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SA Cardiology > Feline cardiomyopathy > Flashcards

Feline cardiomyopathy Flashcards

1
Q

Definition of cardiomyopathy

A

A muscle disease associated with cardiac dysfunction

Can be primary or secondary

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2
Q

Classifications of feline cardiomyopathies

A

Hypertrophic cardiomyopathy (HCM) - left ventricle walls thickened

Restrictive cardiomyopathy (RCM) - dilated atrium

Dilated cardiomyopathy (DCM)

Arrhythmogenic right ventricle cardiomyopathy (ARVC)

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3
Q

Prevalence of different cardiomyopathies in cats

A

HCM: 58-77%
RCM: 15-21%
DCM: 4.4-10%
ARVC: 0.5-1%

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4
Q

Hypertrophic cardiomyopathy

A

Unexplained increase in left ventricular thickness

Myocardial disease charaterised by LV hypertrophy in the abscence of abnormal loading conditions

Very similar clinical and pathological features to HCM in humans

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5
Q

Aetiology of HCM

A

Familial in several breeds (Maine coon, Ragdoll, DSH, Sphynx)

In most cases the genetic mutation is unknown

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6
Q

Diagnosis of HCM

A

Echocardiography
- LV wall thickness (diastole) should be more than/equal to 6.0mm

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7
Q

HCM phenocopies

A

Unexplained increase in left ventricular thickness

Need to screen for the other diseases that look like HCM but aren’t

Thick walls could instead be oedema, cell infiltration etc.

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8
Q

Diseases, aside from HCM, that can cause pressure overload in the left ventricle - myocardial hypertrophy

A

Aortic stenosis (more resistance leaving the left ventricle)

Systemic hypertension (very important in cats)

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9
Q

Acromegaly

A

Hypersomatotropism

Much more prevalent in the UK than previously thought

Frequently presented with diabetes mellitus, but not always

However still much more rare than HCM

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10
Q

Pseudohypertrophy

A

If the patient is dehydrated the ventricular walls look thick but they aren’t

You would also expect the atrium to look small

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11
Q

Systolic anterior motion of the mitral valve (SAM)

A

Seen in both HCM (commonly but not pathognomic) and some HCM phenocopies

During systole the mitral valve should remain in place

Common cause of heart murmurs in cats and humans

Obstruction to the blood flow so the blood will flow faster to get around it

Mitral regurgitation

Mitral valve is dragged towards the septum

In HCM the ventricles are also hypercontractile

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12
Q

Transient myocardial thickening

A

Presents with CHF and looks like HCM

However undergoes reverse remodelling back to normal

Typically young cats, usually that have recently undergone a stressful event

Excellent prognosis

Young cats with ‘HCM’ and heart failure +/- antecedent event > give it a try > treat!!

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13
Q

Causes of thickened ventricular walls on echo (cats)

A

Myocardial hypertrophy

Pseudohypertrophy

Accumulation of cells or fluid

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14
Q

Causes of myocardial hypertrophy

A

Hyperthyroidism

Acromegaly

HCM

Aortic stenosis

Systemic hypertension

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15
Q

Cause of pseudohypertrophy

A

Dehydration

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16
Q

Cause of accumulation of cells or fluid in ventricular walls

A

Lymphoma

TMT

17
Q

Mean age of diagnosis of HCM

A

5.9-6.5yrs

18
Q

What % of cats with HCM develop serious complications?

A

Around 30%

  • congestive heart failure
  • aortic thromboembolism
  • Sudden cardiac death
19
Q

What % of cats with HCM have normal heart sounds?

A

Up to 69%

20
Q

Diagnosis of HCM

A

Ausculation of heart

ECG

Echo

T4 test (hyperthyroidism)

Blood pressure (systemic hypertension)

21
Q

Echocardiography of RCM

A

Normal LV wall thickness

LA or biatrial enlargement

22
Q

Pathology of RCM

A

Bi-atrial dilation

Normal LV wall thickness

Normal LV systolic function

Restrictive LV filling pattern

23
Q

Aetiology of RCM

A

Infiltration of eosinophils > activated eosinophils > cardiac damage
□ Unlikely in cats

Viral induced or immune-mediated
□ Conflicting results
® Histopath evidence of myocarditis and panleukopaenia virus DNA
® Histopath no endocarditis or endomyocarditis and no viral DNA
® 35% of RCM cats had infectious diseases

Familial > sarcomere mutations
□ No genetic studies in cats so far

24
Q

Signalment of RCM

A

Mean age at diagnosis 7-10 years

> > DSH cats, but also in Birmans, Siamese, and Persians

25
Q

Physical examination of cats with RCM

A

Systolic heart murmur (36-77%)

Gallop (31%)

Arrythmias (23%)

26
Q

Diagnosis of RCM

A

Echocardiography
- myocardial RCM
- Endomyocardial RCM

27
Q

Dilated cardiomyopathy in cats

A

Characterised by LV dilation and systolic dysfunction

Classically associated with taurine deficiency
§ Rare after taurine levels in commercial cat food were corrected
§ Cats on unbalanced diets (e.g. vegetarian, dog food)

28
Q

Prognosis of DCM in cats

A

12-49 days MST in DCM non-responsive to taurine > longer survival with pimobendan

29
Q

Diagnosis of DCM in cats

A

Echocardiography
- normal-reduced LV wall thickness
- LV systolic dysfunction
- LA dilation

30
Q

Arrhythmogenic RV cardiomyopathy (ARVC) in cats

A

Characterised by RV fibro-fatty infiltration
§ Severely dilated RV
§ Thin RV wall
§ Can also affect LV

31
Q

Differential diagnosis for ARVC in cats

A

Tricuspid dysplasia

32
Q

Diagnosis of ARVC in cats

A

Echocardiography
- RA and RV dilation
- Arrhythmias and right-sided CHF

Echo and ECG
- malignant ventricular arrhythmias are common

33
Q

Stages of feline cardiomyopathy

A

A: predisposed

B1: low risk, subclinical, normal/mild atrial enlargement

B2: high risk, subclinical, moderate/severe atrial enlargement

C: CHF/ATE

D: refractory CHF

34
Q

Median survial time of cats with asymptomatic HCM

A

May have >10yrs

35
Q

Risk factors for HCM in cats

A

LA dilation

‘Smoke’

LA thrombus

36
Q

Treatment of stage B2 cardiomyopathy in cats

A

Clopidogrel

37
Q

Treatment of Stage C cardiomyopathy in cats

A

Sedation

No stress

O2

Furosemide

Antithrombotics
- heparin
- clopidogrel

Analgesia
- methadone
- fentanyl

38
Q

What is the most common heart disease in cats?

A

HCM

SA Cardiology (12 decks)

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