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cardiopulmonary test 4 > feline myocardial disease > Flashcards

feline myocardial disease Flashcards

1
Q

hypertrophic cardiomyopathy (HCM)

A

primary myocardial disease characterized by thickening of ventricular myocardium-concentric hypertrophy

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2
Q

what is the most common cause of cardiac disease and congestive heart failure in cats?

A

hypertrophic cardiomyopathy

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3
Q
A

hypertrophic cardiomyopathy

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4
Q

cause of hypertrophic cardiomyopathy

A

not known

likely mutations in the genes for sarcomeric proteins-autosomal dominant

Maine Coon

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5
Q

pathophysiology of hypertrophic cardiomyopathy

A

left ventricular diastolic dysfunction

increase in chamber stiffness, impeding normal ventricular filling in diastole

myocardial ischemia, cell death and replacement fibrosis

elevated atrial pressures–>atrial dilation–>blood clots and arrhythmias

Systolic anterior motion

CHF

arteriosclerosis

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6
Q

Systolic anterior motion (SAM) of mitral valve

A

septal leaflet of mitral valve is pulled into left ventricular outflow tract during systole

dynamic subaortic stenosis & mitral valve regurgitation

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7
Q

How does SAM complicate hypertrophic cardiomyopathy?

A

creates a pressure overload to LV

progressive concentric hypertrophy

mitral regurgitation results in highers left atrial pressures than may trigger CHF

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8
Q

etiology of Systolic anterior motion of the mitral valve

A

secondary to concentric hypertrophy

thickening of papillar muscles distorts the direction of pull of the chordae tenineae on the mitral valve leaflets

thickening of the basilar region of the interventricular septum results in narrowing of left ventricular outflow tract with a resultant accerelation of blood flow in this region

creates Venturi force on mitral leaflet, pulling it into the outflow tract

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9
Q

signalment of hypertrophic cardiomyopathy

A

any age (5-7)

ragdolls, Maine Coon, british shorthairs, persians, Turkish Vans, mixed breeds

male

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10
Q

clinical signs of hypertrophic cardiomyopathy

A

asymptomatic

congestive heart failure-pulmonary edema/pleural effusion, tachypnea, dyspnea

systemic arterial thromboembolism

sudden cardiac death

arrhythmias-atrial fibrillation, ventricular premature beats, ventricular tachycardia, third degree AV block

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11
Q

PE findings of hypertrophic cardiomyopathy

A

Systolic (dynamic) heart murmur (loudest over left parasternal)

gallop sound

arrhythmia

tachypnea/dyspnea

increased lung sounds, pulmonary crackles

muffled lung sounds ventrally

cachexia

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12
Q

radiographic findings of hypertrophic cardiomyopathy

A

cannot distinguish HCM from other forms of cardiomyopathy

no increase in cardiac silhouette until atrial enlargement happens

pulmonary edema-interstital to alveolar pulmonary infiltrate-ventral

pleural effusion

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13
Q

Electrocardiography findings of hypertrophic cardiomyopathy

A

increased amplitube of R wave

atrial fibrillation

ventricular arrhythmias

intra-ventricular conduction disturbances (left anterior fascicular block)

insensitibve and non-specific diagnostic modality

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14
Q

echocardiogram of hypertrophic cardiomyopathy

A

test of choice!

markedly thickened left ventricular walls and prominent papillary muscles

diffuse or focal

Left or Left & right involvement

end systolic cavitary obliteration

endocardial surface tends to be hyperechoic secondary to myocardial fibrosis

SAM detected on 2 dimensional views & doppler studies-“V” shape regurge

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15
Q

DDx for left ventricular concentric hypertrophy

A

Hypertrophic cardiomyopathy

hyperthyroidism

hypertension

acromegaly

recent corticosteroid administration

aortic stenosis

dehydrationn

infiltrative disease (ie lymphoma)

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16
Q

how is hypertrophic cardiomyopathy diagnosed?

A

diagnosis of exclusion

r/o other DDx

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17
Q

treatment for asymptomatic cat with hypertrophic cardiomyopathy

A

atenolol (selective Beta-1 blocker)

improves diastolic function by lengthening the diastolic time interval & abolishes SAM

will only work during times of stress

use if v is > 5 m/sec, certain breeds, and younger cats

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18
Q

treatment of acute CHF in hypertrophic cardiomyopathy

A

parenteral furosemide

supplemental O2

thoracentesis

minimize stress

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19
Q

treatment of chronic CHF in hypertrophic cardiomyopathy

A

prevent recurrence of pulmonary edema

furosemide

periodic thoracentesis

ace inhibitor (enalapril) patient must be eating and non-azotemic

prevention of blood clots

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20
Q

hypertrophic cardiomyopathy prognosis

A

asymptomatic: >5 years, guarded in young cats

CHF: highly variable

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21
Q

dilated cardiomyopathy

A

left ventricular systolic dysfunction

secondary to left ventricular dilatation

22
Q

etiology of dilated cardiomyopathy

A

taurine deficiency

idiopathic

secondary to myocardial infarction, toxoplasma myocarditis, lymphoma

23
Q

pathophysiology of dilated cardiomyopathy

A

progressive decrease in myocardial contractility

decreased SV & CO

promotion of sodium and water retention

increased blood volume and end-diastolic pressures causing left ventricular eccentric hypertrophy

left atrial pressure increase

24
Q

signalment of dilated cardiomyopathy

A

any cat!

