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C & R II - wk1 > myxomatous mitral valve disease of the dog > Flashcards

myxomatous mitral valve disease of the dog Flashcards

1
Q

what is the epidemiology and prevalence

A
  • 75-80% of canine cardiac diseases
  • small breed dogs&raquo_space; large breed dogs
  • no sex predilection M=F
  • synonyms: degenerative mitral valve disease, mitral valve disease, endocarditis
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2
Q

what is the etiology

A

unknown

  • collagen abnormality (collapsing trachea, IVDD, luxating patellas, cruciate ligament rupture)
  • hereditay
  • no proven infectious etiology
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3
Q

what is the timing of MMVD murmer

A

systolic

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4
Q

location of MMVD murmur

A
  • left > right
  • apical > basilar
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5
Q

intensity of MMVD

A
  • soft
  • moderate
  • loud
  • thrilling
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6
Q

what is a mitral murmur

A
  • specific and sensitive for presence of disease
  • variable as an indicator of severity of disease
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7
Q

what are false positives with MMVD murmur

A
  • common
  • loud murmur, but mild disease
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8
Q

what are false negatives with MMVD murmur

A
  • uncommon
  • soft murmur, but severe disease
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9
Q

what are the key characteristics in assessing severity of MMVD

A

left atrial and ventricular size

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10
Q

how to directly asses LA and LV size

A
  • thoracic radiography
  • echocardiography
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11
Q

how to indirectly assess LA and LV size

less reliable

A
  • murmur intensity
  • ECG
  • BNP concentration
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12
Q

what do you see in an xray with MMVD

A
  • LA, LV enlargement
  • pulmonary venous distention
  • perihilar interstitial/alveolar
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13
Q

what do you see in an echo with MMVD

A
  • thickened valve leaflets
  • prolapse of leaflets into LA
  • ruptured chordae tendineae
  • color flow doppler reveals regurgitant flow into LA
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14
Q

what are the MVD stages/classification system

A
  • stage A: no disease, at risk (older small breed dog)
  • stage B: MVD present, no current or historical clinical signs (asymptomatic, pre-clinical)
  • stage B1: no cardiac enlargement
  • stage B2: cardiac enlargement present
  • stage C: MVD present, current or historical heart failure, conventional CHF
  • stage D: MVD present, advanced disease, refractory clinical signs
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15
Q

why stage asymptomatic (stage B) MVD?

A
  • many dogs with mild MVD (B1) will never develop CHF (no reason to tx)
  • dogs with secondary cardiac enlargement (B2) have greater risk for future CHF, which is reduced by oral pimobendan
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16
Q

dyspnea in the dog: differential diagnosis (2)

A
  • CHF due to MMVD (stage C) - loud murmur, substantial LH enlargement, high BNP conc
  • primary respiratory disease (pulmonary fibrosis, pneumonia, collapsing trachae) - no or soft murmur, no LH enlargement, normal BNP conc.

dogs can have both

17
Q

what is the acute CHF therapy for MVD

A
  • Furosemide (preload)
  • Oxygen
  • Nitroprusside (pre/afterload)
  • Dobutamine (inotropy)

in less critical cases N & D - pimobendan (FOP)

18
Q

what is the chronic CHF therapy for MVD

A
  • Furosemide (preload)
  • Ace inhibitors (dec. RAAS)
  • Pimobendan
  • Spironolactone
19
Q

what are MVD complications

A
  • LA tears
  • ruptured chordae tendinae
  • arrhythmias
20
Q

what are LA tears due to MVD complications

A
  • acute pericardial effusion and cardiac tamponade
  • low output heart failure - death
21
Q

what is ruptured chordae tendinae due to MVD complications

A
  • acute worsening of regurgitation volume
  • acute, fulminant CHF
22
Q

what are arrhythmias due to MVD complications

A
  • atrial fibrillation
  • atrial and ventricular premature beats
23
Q

what is the effect of atrial fibrillation

A

loss of atrial contraction can increase left atrial and venticular pressures sufficient to cause new onset CHF

24
Q

what is valvular endocarditis

A
  • inflammation of the valve tissue usually due to an infectious agent, usually bacterial
  • dogs, cats, horses, pigs (mitral and aortic valves)
  • ruminants (tricuspid and pulmonic valves)
25
Q

what is the gold standard diagnosis for valvular endocarditis

A

post-mortem isolation of bacteria from affected valve

26
Q

what are the major criteria for antemortem diagnosis

A
  • suspicious valve lesions detected by ultrasound
  • positive blood cultures
  • recent onset of diastolic heart murmur due to aortic valve insifficiency
27
Q

treatment for valvular endocarditis

A
  • long-term antibiotic therapy
  • preferably guided by blood culture results
28
Q

what is the prognosis for valvular endocarditis

A

very guarded

C & R II - wk1 (13 decks)

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