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Cardiology > Small animal congenital cardiology + mitral valve + endocarditis > Flashcards

Small animal congenital cardiology + mitral valve + endocarditis Flashcards

1
Q

What is the only continuous murmur and wht does it sound like

A
  • PDA
    Louder in systole but present throughout
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2
Q

What is the different in tone of valve insufficiency/regurg murmur noise vs outflow obstruction from valve stenosis

A

Valve regurgitation = softer sound
Valve stenosis = harsher

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3
Q

Characteristics of physiological murmurs in puppies

A

Low grade and soft <3
Disappear or change when the puppy is moved around
Listen a few weeks later and will probably be gone

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4
Q

Which congenital heart diseases are more common in dogs vs cats

A

In dogs: pulmonic stenosis, subaortic stenosis, PDA
In cats: tricuspid dysplasia, ventricular septal defect

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5
Q

Signalment of pulmonary stenosis

A

Bulldogs, boxers, GSDs, small dogs … large range

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6
Q

Clinical signs of pulmonary stenosis

A

Left sided systolic heart murmur most intense at heart base
Normal pulse quality
Can lead to right sided CHF
murmur intensity correlates with stenosis severity

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7
Q

What are some consequences of severe pulmonary stenosis

A

Exercise intolerance
Syncope/collapse
Right sided congestive heart failure

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8
Q

Pathogenesis of pulmonary stenosis

A

Pulmonary valve diameter decreased so get pressure overload in the right ventricle
Leads to right ventricular hypertrophy

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9
Q

What are the three types of pulmonic stenosis and which is most common

A

Valvular stenosis is most common
ALso subvalvular/infundibular stenosis
Supravalvular stenosis very rare

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10
Q

What are the three types of pulmonic stenosis and which is most common

A

Valvular stenosis is most common
ALso subvalvular/infundibular stenosis
Supravalvular stenosis very rare

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11
Q

What are the two types of valvular stenosis

A

Type A = where there is pulmonic leaflet thickening and fusion; see parachuting movement due to fusion at the tips

Type B = where the valves and dysplastic and fused and the pulmonary artery is too narrow; this is the more aggressive phenotype

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12
Q

Which breeds do we tend to see anomalous prepulmonic coronary artery in (as a cause of subvalvular stenosis)

A

French and English bulldogs

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13
Q

What is anomalous prepulmonic coronary artery

A

Where both coronary arteries come from one orifice so one must go around the pulmonary artery to reach the correct ventricle, thereby strangling it

= Subvalvular/infundibular cause of pulmonary stenosis

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14
Q

How can we grade pulmonary stenosis

A

Via severity of right ventricular hypertrophy

Via doppler derived pressure gradients where mild is <50mmHg, moderate is 50-80 and severe is >80mmHg

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15
Q

Treatment of pulmonary stenosis based on severity

A

Mild = no treatment
Moderate; only treat if there is another associated cardiac abnormality
Severe = needs treatment; balloon valvuloplasty first line or surgery patch graft

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16
Q

When might we choose surgical patch graft rather than balloon valvuloplasty for pulmonic stenosis

A

In severly displastic valves
If they don’t respond to balloon valvuloplasty

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17
Q

How does a balloon valvuloplasty work

A

Use a balloon to dilate the stenosis and reduce obstruction
Access heart via jugular vein, measure stenosis using contrast to choose which balloon size, inflate balloon with saline and contrast so it ruptures the adhesions between valve leaflets

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18
Q

Potential complications fo balloon valvuloplasty

A

pulmonary regurgitation/insufficiency - this is less of an issue
Arrythmias

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19
Q

At what stage is it better to perform a balloon valvuloplasty for pulmonic stenosis

A

Early on in the asymptomatic phase as better outcome then when there is right sided failure

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20
Q

What is a contraindication for balloon valvuloplasty for pulmonic stenosis

A

Anomalous coronary artery due to risk of rupture

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21
Q

Whehn might transpulmonary stent implantation be indicated

A

In cases of anomalous coronary artery to keep valve leaflets open without risking coronary artery rupture