25
Q

clinical signs of dilated cardiomyopathy

A

asymptomatic

clinical: pulmonary edema/pleural effusion, tachypnea/dyspnea

lethargy and inappetance

at risk for systemic arterial thromboembolism

26
Q

PE findings of dilated cardiomyopathy

A

pulmonary edema/pleural effusion

increased RR and effort, increased lung sounds and pulmonary crackles

lung sounds muffled ventrally

gallop sounds, heart murmurs and arrhthymias

hypothemia, pale MM and jugular distension

27
Q

radiographic findings of dilated cardiomyopathy

A

cardiomegaly, pulmonary edema, and/or pleural effusion

need echo

28
Q

Echocardiographic findings of dilative cardiomyopathy

A

increase in left ventricular end-systolic diameter

marked decrease in fractional shortening

lack of left ventricular wall motion

severe left atrial enlargement

mild mitral regurgitation

29
Q

treatment of dilative cardiomyopathy

A

acute: parentarl furosemide, oxygen supplementation, minimal stress, +/- topical nitroglycerine, +/- thoracocentesis) positive inotropes
chronic: furosemide, ace inhibitor and pimobendan

taurine supplementation until blood taurine concentration levels are completed

30
Q

what test should be done in all cases of feline dilative cardiomyopathy?

A

blood taurine concentrations

31
Q

prognosis of dilative cardiomyopathy

A

if they survive first two weeks and clearly respond to taurine-excellent px

idiopathic: guarded short-term & poor long term

32
Q

restrictive cardiomyopathy

A

characterized by restriction of diastolic filling

infiltration of fibrous tissue into endocardium, subendocardium or myocardium

impairs ventricular compliance which limits total filling, increases diastolic pressures and has normal myocardial relaxation

normal wall thickness and systolic function

33
Q

Diagnosis of restrictive cardiomyopathy

A

pulmonary edema/pleural effusion, tachypnea, dyspnea

ECHO: severe left and bi-atrial enlargement, endocardium may appear thickened & irregulat with increased echogenicity

34
Q

treatment of restrictive cardiomyopathy

A

acute: parenteral furosemide, oxygen supplementation, minimal stress, +/- topical nitroglycerine, +/- thoracocentesis
maintenance: oral furosemide, ace inhibitor, pimobendan

prevention of systemic arterial thromboembolism

35
Q

prognosis of restrictive cardiomyopathy

A

asymptomatic: good short term and long term px unless they already have severe atrial enlargement

CHF: poor long term, weeks to months to live

36
Q

Arrhythmogenic right ventricular cardiomyopathy

A

predominately affects right ventricle

replacement of ventricular myocardium by fatty/fibro-fatty tissue

leads to development of arrhythmias and right sided congestive heart failure

37
Q

pathophysiology of Arrhythmogenic right ventricular cardiomyopathy

A

right ventricle>left ventricle

both atria can be affectred

progressive myocyte death and subsequent replacement with fatty/fibro-fatty tissue

right ventricular systolic dysfunction

arrhythmogenic substrate

right sided CHF

38
Q

clinical signs of Arrhythmogenic right ventricular cardiomyopathy

A

signs of right sided CHF (ascites, tachypnea, pleural effusion)

lethargy, anorexia

syncope

39
Q

diagnosis of Arrhythmogenic right ventricular cardiomyopathy

A

PE: right systolic heart murmur secondary to tricupsid regurgitation, arrhythmias, jugular vein distension, ascite, tachypnea, hepatosplenomegaly

radiographs: cardiomegaly with right atrial and right ventricular enlargement with signs of right sided CHF

ECGs: ventricular arrhythmias & supraventricular arrhythmias

ECHO: severe right atrial and right ventricular enlargment, tricupsid regurgitation

40
Q

treatment of Arrhythmogenic right ventricular cardiomyopathy

A

furosemide and ace inhibitor

periodic abdominocentesis

anti-arrhythmic therapy

41
Q

prognosis of Arrhythmogenic right ventricular cardiomyopathy

A

poor px if in right sided CHF

42
Q

how does hyperthryoidism cause myocardial hypertrophy?

A

chronic volume overload

high sympathetic tone

systemic hypertension

direct stimulation of myocardial contractile protein synthesis by thryoid hormone

43
Q

PE findings in hypertrophic cardiomyopathy secondary to hyperthryoidism

A

tachycardia, strong femoral pulses, systolic heart murmur, gallop sound and arrhythmias

respiratory signs of CHF

lung and heart sounds muffled

44
Q

electrocardiographic findings in hypertrophic cardiomyopathy secondary to hyperthryoidism

A

sinus tachycardia and increased R wave amplitude

supraventricular and ventricular arrhythmias

45
Q

ECHO findings in hypertrophic cardiomyopathy secondary to hyperthryoidism

A

mimic HCM

marked wall thickening (concentric)

atrial enlargment

ventricular chamber dilation

fractional shortening increased

46
Q

treatment of hypertrophic cardiomyopathy secondary to hyperthryoidism

A

asymptomatic-treat hyperthyroidism

symptomatic-treat as per HCM, cautiously treat hyperthryoidism

47
Q

px of hypertrophic cardiomyopathy secondary to hyperthryoidism

A

not in CHF: excellent

CHF: guarded

48
Q

steroid associated heart failure

A

associated with corticosteroid administration

mechanism is via plasma volume expansion: hyperglycemia, osmotic fluid shift, fluid overload and circulatory failure

49
Q

acromegaly

A

concurrent insulin resistant DM

elevated circulating growth hormone causes left ventricular concentrativ hypertrophy and results in CHF

hypertrophy reversible with therapy

50
Q

systemic hypertension

A

systemic arterial hypertension-pressure overload

left ventricular concentric hypertrophy

cardiopulmonary test 4 (11 decks)

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