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MODULE 15 - Cardiorespiratory and Haematopoietic Disease > PATHOLOGY - Feline Acquired Cardiac Disease > Flashcards

PATHOLOGY - Feline Acquired Cardiac Disease Flashcards

1
Q

What is hypertrophic cardiomyopathy?

A

Hypertrophic cardiomyopathy is an inherited generalised disease/dysfunction of the myocardium characterised by increased ventricular wall thickness

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2
Q

Which heart chamber is mainly affected by hypertrophic cardiomyopathy?

A

Left ventricle

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3
Q

Which signalement is more prone to hypertrophic cardiomyopathy?

A

Older (above 9 years) male cats

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4
Q

Which two cat breeds are predisposed to hypertrophic cardiomyopathy?

A

Maine Coon
Ragdolls

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5
Q

Why are Maine Coons and Ragdolls predisposed to hypertrophic cardiomyopathy?

A

Maine Coons and Ragdolls have a mutation in the gene encoding for cardiac myosin-binding protein (MYBPC)

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6
Q

Describe the pathophysiology of hypertrophic cardiomyopathy

A

Hypertrophic cardiomyopathy is generalised dysfunction of the myocardium resulting in diastolic dysfunction, characterised by thickening of the left ventricular wall resulting in reduced compliance and impaired ventricular filling, resulting in a reduction in cardiac output. Due to the reduced ventricular filling, blood will accumulate in the left atrium and the left atrium will dilate to accommodate this increased blood volume. Eventually this will progress to left-sided congestive heart failure due to the decreased cardiac output and the volume overload in the left atrium which will back up into the pulmonary veins causing congestion, increased hydrostatic pressure and pulmonary oedema. This can also progress to right-sided congestive heart failure as pulmonary hypertension will increase the afterload on the right side of the heart, resulting in pressure overload, concentric hyoertrophy of the right ventricle and eventual right-sided congestive heart failure

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7
Q

How does atrial dilation increase the risk of arterial thromboembolisms?

A

Atrial dilation increases the propensity for blood stasis which allows for thombus formation. These thrombi can then travel into the aorta and cause an arterial thromboembolism

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8
Q

What are the nine clinical signs of hypertrophic cardiomyopathy?

A

Asymptomatic
Maybe a murmur
Arrhythmias
Exercise intolerance
Syncope
Signs of left-sided congestive heart failure
Signs of right-sided congestive heart failure
Paradoxical breathing
Signs of arterial thromboembolisms

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9
Q

Why is there often not a heart murmur associated with hypertrophic cardiomyopathy?

A

There is not always a heart murmur as the primary issue in hypertrophic cardiomyopathy is related to the myocardial structure and function rather than turbulent blood flow that typically results in a heart murmur

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10
Q

When would you hear a heart murmur with hypertrophic cardiomyopathy?

A

Hypertrophic cardiomyopathy can alter the structure of the left ventricle resulting in displacement of the mitral valve leaflets towards the left ventricular outflow tract - known as systolic anterior motion (SAM) - which will cause turbulent blood flow and a heart murmur

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11
Q

What kind of murmur would you hear with hypertrophic cardiomyopathy?

A

Left sided basal systolic crescendo-decrescendo mumur

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12
Q

How does hypertrophic cardiomyopathy cause arrhythmias?

A

Arrhythmias can occur due to structural damage to the heart as it enlarges due to hypertrophic cardiomyopathy

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13
Q

Which three arrhythmias are seen due to hypertrophic cardiomyopathy?

A

Atrial fibrillation
Ventricular arrhythmias
Bundle branch blocks

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14
Q

What is stage A of hypertrophic cardiomyopathy?

A

Cats that are at risk of developing hypertrophic cardiomyopathy due to their signalement but have no structural or clinical signs

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15
Q

What is stage B1 of hypertrophic cardiomyopathy?

A

Cats with clear left ventricular thickening (hypertrophy) but no left atrial dilatation

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16
Q

What is stage B2 of hypertrophic cardiomyopathy?

A

Cats with clear left ventricular thickening (hypertrophy) and left atrial dilatation

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17
Q

What is stage C of hypertrophic cardiomyopathy?

A

Cats with clinical signs of congestive heart failure

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18
Q

What is stage D of hypertrophic cardiomyopathy?

A

Cats with congestive heart failure that is refractory to treatment

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19
Q

Which two biomarkers can be indicative of hypertrophic cardiomyopathy?

A

NTproBNP
Cardiac troponin I

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20
Q

When are NTproBNP snap tests particularly useful in cats?

A

If a cat presents with dyspnoea, an NTproBNP snap test can be helpful to differentiate between of the aetiology is cardiac or respiratory in origin

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21
Q

What are the key signs of hypertrophic cardiomyopathy on echocardiography?

A

Thickening of the left ventricle
Dilatation of the left atrium

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22
Q

What are the key signs on echocardiography that indicate there is a risk of arterial thromboembolism secondary to hypertrophic cardiomyopathy?

A

Dilatation of the left atrium
Reduced systolic function of the left atrium
Spontaneous echocontrast (smoke)
Clots in the left atrium

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23
Q

What is spontaneous echocontrast (smoke)?

