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CAEM Pt. 2 > Systemic Hypertension, Pericardial Effusion, HW Disease > Flashcards

Systemic Hypertension, Pericardial Effusion, HW Disease Flashcards

1
Q

What two factors determine MAP?

A

CO (SV & HR) and SVR

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2
Q

What BP value is considered hypertensive?

A

Systolic > 160 mm Hg

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3
Q

What BP value is dangerous and can lead to target organ damage?

A

Systolic > 180 mm Hg

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4
Q

Top 5 diseases associated with hypertension in dogs

A

1) Renal disease - esp protein-losing nephropathies
2) Hyperadrenocorticism
3) Diabetes mellitus
4) Pheochromocytoma
5) Hyperaldosteronism

  • Others = acromegaly, hypertensive meds (PPA, palladia)
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5
Q

Top 3 diseases associated with hypertension in cats

A

1) Renal disease of any variety
2) Hyperthyroidism
3) Diabetes mellitus

*Age is no a risk factor for HT, but it is a risk factor for the above diseases

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6
Q

Is idiopathic hypertension common in dogs and cats

A

No - more common in people, usually suspected in cat and dogs because the underlying disease hasn’t been found

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7
Q

What are the target organs that can be damaged with hypertension? (4)

A
  • Brain = HT encephalopathy
  • Eye = HT choroidopathy
  • Kidney = functional decline
  • Heart = adaptation like hypertrophy and diastolic dysfunction
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8
Q

What clinical signs do we see because of target organ damage (4)?

A

1) Eye = hemorrhage, retinal detachment, photophobia, acute onset blindness
2) Brain = intracranial signs (with very severe HT)
3) Kidney = proteinuria
4) Heart = new mitral murmurs, new gallop rhythms

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9
Q

Which patients do we measure BP and perform a fundic exam in? (2)

A

1) Presenting clinical signs of hypertension

2) Confirmed compatible and causative disease, Ex: diabetes mellitus

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10
Q

At what age, in cats, do we start to worry about hypertension?

A

> 10 years - risk factor for diseases that cause HT

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11
Q

What things should we ensure when measuring BP of our patients? (5)

A
  • Ensure the animal is as unstressed as possible
  • Utilize the same measurement method for every patient
  • Patient should be conscious, unsedated, sitting/recumbent
  • Measure after a period of acclimation
  • Measure before any stressful procedures
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12
Q

How do we treat hypertension in general?

A

1) Treat any underlying diseases
2) Medications that modify the RAAS and vasodilate
a) RAAS = ACE-i
b) Vasodilator = amlodipine
3) Discontinue any BP elevating meds
4) Monitor fluid administration

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13
Q

What do we use to prevent proteinuria with renal disease?

A

ACE-inhibitors

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14
Q

What do we use to treat the cardiac abnormalities with hyperthryoidism?

A

Beta blockers

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15
Q

What drug do we use to modify the RAAS system to control hypertension?

A

> ACE inhibitor

  • Blocks formation of AG II = blocks vasoconstriction and formation of aldosterone
  • Returns vasoconstriction to normal tone = less proteinuria
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16
Q

What type of patient do we never want to use ACE inhibitors in?

A

Dehydrated patients

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17
Q

What is the hypertensive drug of choice in cats?

A

> Amlodipine = Ca++ channel blocker
- Vasodilator

+/- Add ACE-I if proteinuric

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18
Q

What is the hypertensive drug of choice in dogs?

A

> ACE-inhibitor

- Add on amlodipine if needed after one week

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19
Q

Clinical signs of pericardial effusion

A 
\+ Hypotension
\+ Weakness
\+ Cough
\+ Vomiting
\+ Dyspnea
\+ Collapse
\+ Death

+ Chronic = lethargy, weakness, exercise intolerance, weight loss

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20
Q

PE findings of pericardial effusion

A 
\+ Muffled heart sounds
\+ Muffled lung sounds
\+ Ascites
\+ Jugular vein distension
\+ Weak pulses
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21
Q

