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PC Vet > MMVD > Flashcards

MMVD Flashcards

1
Q

How do diuretics affect the (a) lungs and (b) heart?

A

(a) reduce cardiogenic pulmonary oedema

(b) reduce preload

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2
Q

What stage heart disease do you start frusemide?

A

Stage C (Heart failure)

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3
Q

What is a mid-moderate frusemide dose?

A

1-3mg/kg q8-12h

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4
Q

What dose of frusemide would you use in severe/refractory heart failure?

A

4mg/kg q8h

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5
Q

What is a potential serious side effect when starting frusemide therapy?

A

XS volume depletion and reduction in CO if circulating V decreases XS or if patient is dependent on high ventricular filling pressure to maintain CO (HCM, pericardial effusion) –> severe fall in CO –> Hypotension –> azotaemia

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6
Q

What electrolyte abnormality can occur dt frusemide tx?

A

hypokalaemia

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7
Q

How do venodilators effect the heart?

A

Cause relaxation in systemic and pulmonary veins –> increase capacity –> reducing preload

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8
Q

How do arteriodilators effect the heart?

A

Reduce afterload - thus reduce workload

(dt reduction of SNS and peripheral vasoconstriction mediated by RAAS and SNA)

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9
Q

What is a ‘balanced’ vasodilator?

A

it has both arterio and venodilator properties ie. Pimobendan

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10
Q

When is pimobendan indicated?

A

Stage B2 onwards

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11
Q

What is the IV dose of pimobendan in dogs?

A

0.15mg/kg IV (once then switch to PO)

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12
Q

What is the oral dose of pimobendan in dogs?

A

0.1-0.3mg/kg PO q12h (one hour before food)

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13
Q

When is pimobendan contraindicated?

A

hypertrophic cardiomyopathy or aortic stenosis

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14
Q

Why is pimobendan known as an ‘inodilator’

A

i. Increases binding affinity of calcium to cardiac troponin C
ii. inhibits cardiac phosphodiesterase (PDE) III -> reduces breakdown of cAMP –> increases myocardial contraction (and subsequent relaxation)

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15
Q

What vessels does Sildenafil act on?

A

predominantly veins (venodilator)

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16
Q

When do you start ACE inhibitors?

A

Stages C onwards

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17
Q

List 4 ACE inhibitors

A
  1. Benazepril
  2. Ramipril
  3. Imidapril
  4. Enalapril
18
Q

What is the MOA of ACE inhibitors?

A
  1. Blocks conversion of angiotensin I –> angiotensin II
    - -> decreases plasma aldosterone –> mild arteriolar/venous dilation –> Less Na+/H2O retention
    - –> reduces pathologic remodelling/fibrosis
19
Q

Dose of benazepril

A

0.25-0.5mg/kg q24h

20
Q

What is the MOA of nitrates?

A

releases nitric oxide which causes vascular smooth muscle relaxation

21
Q

When are nitrates indicated?

A

In acute, severe heart failure

22
Q

Contrast administration of nitroprusside and nitroglycerin

A

Nitroprusside IV CRI (rapid acting, v. potent) in ECC

Nitroglycerin percutaneous ointment

23
Q

MOA of sildenafil

A

Phosphodiesterase V inhibitor –> acts predominantly on pulmonary arterial vasculature –> reduces pulmonary arteriolar resistance

24
Q

Indication of use of sildenafil

A

Treats pulmonary hypertension

i. Heartworm/severe lung disease
ii. Late stage MMVD

25
Q

What is the oral dose of sildenafil?

A

0.25mg/kg q12h to 2mg/kg q8h

Start at low end and titrate upwards

26
Q

Inotrope indications

A

i. Primary myocardial dysfunction (DCM)
ii. Secondary myocardial dysfunction (eg. myocardial exhaustion) in late MMVD/ severe arrhythmia causing rapid and prolonged contraction

27
Q

What is the MOA of dobutamine?

A

Sympathomimetic direct acting on B1 receptors. –> increases force of ventricular contraction + rate of myocardial relaxation

28
Q

When do you use dobutamine in heart disease?

A

IV by CRI (ECC) as rescue drug in acute heart failure.

29
Q

Describe the pathology of MMVD

A

i. Affects mitral and tricuspid valve leaflets and chordae tendinae: pathology alters valve motion and closure
ii. Valve thickening, prolapse, annular dilation, mitral (and tricuspid) regurgitation

30
Q

Compare the typical onset of MMVD in a toy poodle vs. a dalmation

A

typically smaller breeds have a slow progression through stages A–> D where in larger sized dogs they have a more rapid progression and onset of CHF.

31
Q

List 5 more serious, later stage complications of chronic MMVD

A

i. chordae tendinae may rupture
ii. arrhythmias esp. supraventricular: atrial premature contractions, atrial fibrillation, syncope may become freq. w/ these arrhythmias
iii. cardiac cachexia develops in some cases
iv. atrium may rupture –> haemopericardium (sudden deterioration)
v. myocardial exhaustion

32
Q

Actions taken at Stage A

A

simple recognise that some dogs such as CKCS/small breeds have a high risk of MMVD
No treatment

33
Q

Actions taken at Stage B1

A 
- thoracic rads +/or refer for echo:
VHS<10.5 follow up rads q12m
10.5-11.4 q6-12m
- measure BP for baseline
- advise O to observe for disease progression (RR>30bpm sleeping)

No medications

34
Q

Actions taken at B2

A

Pimobendan 0.25mg/kg q12h PO

+ all B1 actions if not already done

35
Q

Actions taken at stable Stage C

A

Full cardiac evaluation (Echo)
Pimobendan 0.25mg/kg POq12h + frusemide 1-3mg/kg PO q12h
(+/- anti-arrhythmic if indicated)

36
Q

List 3 anti-arrhythmics

A

Digoxin
Sotalol
Beta-blockers

37
Q

Actions taken at acute Stage C presenting as an emergency

A

i. Oxygen
ii. Frusemide 2mg/kg IV –> then 2mg/kg IM/IV q1h until RR/RE good
iii. Pimobendan 0.15mg/kg IV
iv. Absolute rest
v. Anxiolytics (butorphanol, buprenorphine)
vi. Stabilise before rads.

38
Q

Actions taken at progressing Stage C

A

Pimobendan + frusemide (as w/ C)
+ ACE inhibtor - Benazepril 0.25-0.5mg/kg PO q24h
+ Diet: low salt, prevent cachexia

39
Q

Actions taken at Stage D

A 
Meds (4)
Pimobendan 0.25-0.3mg/kg PO q12h
Frusemide >4mg/kg PO q12h
Benazpril 0.25-0.5mg/kg PO q24h
Spironolactone 1mg/kg q12h PO
Diet: low salt
\+/- anti-arrythmics
\+/- drain effusions (pleural +/-ascites)
40
Q

Actions taken at acute stage D CHF

A

i. O2
ii. Frusemide 2mg/kg IV q1h OR 0.66-1mg/kg/h CRI
iii. Pimobendan 0.25mg/kg PO or IV
iv. Drain effusions (pleural/ascites)
v. Buprenorphine 0.0075-0.01mg/kg + ACP 0.01-0.03mg/kg IV/IM (anxiolytic)
vi. Dobutamine 2.5-10ug/kg CRI (myocardial failure)
vii. Nitroprusside CRI (poorly responsive oedema)
viii. allow free access to water

41
Q

3 signs of MMVD cardiac remodelling on rads

A

i. Straight cd. border (enlarged LV)
ii. Increased sternal contact (enlarged RV)
iii. Large left atrial wedge

PC Vet (16 decks)

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