In severe cases with unsuccessful balloon valvuloplasty or re-stenosing

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22
Q

What is the pathogenesis of patent ductus arteriosus

A

When the ductus arteriosus doesn’t close after birth, blood shunts from the aorta to the pulmonary artery (from higher to lower pressure)
So goes back around lungs
Get overloading of lungs causing congestion

Issue of volume overload

Left ventricle becomes dilated to accommodate extra blood

Then get backwards congestion to capillaries and pulmonary oedema

= L sided CHF

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23
Q

What is the normal ratio of width or right to left ventricle

A

1:3

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24
Q

What do chicken fat bloot clots suggest about the animal

A

It was anaemia (or there was prolonged agony)

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25
In which breed is PDA an inherited trait
Poodles
26
Which breeds do we commonly see PDA in
Poodles Chihuahua, mlatese pom
27
What is the cause of 'nutmeg liver'
Right sided CHF where there is backing up of bressure from right atrium to caudal VC and liver = due to centrolobar congestion causing hypoxia, degeneration and necrosis of centrolobulary hepatocytes
28
Which breeds most commonly have persistent foramen ovale
Boxers, Dobermans, Samoyed
29
Which breeds do we see ventricular septal defects in more commonly
English bulldog English springer WHWT
30
How does the heart septum form (two parts)
Septum membranosum comes from the base of the heart while septum muscularis is from the apex Defect in the septum membranosum is more common
31
Which breeds do we see tetralogy of fallot in most
Keeshonds (inherited) English bulldogs (congenital)
32
What are the primary and secondary defects in tetralogy of fallot
Ventricular septal defect Pulmonic stenosis Dextraposition of aorta Secondary defect = hypertrophy of right ventricle
33
Which breeds is pulmonic valvular stenosis inherited in
Beagle, English bulldog, Chihuahua
34
What does the heart look like in pulmonic valvular stenosis
Valves are thickened white and less elastic There is blood overload in the right venitrcle leading to right ventricular concentric hypertrophy
35
What two things could happen in subaortic valvular stenosis
Normal response is concentric hypertrophy of left ventricle Can get dilation instead; this is worse
36
WHat breeds is subaortic valvular stenosis more common in
Boxer (inherited) Newfoundland, GSD
37
What signs do we notice with persistent right IV aortic arch
= vascular ring over oesophagus so see megaoesophagus and regurgitation at weaning
38
What is the most common cardiovascular disease in dogs
Myxomatous mitral valve disease
39
How does MMVD work
Get progressive degenerative lesions to the mitral valve (accumulation of proteoglycans in leaflets causing thickening) -> Leads to mitral regurgitation and secondary volume overload of the left heart i.e increase in preload This chronic volume overload causes eccentric hypertrophy and chamber dilates
40
When does mitral valve disease progress to heart failure
When unable to compensate
41
How does MMVD lead to pulmonary oedema
Get progressive LV and LA dilation via eccentric hypertrophy Increase in left atrial pressure When this becomes high than the pulmonary venous pressure causes congestion and pulmonary oedema `
42
What are common sequelae of MMVD
**Left sided congestive heart failure i.e pulmonary oedema **Arrhythmias esp atrial fibrillation following enlarged LA Can see left atrial tears or septal defect Pulmonary hypertension
43
What are the stages of mitral valve disease
A = predisposed i.e cavalier king charles spaniel B = preclinical disease > B1 means there is mitral regurgitation but no secondary remodelling > B2 means there has been remodelling so see LA and LV dilation C = congestive heart failure D = refractory CHF
44
Which breeds are predisposed to MMVD
Mostly small breeds Middle aged to older Can see in large breeds where it tends to progress quicker
45
What do we see in history and clinical exam of stage B MMVD dogs
ASymptomatic May have a cough/resp disease that isn't due to heart failure i.e from enlarged atrium compressing the trachea Left apical systolic murmur
