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Y4 SA - Cardio-Respiratory > Feline Myocardial Disease > Flashcards

Feline Myocardial Disease Flashcards

1
Q

List the 4 primary feline myocardial diseases

A
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
  • Dilated cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
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2
Q

List the 3 secondary feline myocardial diseases

A
  • Hypertensive cardiomyopathy
  • Hyperthyroid cardiomyopathy
  • Cardiomyopathy associated with other systemic disease e.g. renal failure, acromegaly (normally associated with insulin resistant diabetes mellitus) etc
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3
Q

Which conditions need to be excluded in cats to diagnosed cardiomyopathies?

A

Conditions that will cause a pressure overload on the left ventricle
e.g. systemic hypertension: need to measure BP and look for primary causes of this e.g., hyperthyroidism, chronic kidney disease

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4
Q

Describe the features of feline systemic hypertension

A
  • May result in secondary cardiomyopathy
  • Heart murmurs frequently identified
  • Need to screen for underlying systemic disease (Haematology, Biochemistry, TT4 etc.)
  • Vital to recognise prior to ocular / CNS complications.
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5
Q

Feline hypertrophic cardiomyopathy is characterised by?

A

A marked concentric hypertrophy of the left ventricle
Diastolic dysfunction - difficulty in filling

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6
Q

How is feline hypertrophic cardiomyopathy diagnosed?

A

A diagnosis of exclusion
Rule out other potential causes of concentric hypertrophy

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7
Q

List some other potential causes of concentric hypertrophy in cats

A
  • Aortic stenosis
  • Systemic hypertension
  • Hyperthyroidism
  • Chronic renal failure
  • Acromegaly (+/- diabetes mellitus)
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8
Q

What happens if cats with hypertrophic cardiomyopathy become very stressed or tachycardic?

A

Can push them into left sided congestive heart failure and
can be known as flash pulmonary oedema

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9
Q

How do cats with preclinical hypertrophic cardiomyopathy present

A
  • Identified because of detection of an asymptomatic heart murmur most commonly
  • Sometimes, arrhythmias or diastolic gallops detected on physical examination.
  • Blood samples: Increased NT-pro-BNP (ref. <100 pmol/L) and / or Troponin I (cardiac biomarkers)
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10
Q

How do cats with clinical hypertrophic cardiomyopathy present

A
  • Dyspnoea or tachypnoea because of congestive heart failure (pulmonary oedema and / or pleural effusion
  • Feline arterial thrombo-embolism (FATE)
  • Syncope / odd episodes (seem frightened or painful)
  • Periods of open-mouth panting
  • Sudden death
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11
Q

What are the clinical signs/findings in feline arterial thrombo-embolism? in cats with HCM?

A
  • Purple looking pads
  • Off back legs
  • Painful
  • PM: saddle thrombus in the aorta going to the external iliac arteries
  • Severe underlying heart disease with poor prognosis
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12
Q

What drugs should be given to a cat presenting with clinical HCM?

A

Give oxygen
Butorphanol sedation
Furosemide IV

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13
Q

Describe how echocardiography is used to diagnose feline HCM?

A

Demonstration of a concentric hypertrophy (with wall measurements ≥6 mm in diastole) is sufficient for the diagnosis, after active exclusion of underlying disease and systemic hypertension
- Aortic to left atrial ratio is more than 1.5
- Left atrium is increasing in size – risks = heart failure and thromboembolism

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14
Q

Describe how feline hypertrophic cardiomyopathy is classified/staged

A

A = predisposed
B1 (low risk) = sub clinical - normal/mild atrial enlargement
B2 (higher risk) = subclinical - moderate/severe atrial enlargement
C = Current/previous CHF
D = refractory CHF

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15
Q

Define refractory CHF

A

Also known as end stage or advanced heart failure - heart failure symptoms persist despite taking prescribed medications

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16
Q

Describe the appearance of feline HCM on radiographs

A
  • Typically have pulmonary oedema
  • Air bronchograms: alveolar interstitial pattern
  • Effacement of the cardiac silhouette
  • Resolving of the pulmonary oedema allows for a better view of the cardiac silhouette
  • Typically no cardiomegaly due to concentric hypertrophy
17
Q

