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Y4 SA - Cardio-Respiratory > Vascular diseases in dogs and cats > Flashcards

Vascular diseases in dogs and cats Flashcards

1
Q

Name two indirect methods of measuring blood pressure

A

Doppler
Oscillometric

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2
Q

Define systemic hypertension

A

Sustained increased of systemic blood pressure

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3
Q

List the main causes of systemic hypertension

A

Environmental or situational
Secondary to other diseases
Idiopathic hypertension

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4
Q

List 3 major indicators for blood pressure recording?

A

Assessing severity of heart disease
Identification of systemic hypertension
Assessing response to drugs

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5
Q

List some causes of secondary systemic hypertension

A
  • Chronic renal failure
  • Hyperthyroidism (cats)
  • Hyperadrenocorticism
  • Diabetes
  • Liver disease
  • Hypothyroidism
  • Acromegaly
  • Hyperaldosteronism
  • Chronic anaemia (cats)
  • Obesity
  • CNS disease
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6
Q

Which 4 systems in the body are most affected by hypertension?

A

Ocular
CNS
Cardiac
Renal

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7
Q

How does hypertension impact the cardiovascular system?

A
  • Concentric LV hypertrophy
  • Development of heart murmurs
  • Degenerative valve disease
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8
Q

How is systemic hypertension classified in dogs and cats?

A

Based on the risk of target organ damage

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9
Q

Name 2 ocular manifestations of systemic hypertension

A

Hyphaema (bleed inside the eye)
Retinal detachment

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10
Q

Describe the blood pressure levels in:
1. Normotensive animal - minimal TOD risk
2. Prehypertensive animal - low TOD risk
3. Hypertensive animal - Moderate TOD risk
4. Severly hypertensive animal - high TOD risk

A
  1. <140mmHg
  2. 140-159mmHg
  3. 160-179mmHg
  4. > 180mmHg
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11
Q

How is systemic hypertension treated?

A
  • The underlying cause must be identified and treated (e.g. hyperthyroidism)
  • Amlodipine is the drug of choice to reduce systemic blood pressure
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12
Q

How does Amlodipine work to reduced systemic hypertension?

A

Ca channel antagonist

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13
Q

If there is a significant proteinuria with systemic hypertension, which drug is indicated for treatment?

A

Benazepril (or other ACE inhibitors)

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14
Q

Describe the action of ACE inhibitors

A

Reduce glomerular capillary pressure and reduce protein loss and therefore progression of renal disease in cats
Have a different effect on afferent and efferent arterioles

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15
Q

ACE inhibitors can be paired with which other drugs to reduce blood pressure?

A

Angiotensin II receptor blockers

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16
Q

Blood clots may form within the heart or circulation with changes to any one or more of the following (known together as Virchow’s triad):

A
  • Stasis of blood flow
  • Hyper-coagulable state
  • Damaged endothelium
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17
Q

Describe the pathophysiology arterial thrombosis/emboli in cats

A
  • A thrombus normally forms in the left atrium, due to myocardial disease associated with marked left atrial dilation - stasis of blood flow, plus a possibly damaged endocardium
  • Cats’ platelets are highly reactive, and embolization results in further platelet activation, with further platelet aggregation and adhesion
  • Vasoconstriction of collateral vessels
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18
Q

Where does embolisation most commonly occur in cats?

A

In the distal aorta - Feline arterial thromboembolism (FATE)
Saddle embolus

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19
Q

How do cats with FATE present?

A

Severe, acute pain and loss of function e.g. both hindlimbs
Affected limbs are cold, nail beds and non-pigmented pads may be cyanotic
Muscles are painful on palpation and in spasm (ischaemic neuromyopathy)

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20
Q

What is the prognosis of FATE in cats?

A

Grave

21
Q

How does a thromboembolism appear on echocardiography?

A

‘Smoke’ in the left atrium

22
Q

Describe the two drugs used to help prevent FATE in cats

A
  • Clopidogrel (Plavix®) is an antiplatelet drug, inhibiting the binding of ADP to its platelet receptor.
  • Aspirin helps prevent further platelet activation
23
Q

Which drugs can be used in cats with FATE to reduce activation of the coagulation cascade?

A

Unfractionated heparin

24
Q

Describe the pathophysiology of thrombus formation in dogs

A
  • Rare in cardiac disease
  • Occurs as a consequence of an endocrinopathy e.g. Cushing’s disease, Hypothyroidism.
  • Also commonly affects distal aorta, possibly only single limb
25
Q

How do dogs with an arterial thromboembolism present?

