HCM - Hypertrophic Cardiomyopathy

Question 1

What is HCM a disease of?

Answer 1

Sarcomeres

Question 2

With HCM, where is the specific genetic mutation located?

Answer 2

MyBPC (Myosin-binding protein C)

Question 3

In cats with HCM, which is abnormal, systolic function or diastolic function?

Answer 3

Diastolic function

Question 4

What type of hypertrophy develops with HCM?

Answer 4

Concentric hypertrophy

Question 5

Explain how concentric hypertrophy develops with HCM…

Answer 5

1. Abnormal diastolic function (impaired LV myocardial relaxation)
2. Body responds by making more sarcomeres
3. Get thickening of the left ventricle
4. Concentric hypertrophy

Question 6

What is the primary etiology of HCM?

Answer 6

Not enough relaxation/filling

Question 7

What is the typical signalment of a cat with HCM?

Answer 7

1. Male (75%)
2. Main coon or Ragdoll
3. Middle-aged (median 6 yo)

Question 8

What would you expect to see on echocariography of a cat with HCM?

Answer 8

1. LV hypertrophy

2. LV diastolic dysfunction

Question 9

What are the 4 differentials for LV hypertrophy in the cat?

Answer 9

1. Hyperthyroidism
2. HCM
3. Hypertension systemically
4. Hypersomatotopism (acromegaly)

Question 10

What causes the heart murmur in HCM?

Answer 10

Mitral valve regurgitation

Question 11

Where does the fluid go in a dog with left-side CHF?

Answer 11

Pulmonary edema

Question 12

Where does the fluid go in a cat with left-sided CHF?

Answer 12

1. Pulmonary edema
2. Pleural effusion
3. Pericardial effusion

Question 13

Where does the fluid go in a dog with right-sided CHF?

Answer 13

Ascites

Question 14

Where does the fluid go in a cat with right-sided CHF?

Answer 14

1. Ascites
2. Pleural effusion
3. Pericardial effusion

Question 15

What are the 4 anti-thrombin drugs?

Answer 15

1. Clopidogrel
2. Heparin
3. Aspirin
4. tPA (tissue plasminogen activator)

Question 16

What are the 3 drugs you could utilize to treat asymptomatic (stage B) HOCM?

Answer 16

1. Atenolol
2. Clopidogrel
3. ACE inhibitor

Question 17

When would you use atenolol?

Answer 17

With LVOT obstruction

Question 18

When would you use clopidogrel?

Answer 18

With moderate-severe LA enlargement

Question 19

When would you use ACE inhibitors?

Answer 19

With LV/LA remodeling

Question 20

What are the 3 drugs you could utilize to treat CHF (stage C) associated with HCM?

Answer 20

1. Furosemide
2. Pimobendan
3. ACE inhibitor

Question 21

In treating CHF secondary to HOCM in the cat, what would you utilize for acute therapy (in hospital)?

Answer 21

1. Furosemide
2. Oxygen
3. Pimobendan
4. Sedation
5. Thoracocentesis

Question 22

In treating CHF secondary to HOCM in the cat, what would you utilize for chronic therapy (at home)?

Answer 22

1. Clopidogrel
2. ACE inhibitor
3. Furosemide
4. Dietary Na restriction
5. Pimobendan

Question 23

Which drug would you consider utilizing if pulmonary hypertension were present?

Answer 23

Sildenafil