moderate to severe atrial enlargement

stage c - current/previous CHF/ATE (arterial thromboembolism)

stage d - refractory CHF

Question 18

what 3 clinical signs indicate CHF in cats?

Answer 18

pulmonary edema, pleural effusion, & pericardial effusion

Question 19

what does left or right atrial enlargement indicate for prognosis of cardiac disease in cats?

Answer 19

increased risk of CHF

left atrial enlargement - increased risk of arterial thromboembolism

Question 20

what are some differentials for cats with pericardial effusion?

Answer 20

heart failure!!!!

neoplasia

infectious - FIP

Question 21

what are some differentials for dogs with pericardial effusion?

Answer 21

neoplasia!!!

idiopathic

infectious

coagulopathy

Question 22

what are some risk factors for a cat with cardiac disease developing heart failure?

Answer 22

stressful situations

long acting corticosteroids

anesthesia

Question 23

what are some poor prognostic indicators of heart failure in a cat?

Answer 23

clinical signs at presentation, left atrial enlargement, HCM, arterial thromboembolism, hypothermia

Question 24

what clinical signs are caused by an arterial thromboembolism in a cat?

Answer 24

acute paresis or paralysis of any limb - 90% embolize the distal aorta, cat will lack palpable pulses, cyanotic nail beds, & cool limbs

Question 25

how can you prevent an arterial thromboembolism?

Answer 25

prevent with a platelet inhibitor - clopidogrel

Question 26

why does renal disease complicate treating cardiac disease in cats?

Answer 26

need to consider the use of diuretics & ace inhibitors

Question 27

what is the acute management plan for a cat presenting in acute CHF?

Answer 27

oxygen supplementation, furosemide IV, sedation, thoracocentesis, & +/- pimobendan

Question 28

what are the 5 general categories of causes of cardiac disease in cats? which is most common?

Answer 28

1. cardiomyopathy - most common
2. valve disease
3. congenital heart disease
4. heartworm disease
5. neoplasia

Question 29

what is HCM?

Answer 29

left ventricular wall thickening that is focal/concentric causing diastolic dysfunction

Question 30

what is obstructive hypertrophic cardiomyopathy in cats?

Answer 30

left ventricular basilar septal wall thickening causing obstruction to left ventricular outflow

results in mitral regurgitation & left atrial enlargement

Question 31

what is dilated cardiomyopathy in cats?

Answer 31

chamber dilation + reduced contractility (systolic dysfunction)

either dietary (taurine deficiency) or idiopathic

Question 32

what is restrictive cardiomyopathy in cats?

Answer 32

normal to mild left ventricular hypertrophy causing wall motion abnormalities & biatrial enlargement

fibrotic tissues in the ventricles = diastolic dysfunction

Question 33

what is the pathogenesis of arrhythmogenic right ventricular cardiomyopathy?

Answer 33

fibrotic or fatty tissues replaces myocardial cells causing dilation of the right ventricle & atrium & systolic dysfunction & arrhythmias