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RUSVM SAM 1 > Hypertrophic Cardiomyopathy and RCM > Flashcards

Hypertrophic Cardiomyopathy and RCM Flashcards

1
Q

T/F: feline hypertrophic myopathy is secondary to increased ventricular pressures

A

False

Primary concentric hypertrophy
Usually LV but RV can be affected

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2
Q

What breeds of cats are most predisposed to HCM?

A

Maine coon
Rag dolls
American shorthair

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3
Q

Cardiomyocyte hypertrophy occurs in reponse to _________

A

Sarcomeric dysfunction

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4
Q

What do you see on histopathology in HCM?

A

Myofiber disarray
Arteriosclerosis (hardening of the arteries)
Fibrosis

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5
Q

Hypertrophic cardiomyopathy results in _______ dysfunction due to increased ventricular wall stiffness

A

Diastolic

—> impaired relaxation

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6
Q

How does hypertrophic cardiomyopathy impact blood flow?

A

Diastolic dysfunction leads to increased ventricular filling pressures

—> increase LV pressures increase atrial and pulmonary venous pressures —> develop pulmonary edema +/- pleural effusion

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7
Q

What is the obstructive form of HCM?

A

Systolic anterior motion of the mitral valve (SAM)

—> papillary muscle hypertrophy leads to displacement of chordae tendineae to the LV outflow tract during systole

—> impaired flow to aorta and some regurgitation through mitral valve

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8
Q

T/F: cats with HCM do not have murmurs

A

True

Except in obstructive form

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9
Q

Why do you see left atrial dilation in HCM>

A

Dilation due to chronically elevated filling pressures of the ventricles

-can be exacerbated by mitral regurgitation from SAM

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10
Q

If the LA becomes moderately/severely dilated, what would you be concerned about in you cats?

A

Thrombus formation

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11
Q

What is the usual signalment of cats with HCM?

A

Av age 6years
Younger presentation in pure breeds

Male>female

DSH is the most common breed diagnosed

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12
Q

What is the most common presenting complaint in HCM cats?

A

Dyspnea (due to CHF)

Although 50% of cats are asymptomatic at time of diagnosis

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13
Q

What co-morbidities are common with HCM?

A

Hyperthyroidism and renal disease

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14
Q

Where is a murmur heard in a cat with HCM with SAM?

A

Systolic murmur, often left sided

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15
Q

What can be present in auscultation of a cat with HCM?

A

Normal auscultation normal in cats with HCM

Gallop
Heart rate normal, low, or high

Premature beats

Femoral pulses are usually normal (unless ATE, arrhythmia, low output HF)

Abnormal lung sounds with CHF
Hypothermic if ATE or low output

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16
Q

What are the DDX for murmurs in cats?

A

Structural heart disease

  • HCM
  • RCM
  • degenerative valve disease
  • congenital heart disease (young)

Physiological

  • dynamic right ventricular outflow tract obstruction
  • anemia
  • hyperthyroid
  • fever

Innocent

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17
Q

How can we get a definitive diagnosis for HCM?

A

Echo

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18
Q

What are DDX for LV concentric hypertrophy that you must rule out before you can contribute the hypertrophy to HCM?

A

Aortic stenosis
Systemic hypertension
Acromegaly
Infiltrative debase (lymphoma)

19
Q

What are the most common arrhythmias in cats with HCM?

A 
VPC
VT
APC
SVT
A fib

Test of choice if arrhythmia is auscultated is ECG

20
Q

What is the test of choice if there are intermittent signs suspected to be due to arrhythmia ?

A

24hr holter monitor

21
Q

What is the most commonly used biomarker in clinical feline cardiology?

A

N proBNP

-IDEXX snap test

22
Q

What are drugs with potential benefits in treating asymptomatic cats with HCM

A 
Diltiazem 
ACE inhibitor s
Aldosterone antagonist 
B blocker 
Antiplatelet drug (clopidogrel)

—> consider severity, risk factors, disease progression, drug side effects

23
Q

Left atrial enlargement is a risk factor for what diseases?

A

CHF
ATE
Sudden death

—cardiologists recommend 1>drugs when LAE is present

24
Q

What drug has been show to significantly reduce dynamic LVOTO?

