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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

25
clinical signs of dilated cardiomyopathy
asymptomatic clinical: pulmonary edema/pleural effusion, tachypnea/dyspnea lethargy and inappetance at risk for systemic arterial thromboembolism
26
PE findings of dilated cardiomyopathy
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
radiographic findings of dilated cardiomyopathy
cardiomegaly, pulmonary edema, and/or pleural effusion need echo
28
Echocardiographic findings of dilative cardiomyopathy
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
treatment of dilative cardiomyopathy
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
what test should be done in all cases of feline dilative cardiomyopathy?
blood taurine concentrations
31
prognosis of dilative cardiomyopathy
if they survive first two weeks and clearly respond to taurine-excellent px idiopathic: guarded short-term & poor long term
32
restrictive cardiomyopathy
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
Diagnosis of restrictive cardiomyopathy
pulmonary edema/pleural effusion, tachypnea, dyspnea ECHO: severe left and bi-atrial enlargement, endocardium may appear thickened & irregulat with increased echogenicity
34
treatment of restrictive cardiomyopathy
acute: parenteral furosemide, oxygen supplementation, minimal stress, +/- topical nitroglycerine, +/- thoracocentesis maintenance: oral furosemide, ace inhibitor, pimobendan prevention of systemic arterial thromboembolism
35
prognosis of restrictive cardiomyopathy
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
Arrhythmogenic right ventricular cardiomyopathy
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
pathophysiology of Arrhythmogenic right ventricular cardiomyopathy
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
clinical signs of Arrhythmogenic right ventricular cardiomyopathy
signs of right sided CHF (ascites, tachypnea, pleural effusion) lethargy, anorexia syncope
39
diagnosis of Arrhythmogenic right ventricular cardiomyopathy
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
treatment of Arrhythmogenic right ventricular cardiomyopathy
furosemide and ace inhibitor periodic abdominocentesis anti-arrhythmic therapy
41
prognosis of Arrhythmogenic right ventricular cardiomyopathy
poor px if in right sided CHF
42
how does hyperthryoidism cause myocardial hypertrophy?
chronic volume overload high sympathetic tone systemic hypertension direct stimulation of myocardial contractile protein synthesis by thryoid hormone
43
PE findings in hypertrophic cardiomyopathy secondary to hyperthryoidism
tachycardia, strong femoral pulses, systolic heart murmur, gallop sound and arrhythmias respiratory signs of CHF lung and heart sounds muffled
44
electrocardiographic findings in hypertrophic cardiomyopathy secondary to hyperthryoidism
sinus tachycardia and increased R wave amplitude supraventricular and ventricular arrhythmias
45
ECHO findings in hypertrophic cardiomyopathy secondary to hyperthryoidism
mimic HCM marked wall thickening (concentric) atrial enlargment ventricular chamber dilation fractional shortening increased
46
treatment of hypertrophic cardiomyopathy secondary to hyperthryoidism
asymptomatic-treat hyperthyroidism symptomatic-treat as per HCM, cautiously treat hyperthryoidism
47
px of hypertrophic cardiomyopathy secondary to hyperthryoidism
not in CHF: excellent CHF: guarded
48
steroid associated heart failure
associated with corticosteroid administration mechanism is via plasma volume expansion: hyperglycemia, osmotic fluid shift, fluid overload and circulatory failure
49
acromegaly
concurrent insulin resistant DM elevated circulating growth hormone causes left ventricular concentrativ hypertrophy and results in CHF hypertrophy reversible with therapy
50
systemic hypertension
systemic arterial hypertension-pressure overload left ventricular concentric hypertrophy

cardiopulmonary test 4 (11 decks)

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