46
What do we see in history of stage C CHF dog MMVD
Murmur in history Now increased resp rate and effort Cough Exercise intolerance Lethargy Collapse/syncope. + may have weight loss etc
47
What do we see on clinical exam in MMVD dogs stage C
Murmur Tachynoea Dyspnoea Tachycardia Tachyarrhythmias May see signs of right sided congestive heart failure too
48
What do we look for on a heart echo
Identify the cause of the murmur i.e assessing for mitral regurgitation Assessing for seconadry cardiac remodelling to stage the disease Identify any comorbidities
49
What measurements do we take on a cardiac echo to assess for remodelling
Left ventricular size Left atrial size (want La:Ao <1.6)
50
What imaging modality is gold standard for diagnosing pulmonary oedema in stage C MMVD
Radiography because can look for concurrentr esp disease suggesting pulmonary oedema and stage C + can try to assess for cardiomegaly via vertebral atrial size and heart size to stage B1 vs B2
51
What does BNP tell us about
Stretch on the heart But takes a long time to get results and no cut off currently to stage between B1 and B2
52
Treatment for stage B1 MMVD
No treatment Recommend biannual auscultation and imaging repeated
53
Treatment for stage B2 MMVD
Pimobendan + start monitoring the resting respiratory rate and effort at home; should be below 30 Take care with fluids during GAs
54
How does pimobendan work
PDE III inhibitor, calcium sensitsor, positive inotrope, arterial and venous dilator
55
What will owners report as an animal progresses from stage B2 to C
Slowing down, coughing, resting resp rate has increased, increase in heart rate, higher murmur intesntiy Confirm with X rays looking for pulmonary oedema
56
What should we do if we get unstable heart failure case to diagnose
Just avoid sedating for X rays and start treating without them
57
What drug do we add in to threat MMVD stage C
Furosemide diuretic
58
What do we see on a radiograph on stace C MMVD
Marked cardiomegaly with left atrial dilation Diffuse bronchointerstitial lung pattern Pulmonary oedema?
59
What extra drugs can we add in to treat heart failure once stable on diuretics and pimobendane
ACE inhibitors
60
What other possible condition must we excluse before starting diuretics if we se effusions and right sided CHF failure signs
Pericardial effusion and cardiac tamponade
61
with CHF we should avoid diets high in what
Sodium
62
What is endocarditis and what organisms are typically involved
Bacterial infection of endocardial surface of the heart; due to bacteraemia and endothelial damage allows bacteria to lodge Key = CONCURRENT pathology creating risk factors for endocarditis Involves staph, strep, E coli, pseudomonas, bartonella
63
What is the typical presentation of endocarditis
Medium to large breed dogs New murmur typically a red blad, arrhtyhmias, CHF
64
What are some potential consequences of endocarditis
Thromboembolic event Valve regurgitation Myocarditis Arrhtymias Immune stimulation Can quickly go from no regurgitation to severe regurgitation so there is a risk of sudden onset heart failrue
65
Diagnosis of endocarditis
No definitive test: key = try blood culture, aspectially taken 3 times for 3 different veins ~30 mins apart - Do clinical exam - Haem/biochem for inflammatory markers - Echo - ECG - Thoracic radiographs
66
What is the modified Duke's criteria for endocarditis definitive vs possible result (in terms of number of major vs minor critera)
Definitive result = 2 major critera or 1 major and two minor Possible result = 1 major and 1 minor; or 3 minor
67
What are major criteria for endocarditis
Positive echo i.e vegetative lesions on valve Positive blood culture on at least 2 cultures (or 3 if risk of skin contamination) New valvular insufficiency
68
What are minor criteria for endocarditis
Fever Medium/large breed Subaortic stenosis Thromboembolic disease Immune mediated disease positive blood culture but not meeting major criteria High bartonella serology
69
Treatment for endocarditis
Antibioitics IV for a few days Anti-thrombotics e.g clopidogrel to reduce risk of thromboembolic events Treat the heart failure
70

Cardiology (6 decks)

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