A 
Beta blocker (atenolol) 
-negative inotropic
25
Q

What is the inpatient procedure for CHF due to HCM?

A

Thoracocentesis for pleural effusion

Furosemide

Supplemental O2

Clopidogrel

Diltiazem /Pimobendan ?

Dobutamine for low output HF (uncommon in HCM)

26
Q

What is the outpatient procedure for patients with CHF due to HCM?

A

Thoracocentesis

Oral furosemide

Clopidogrel

ACE inhibitor

Pimobdenan/Diltiazem

Refractory CHF: spironolactone, higher doses of furosemide, HCTZ, or pimobdenan

27
Q

What is the treatment for arterial thromboembolism ?

A

Analgesia (fentanyl or buprenorphine)

Antithrombic therapy

  • heparin
  • clopidogrel

Supportive care

  • bladder and prevention of urine/fecal scald
  • musculoskeletal support
  • nutritional
  • monitor for reperfusion injury (hyperkalemia/acidosis), azotemia, arrhythmia, CHF, necrosis, infection
28
Q

What is the criteria for treating arrhythmias?

A

Ventricular or supraventricular tachycardia

Frequent singles, couplets, and/or triplets

R on T

29
Q

How can you treat acute SVT?

A

Diltiazem or esmolol

30
Q

How do you treat chronic SVT?

A 
Diltiazem 
Atenolol 
Digoxin 
Ivabradine 
Amiodarone
31
Q

How do you treat acute ventricular tachycardia ?

A

Lidocaine

Esmolol

32
Q

How do you treat chronic ventricular tachycardia?

A

Atenolol
Sotalol
Amiodarone

33
Q

How can clients monitor for progression of heart failure?

A

Sleeping/resting respiratory rate (>30br/min indicates HF)

New/increased cough (dog)

Lethargy, syncope, weakness, decreased appetite, abdominal distention

34
Q

How can progression of HR be monitored in the clinic?

A 
HR and rhythm
RR and effort 
Mentation 
BP
Weight 
Renal values and electrolytes 
Radiographs 
ECG
Holter 
Echo
35
Q

What side effects can result from HF medications that clients should watch for at home?

A

Appetite
Energy level
Vomiting, diarrhea

Hydration
Mentation

36
Q

What is the prognosis of HCM?

A

Good (several years for most) asymptomatic cats

Poor long term prognosis if CHF develops

Sudden death can occur (10-25% of HCM related deaths)

ATE also a potential complications

37
Q

RCM is a primary myocardial disease that is characterized by _________ dysfunction

A

Diastolic

38
Q

T/F: both HCM and RCM are due to diastolic dysfunction and increase in ventricular wall thickness

A

False

Both are due to diastolic dysfunction

HCM—>increased ventricular wall thickness
RCM—>normal ventricular wall thickness

39
Q

What changes occur to the heart in RCM?

A

Focal or diffuse fibrosis in the endocardium and/or myocardium

Walls are usually normal thickness but focal thinning/thickening is possible

Atrial dilation in most common

40
Q

How does the diastolic filling differ between HCM and RCM?

A

HCM: prolonged myocardial relaxation -> decreased passive filling

DCM: restrictive filling —> ventricle is stiff impairing atrial systolic filling

41
Q

What is the signalment of RCM?

A

Adult onset
Av age 7
No sex or breed predisposed

42
Q

What are possible PE findings in cats with RCM?

A

Can have no auscultable abnormalities

Gallop/low grade murmur possible
HR normal/low/high

Premature beat possible
Femoral pulses normal unless ATE

Abnormal lung sounds

Hypothermic if ATE or low output HF

43
Q

How do you treat cats with RCM?

A 
Asymptomatic with atrial enlargement: 
antithrombic (clopidogrel)
ACE inhibitor (enalapril or benazepril ) 
\+ pimobdenan if systolic dysfunction is present

Symptomatic: same treatment for HCM with HF

44
Q

What is the prognosis for cats with RCM?

A

Symptomatic - mean survivial is 4-9months

RUSVM SAM 1 (26 decks)

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