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23 spring: med surg > Test 1: lecture 18: canine > Flashcards

Test 1: lecture 18: canine Flashcards

1
Q

primary myocardial disease

A

Idiopathic or heritable disorders resulting in structural or functional abnormalities of the heart muscle
* Cardiomyopathies

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2
Q

secondary myocardial disease

A

inflammatory, metabolic, toxic or infiltrative disease of the myocardium with a known etiology or causative agent
* May or may not be reversible

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3
Q

two primary myocardial diseases

A

dilated cardiomyopathy (DCM)

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

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4
Q

two secondary myocardial diseases

A

nutritional cardiomyopathy (taurine)

myocarditis

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5
Q

secondary dilated cardiomyopathy can be caused by

A

Nutritional factors – taurine, carnitine, other
* Toxins – chemotherapy
* Infection/inflammation – myocarditis
* Arrhythmias – chronic tachycardia
* Endocrine disease – hypothyroidism

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6
Q

— is Myocardial disease characterized by systolic dysfunction and secondary cardiac chamber dilation

A

dilated cardiomyopathy

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7
Q

what does heart with primary DCM look like

A

eccentric hypertrophy (thin walls- stretched out)

all four chambers but left>right

papillary muscles can be atrophies

heavy heart

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8
Q

histopath of DCM

A
  • Attenuated wavy fibers
  • Fibrofatty infiltration
  • Myocyte atrophy/necrosis
  • Minimal inflammation
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9
Q

DCM will lead to — stroke volume and — chambers

A

reduced
dilated

(impaired systolic function- reduced contractility)

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10
Q

what kind of failure will DCM cause

A

foward (poor ejection)
reduced cardiac output, hypotension → weakness and exercise intolerance

backward failure (congestion)
elevated ventricular end-diastolic pressure, high atrial pressures, high pulmonary venous pressure →CHF

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11
Q

what kind of dogs get DCM

A

large and giant male breeds

  • Doberman Pinscher
  • Boxer (ARVC)
  • Giant breeds (GD, Newfie, Irish Wolfhound)
    Exceptions: PWD, Manchester Terrier, Cocker Spaniel

Adults except PWD, Manchester Terrier (juvenile DCM)

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12
Q

clinical signs of DCM

A

from low output: weakness, lethargy, exercise intolerance, syncope, death

from congestion: cough, dyspnea, Orthopnea, insomnia, Abdominal distension, Anorexia, weight loss, Cardiac cachexia

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13
Q

why can you hear S3 with dog with DCM

A

ventricles do not fully empty (low output)

therefore when blood from atria pushed into ventricle will make a murmur

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14
Q

PE of dog with DCM

A
  • Arrhythmia
  • Pulse deficits
  • Gallop heart sound (S3)
  • Soft murmur (AV valves)
  • Weak pulses
  • Cold extremities
  • Tachypnea, dyspnea
  • Jugular distension, ascites
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15
Q

EKG of DCM

A

LV enlargement pattern
* Tall R wave
* Prolonged QRS duration (mild)

LBBB
* Prolonged QRS duration

Atrial enlargement pattern
* Increased P wave duration (P-mitrale)
* Increased P wave amplitude (P-pulmonale)

75% will get Afib

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16
Q
A

VPC
with ventricular tachycardia

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17
Q
A

Afib

75% of dogs with DCM will also have Afib

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18
Q

Xray of DCM

A

cardimegaly: left sided or generalized

left sided CHF
* distended pulmonary veins
* pulmonary edema : perihilar to caudodorsal, intersitial to alveolar

right sided CHF
* distended caudal vena vava
* pleural effusion
* ascites

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19
Q
A

DCM

large left atrium and ventricle (double opasity on VD)

diffuse perihilar and caudodorsal pulmonary edema

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20
Q

how to measure systolic function on echo

A

fractional shortening
ejection fraction

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21
Q

stages of DCM

A

stage 1: normal Heart, no signs

stage 2 occult: abnormal heart, no signs

stage 3 overt: abnormal heart with clinical signs/CHF

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22
Q

—% of dobermans have DCM

A

50-60

occurs in males 4-10 years old

sudden onset with syncope and CHF

23
Q

DCM in dobermans

A

50-60% of all males 4-10 years old

sudden onset of symptoms: syncope and CHF

ventricular arrythmia more common then Afib

sudden death (VT→VF) 30-50%
CHF made worse by AFib

24
Q

what genetic mutation in dobermans with DCM

A

autosomal dominant
incomplete, age related penetrance

PDK4 (DCM1)
DCM2

both mutations = 30% increased risk

25
Q

PDK4( DCM1) encodes for

A

Encodes mitochondrial protein pyruvate
dehydrogenase kinase 4

  • PDK4 has an important role in cardiac energy metabolism

DCM in dobermans

26
Q

DCM2 codes for

A
  • Encodes sarcomeric protein titin
  • Titin contributes to active contraction, passive stiffness