Diagnostics for pericardial effusion

A
  • History and PE
  • ECG
  • Echocardiograph to visualize the effusion
  • Thoracic radiographs
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22
Q

Abnormalities seen on ECG with pericardial effusion (4)

A
  • Tachycardia
  • Ventricular arrhythmias
  • Attenuated QRS complexes
  • Electrical alternans
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23
Q

Abnormalities seen on chest rads, with pericardial effusion (4)

A
  • Large globoid cardiac silhouette
  • Enlarged vena cava
  • Pleural effusion
  • Loss of abdominal detail
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24
Q

Abnormalities seen on echo with pericardial effusion (2)

A

+/- Masses, esp in the right atrium or heart base

- Right atrial tamponade

25
Q

What is troponin I and what does it tell you?

A

Cardio-specific biomarker that is released from the myocardium - elevated in dogs with pericardial effusion

26
Q

What do you always want to submit along with performing thoracocentesis?

A

CYTOLOGY - often non-diagnostic, but may lead exfoliated cells

27
Q

What is the most common cause of pericardial effusion in cats?

A

FIP (exudative)

  • Other = CHF (transudate)
28
Q

What are the most common causes of pericardial effusion in dogs?

A

1) Idiopathic (hemorrhagic)

2) Neoplasia - HSA, heart base tumors, mesotheliomas

29
Q

How do we treat first time pericardial effusion?

A

Pericardiocentesis

30
Q

What do we recommend with repeat pericardial effusion?

A

Pericardectomy - subtotal or window

31
Q

Life cycle (L1 to L5) of heartworm

A
  • L1-infected dog is bit by a mosquito
  • Microfilaria infect the mosquito and spread in the bloodstream, mature to L3
  • L3-infected mosquito bites a dog
  • Matures through juvenile L4 to adult L5 in the dog (migrates from blood > pulmonary artery right heart)
  • Adult HW’s produce infective L1 microfilaria
  • Mosquito bites infected dog…
32
Q

Lesions seen with heartworm (4)

A

> Vascular = endothelial cell hypertrophy, pulmonary artery endarteritis from worm byproducts, produce thromboemboli
Pulmonary = (eosinophilic) pulmonitis, granulomas
Heart = right ventricular hypertrophy (pulmonary hypertension), caval syndrome
Renal = immune mediated glomerulonephritis, glomerulosclerosis from microfilaria
Aberrant migration systemically

33
Q

What is caval syndrome?

A

> High worm burden that the worms overwhelm the right atrium and cause tricuspid regurgitation
- Hemolysis due to blood flowing through the worms, acting as a sieve
- Blood backs up systemicaly due to high right atrial/ventricular pressures
+/- Renal and hepatic failure due to hemolysis

34
Q

What pathogen accompanies the heartworm and what problems can it cause?

A

> Wolbachia

  • Surface antigen induces IgG response, thought to contribute to pulmonary and renal inflammation
  • Released when you kill the HW
35
Q

True or false - infected and asymptomatic dogs will not have microfilaria in their blood

A

False - need to examine blood smears at low power

36
Q

Clinical signs of HW disease in dogs

A

+ Cough
+ Exercise intolerance = pulmonary HT and lung lesions
+ Weight loss
+ R-CHF = ascites, etc.
+ Severe = dyspnea, syncope (pulmonary HT), hemoptysis, ascites (caval syndrome)

37
Q

Findings on blood smear, CBC, and chem panel with HW positive animals

A
  • Microfilaria in the blood
  • Hyperproteinemia = hyperglobulinemia
  • Eosinophilia and basophilia
  • Anemia from chronic disease
  • U/A = proteinuria from glomerulonephritis, casts, RBC’s
    +/- Abnormal renal and liver values
38
Q

Findings on chest rads with HW disease

A
  • Right caudal lung lobe interstitial to alveolar infiltrates
  • Lung granulomas
  • Tortuous or blunted pulmonary vessels
    +/- SEVERE = enlarged pulmonary arteries
    +/- Right sided heart failure
39
Q

ECG findings with HW disease

A

Right axis deviation from right ventricular enlargement

40
Q

Why is ID of microfilaria a poor choice for HW diagnosis? (5)

A
  • Seasonality and daily periodicity complications
  • Dogs may or may not be shedding microfilaria if on tx
  • Dogs with pneumonitis may not have microfilaria (may be concentrated in lung parenchyma)
  • Need to differentiate D. immitis from Dipetalonema reconditum
  • Unisex infection may create an amicrofilaremia
41
Q

What is the number one diagnostic tool for HW in dogs?