Describe the diastolic ‘gallops’ heard in feline heart disease

A

The detection of third (S3) and fourth heart (S4) sounds
Abnormally detected in cats and dogs
S3 = rapid deceleration of blood in LV
S4 = LV filling associated with atrial contraction

18
Q

Describe treatment of feline HCM if the patient is in heart failure

A
  • Diuretics (furosemide) (IV if it can be administered without stress if severe dyspnoea)
  • Venodilator if life-threatening pulmonary oedema.
  • ACE inhibitor (ACE inhibitors are not licensed for the treatment of feline CHF. However benazepril is licensed in cats (for CKD)
  • Angiotensin II receptor blocker (Telmisartan; Semintra) is an alternative (licensed for feline CKD)
19
Q

Which drugs can be used to prevent thromboembolism in cats with HCM?

A

Clopidogrel
Aspirin

20
Q

Which drugs may be used in the asymptomatic cat with HCM?

A

Beta blocker: reduce severity of dynamic LVOT obstruction, slow HR (improves diastolic function)
ACE-I
Diltiazem: positive inotrope (improves relaxation)
- No evidence available that any drug slows down progression into CHF

21
Q

Which group of drugs cannot be used in cats with CHF?

A

Beta blockers

22
Q

What must be excluded from cats to diagnose suspected dilated cardiomyopathy?

A

Taurine deficiency - assess response to taurine supplementation

23
Q

How is feline dilated cardiomyopathy treated?

A
  • Warmth
  • Humidified oxygen
  • Drain significant pleural effusions
  • Furosemide
  • ACE inhibitors
  • Pimobendan (unlicensed for cats)
  • Taurine: even if not deficient
24
Q

Describe the two forms of restrictive cardiomyopathy

A

Myocardial form – associated with fibrosis
Endomyocardial form – endocardial thickening

25
Q

Describe the characteristics of restrictive cardiomyopathy

A
  • Relatively normal LV wall measurements
  • Relatively normal LV chamber dimensions
  • Relatively normal LV systolic function
  • Usually marked LA enlargement
  • Diastolic function: restrictive physiology
26
Q

What is non-specific cardiomyopathy?

A

Features of more than one form of cardiomyopathy
e.g. Systolic dysfunction with abnormal LV filling

27
Q

Describe arrhythmogenic right ventricular cardiomyopathy in cats

A
  • Fatty replacement of myocardium, initially around RVOT. Usually marked dilatation of the right heart.
  • May show ventricular arrhythmias or conduction disturbances but most commonly, affected cats present with R-CHF (e.g. ascites).
  • Some cats have 3rd degree AV block.
28
Q

What are the key considerations when presented with a dyspnoeic cat due to pulmonary oedema

A
  • These cats are very fragile and seriously ill
  • Do not stress
  • They will not tolerate echocardiography, radiography and ECG
  • Must be stabilised prior to further investigation
29
Q

Describe how to stabilise a dyspnoeic cat

A
  • Oxygen therapy (humidified)
  • Reduce anxiety (e.g. butorphanol)
  • Calm, gentle handling & environment
  • Delay investigations until more stable.
  • Intravenous furosemide (IM if very stressed)
  • Drain pleural effusions
30
Q

Describe using a NT pro-BNP SNAP test

A
  • Immediate results, so very useful in a dyspnoeic patient to identify a cardiac cause or to exclude it.
  • Can also run the test on pleural effusion post-Thoracocentesis
  • Not useful to screen healthy cats for HCM (need values of >200pmol/L for “Abnormal” on the SNAP test).
31
Q

Describe treatment of stages A and B1 of feline cardiomyopathy

A

No treatments indicated

32
Q

Describe treatment of stage B2 of feline cardiomyopathy

A

Clopidogrel if at risk of FATE

33
Q

Describe treatment of stages C and D of feline cardiomyopathy

A
  • Diuretics: Furosemide
  • Consider pimobendan
  • ACE-I once recovered from acute decompensation
  • Consider spironolactone

Y4 SA - Cardio-Respiratory (10 decks)

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