21% risk increase

DCM in dobermans

27
Q

testing in dobermans for DCM

A

annual echo and holter starting at 3 years old

genetic testing (NCSU) for PDK4 and DCM2

28
Q

boxers with advanced — can develop DCM

A

ARVC

29
Q

DCM is — in great danes

A

x linked

with Afib more common then Vtach

30
Q

DCM in newfoundlands and irish wolfhounds is —

A

autosomal dominant

with Afib more common then Vtach

31
Q

what causes DCM in cocker spaniels

A

inherited?
diet?
unknown

32
Q

what two dogs get juvenile DCM

A

portugese water dogs (2-32 weeks old), autosomal recessive

Toy machester terrier (10 weeks-1 year old), autosomal recessive, K channel, complete penetrance

33
Q

how to treat preclinical DCM

A

pimobendan (inodilator)

34
Q

how to treat clinical stage of DCM

A

pimobendan
diuretic
ACE inhibitor
spironolactone

35
Q

how to treat ventricular arrhythmias in DCM

A

sotalol, mexiletine, amiodarone

used for VPCs or Vtach

36
Q

how to treat supraventricular arrhythmias in dogs with DCM

A

AFib

diltiazem, digoxin

37
Q

what did protect study show

A

DCM study in dobermans

pimobendan prolonged survival and kept dogs asymptomatic for an extra 9 months

38
Q

outcome of DCM in different dog breeds

A

mean survival 6-9 months

39
Q

ARVC is common in

A

boxers, english bulldogs, cats and humans

ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY (ARVC)

40
Q

how is ARVC inherited

A

autosomal dominant mutation in Striatin (ARVC1) and ARVC 2

41
Q

what does ARVC do

A

attacks desmosomes that hold cardiac cells together

causes mechanical and electrical uncoupling
atrophy of cells and replacement by fibrofatty tissue

42
Q

scar tissue from ARVC causes

A

arrhythmias: VPCs, Vtach → right ventricle origin

systolic failure → heart failure →fainting and sudden death (40%)

43
Q

ARVC will lead to — in 40% of cases

A

sudden cardiac death

44
Q

what genes for ARVC in boxers

A

autosomal dominant

Striatin (ARVC 1)
* Colocalizes to intercalated disk
* Homozygotes - higher risk of severe disease (DCM phenotype)

ARVC 2
* SNP in a regulatory gene

45
Q

what happens to english bulldogs with ARVC

A

no gene found yet but happens more often in males

most will get CHF instead of arrhythmias

46
Q

Sotalol is treatment of choice for — arrhythmias
in Boxers

A

ventricular

ARVC (will get ventricular arrhythmias (VPC and Vtach), syncope, sudden death and CHF)

47
Q

what are some things that cause nutritional cardiomyopathy

A
  • Taurine deficiency
  • L-carnitine deficiency
  • Boutique, exotic ingredient, grain-free (BEG) diets

can be reversible

48
Q

what breeds can develop taurine deficiency?

A

cocker spaniel
golden
newfoundland

dogs can make taurine, cats can not

found in seafood and meat

49
Q

how to diagnose taurine deficiency

A

paired (whole and plasma) taurine levels

if low supplement

50
Q

— helps transport fatty acids into mitochondria for beta oxidation

A

L- carnitine

found in red meat and dairy or synthesized in skeletal and cardiac muscle

51
Q

why is diagnosis of L carnitine deficiency hard

A

normal levels could be false positive

carnitine found in red meat, dairy or synthesized in skeletal and cardiac muscle

helps transport fatty acids into mitochondria for beta oxidation

52
Q

some causes of myocarditis

A

parvo
trypanosoma

53
Q

how to diagnose myocarditis

A

high troponin
infectious disease screening
echo with low EF
ECG with arrhythmias
post mortem

23 spring: med surg (60 decks)

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