A

Spontneous echocontrast (smoke) is an echogenic swirling pattern seen in instances of stagnant or low velocity blood flow

24
Q

What is a saddle thrombus?

A

A saddle thrombus is a thromboembolism at the aortic trifurcation

25
Q

Which forelimb is more commonly affected by arterial thromboembolism in cats?

A

Right forelimb

26
Q

What are the five clinical signs of a thromboembolism in cats?

A

Pallor of affected limb(s)
Cold extremities of affected limb(s)
Loss of pulse of affected limb(s)
Limb paralysis of affected limb(s)
Pain of affected limb(s)

27
Q

How would you treat an arterial thromboembolisim in a cat?

A

Administer clopidogrel/heparin and provide analgesia

28
Q

In cats at risk of hypertrophic cardiomyopathy, what should owners monitor for at home?

A

An increased resting respiratory rate as this can precede signs of left-sided congestive heart failure, and paradoxical breathing due to the risk of pleural effusion

29
Q

How should you treat stage A hypertrophic cardiomyopathy?

A

No treatment

30
Q

How should you treat stage B1 hypertrophic cardiomyopathy?

A

No treatment

31
Q

How should you treat stage B2 hypertrophic cardiomyopathy?

A

Treat with clopidogrel

32
Q

How should you treat stage C hypertrophic cardiomyopathy?

A

Treat with clopidogrel and diuretics

33
Q

What is clopidogrel?

A

Clopidogrel is an antiplatelet drug

34
Q

What is the prognosis for cats with hypertrophic cardiomyopathy exhibiting signs of left-sided congestive heart failure?

A

Generally a prognosis of one year

35
Q

What is the prognosis for cats with hypertrophic cardiomyopathy with an arterial thromboembolism?

A

Poor prognosis of around 184 days if they survive the first arterial thromboembolism

36
Q

List three potential causes of secondary hypertrophic cardiomyopathy in cats

A

Systemic hypertension
Hyperthyroidism
Transient myocardial thickening (TMT)

37
Q

What are four possible causes of systemic hypertension in cats?

A

Kidney disease
Hyperthyroidism
Hyperaldosteronism
Idiopathic

38
Q

What should you do to investigate systemic hypertension in cats?

A

Blood pressure
Assess target organ damage (damage to brain, kidneys, eyes and heart)

39
Q

Why is it important to assess brain function if you suspect systemic hypertension?

A

It is important to assess brain function if you suspect systemic hypertension as systemic hypertension can lead to damage of blood vessels in the brain leading to strokes and encephalopathies

40
Q

Why is it important to assess the eyes if you suspect systemic hypertension?

A

It is important to assess the eyes if you suspect systemic hypertension as systemic hypertension can cause retinal detachment and acute onset blindness

41
Q

Why is it important to assess kidney function if you suspect systemic hypertension?

A

It is important to assess kidney function if you suspect systemic hypertension as systemic hypertension can cause lead to or worsen existing kidney disease

42
Q

Which drug should you use to treat systemic hypertension?

A

Amlodipine

43
Q

Which sites can you use to measure blood pressure in cats?

A

Distal limbs
Tail (coccygeal artery)

44
Q

How can hyperthyroidism cause secondary hypertrophic cardiomyopathy?

A

Hyperthryroidism results in increased T3 and T4 production which will increase metabolic rate resulting in secondary hypertrophic cardiomyopathy

45
Q

How do you treat hypertrophic cardiomyopathy secondary to hyperthyroidism?

A

Treat the hyperthyroidism
Atenolol (betablocker) if severe tachycardia
Treat congestive heart failure
Clopidorgel if necessary

46
Q

What is transient myocardial thickening (TMT)?

A

Transient myocardial thickening (TMT) is a reversible concentric hypertrophy of the myocardium caused by an infiltrative process

47
Q

Which signalement is more prone to transient myocardial thickening (TMT)?

A

Young cats

48
Q

How do you treat transient myocardial thickening (TMT)?

A

You treat transient myocardial thickening (TMT) the same way as hypertrophic cardiomyopathy

49
Q

What is the prognosis for transient myocardial thickening (TMT)?

A

Good prognosis if it regresses

50
Q

What happens in end-stage hypertrophic cardiomyopathy in cats?

A

End-stage hypertrophic cardiomyopathy is characterised by relative thinning of the ventricular walls and systolic dysfunction

51
Q

What is restrictive cardiomyopathy?

A

Restrictive cardiomyopathy is an inherited generalised disease/dysfunction of the myocardium characterised by increased ventricular wall rigidity

52
Q

What are the two subtypes of restrictive cardiomyopathy?

A

Endomyocardial form
Myocardial form

53
Q

What is the characteristic feature of the endomyocardial form of restrictive cardiomyopathy?

A

The endomyocardial form of restrictive cardiomyopathy has a endocardial scar

54
Q

What are the characteristic features of the myocardial form of restrictive cardiomyopathy?

A

The myocardial form of restrictive cardiomyopathy has normal ventricular wall structure and function but increased size of the atriums

55
Q

What are the clinical signs of endocarditis in cats?

A

Pyrexia
New heart murmur
Limb weakness/paresis
Respiratory distress
Apathy

MODULE 15 - Cardiorespiratory and Haematopoietic Disease (21 decks)

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