A

> Antigen testing

  • Good sensitivity after 6 months of infection (don’t test puppies < 6 mo)
  • Should still confirm positives with blood smears, thoracic rads, CBC (eosino/basophils), or Ab test
42
Q

Why might an antigen test be negative (falsely)?

A
  • Worms aren’t mature enough to shed microfilaria (too early)
  • Too low of worm burden
  • Unisex infection of only male worms
43
Q

Treatment of canine HW (4)

A
  • Melaromine, 3 doses = adulticide, kills L4-L5, deep lumbar injection
    *Strict cage rest for 6-8 weeks
  • Monthly avermectin microfilariacide to kill L1
  • Doxycycline = against Wolbachia to reduce arterial lesions
    +/- Surgical worm removal with caval syndrome + heparin therapy
    +/- Steroids
  • Sildenafil for hypertension
44
Q

How do we prevent HW?

A

Monthly preventative, starting at 8 weeks of age (kill L1, L3, and L4)
*Test prior to using preventative

45
Q

How does cat HW infection differ from dogs?

A
  • Cats = infected with only 1-4 worms
  • Worse arteritis
  • Longer pre-patent period
  • Cat HW’s live longer
46
Q

What do we suspect with coughing cats?

A

Respiratory disease - ddx = HW or asthma

47
Q

Clinical signs of feline HW

A 
\+ Coughing
\+ Gagging
\+ Dyspnea
\+ Tachypnea
*Looks like asthma
*Can die suddenly due to HW embolization
48
Q

Is caval syndrome common in cats?

A

No - don’t have high worm burdens

49
Q

PE findings of feline HW

A
  • Abnormal lung sounds
  • Cough
  • Open mouth breathing
    +/- Murmur
    +/- Jugular distension with right CHF
50
Q

Findings on CBC, blood smear, and chem with feline HW

A
  • Microfilaremia
  • Hyperproteinemia, high globulins
  • Eosinophilia
  • Basophilia
  • Anemia from chronic disease
  • U/A = proteinuria, casts, RBC’s
    +/- Renal and hepatic values
51
Q

What might you see on tracheal washes in feline and canine HW?

A

Eosinophils

52
Q

Radiological findings of feline HW

A
  • Peribronchial cuffing
  • Diffuse or focal interstitial infiltrates
  • Focal alveolar infiltrates
  • Pleural effusion
  • Enlarged caudal pulmonary arteries and pruning of pulmonary arteries
53
Q

Do we use ID of microfilaria to diagnose feline HW?

A

No - few cats are persistently microfilaria

54
Q

Do we use antigen testing to diagnose HW in cats?

A

No - high rate of false negatives

55
Q

Reason for false negatives in antigen testing with feline HW (4)

A

1) Worms are not mature enough to shed microfilaria
2) Low worm burdens = difficult to detect Ag
3) Only male worms present
4) May take up to 170 days for cats to test Ag-positive post-infection

56
Q

What is the first line diagnostic for feline HW?

A

> Antibody testing

  • Negative Ab test rules it out but - Positive Ab test only confers exposure
  • Highly sensitive for detecing HW Ab’s 3 months post-infection
  • Use Ag testing in conjunction
57
Q

Treatment of feline HW

A

*Assess each cat as an individual
+/- Tx with subclinical animals
> Prednisone (clinical signs are due to inflammatory reactions)
+/- Doxycycline for Wolbachia

58
Q

Do we use melarsomine in cats?

A

NO - really only a last ditch effort

59
Q

How do we prevent feline HW?

A

Monthly prophylactics for cats in endemic areas

CAEM Pt. 2 (27 decks)

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