A

Hindlimb weakness or pain, worse with exercise
Pale / Pulseless / Cold compared with non-affected limb

26
Q

How are dogs with an arterial thromboembolism treated?

A

Address the underlying condition
Analgesia

27
Q

List some causes of pulmonary hypertension

A
  • Pulmonary vascular changes e.g. Dirofilaria or Angiostrongylus infections
  • High left atrial pressure due to left sided congestive heart failure
  • Pulmonary thromboembolism
  • Respiratory conditions e.g. brachycephalic obstruction
28
Q

How can pulmonary hypertension be diagnosed by auscultating the heart?

A

Loud second heart sound (S2) - may be split due to delayed pulmonic valve closure
Murmur of tricuspid regurgitation may be present or loud

29
Q

How can pulmonary hypertension be diagnosed on radiography?

A

Right heart enlargement, and pulmonary arterial dilation

30
Q

How might a dog with pulmonary hypertension present?

A
  • Syncope
  • Respiratory distress/increased respiratory effort
  • Exercise intolerance
  • Right sided HF
  • Cyanotic or pale mm
31
Q

How might a dog with pulmonary hypertension present on echocardiography?

A
  • High tricuspid regurgitation velocity
  • Decreased size of LV
  • Right ventricular hypertrophy: wall thickening, chamber dilation
  • Pulmonary artery enlargement
  • Right atrial enlargement
  • Caudal vena cava enlargement
32
Q

What are the aims of treating pulmonary hypertension?

A
  • Decrease the risk of progression or complications
  • Target underlying diseases or factors contributing to PH
  • PH-specific treatment
33
Q

List 4 drugs that can be used to treat pulmonary hypertension

A

Vasodilators:
- Sildenafil
- Pimobendan
- Tyrosine kinase inhibitors
- L-arginine

34
Q

How is pulmonary thromboembolism diagnosed?

A
  • Results in large ventilation: perfusion mismatch: this can be diagnosed on arterial blood gas analysis by identifying a large Alveolar (A) to arterial (a) oxygen gradient.
  • FDPs (fibrin degradation products) or D-dimers (more specific in the dog and cat) indicate clot breakdown, and elevated levels suggest PTE
35
Q

Name the heartworm spp of dogs

A

Dirofilaria immitis

36
Q

Describe the life cycle of Dirofilaria immitis

A
  • Intermediate host is the mosquito: needs warm temperatures to allow L1 to mature into infective stage in the mosquito
  • L3 transmitted with mosquito bite into dog.
  • L3 -> L5 in pulmonary arteries
  • Microfilaria released into blood stream (so can infect another mosquito).
37
Q

How long is the PPP of dirofilaria?

A

6 months

38
Q

What is Caval syndrome?

A

The result of right sided congestive heart failure as a consequence of a severe worm burden.

39
Q

How is Dirofilaria immitis diagnosed?

A
  • Thoracic radiographs / echocardiography
  • Heart worm antigen tests.
  • Blood microfilaria test (only dogs with patent infection, over 6 months of likely infection)
  • Antibody test (cats)
40
Q

Describe the migration of dirofilaria in the body

A

Parasites live in the distal parts of the pulmonary vessel. As they grow they migrate further to the heart -> pulmonary artery -> right ventricle -> right atrium -> vena cava (occlusion)

41
Q

Describe diagnosis of Dirofilaria in cats

A
  • Antigen test and echocardiography: +ve test diagnostic, -ve test may be inconclusive
  • Antibody test and radiography: +ve test increases suspicion, -ve test decreases suspicion
42
Q

Which treatment of heartworm is indicated with very heavy worm burdens?

A

Mechanical removal (by jugular catheterisation and retrieval forceps).

43
Q

Which drugs are used to treat heartworm?

A
  • Adulticide + strict rest
  • 3-4weeks later -> Microfilaricide (ivermectin)
  • Concurrent doxycycline
44
Q

Name the ‘french heart worm’

A

Angiostrongylus vasorum

45
Q

Where is Angiostrongylus vasorum found in the body?

A

Pulmonary vessels

45
Q

What are the clinical signs of an Angiostrongylus vasorum infection?

A

Cough
Shortness of breath
Hypoxaemia
Exercise intolerance
Coagulopathies
CNS signs

46
Q

How is Angiostrongylus vasorum diagnosed?

A

Need index of suspicion – may be weird clinical signs!
Faecal Baermanns to see larvae
Rectal swab, smeared onto slide, direct microscopy
Angio Detect (IDEXX) - snap tes t

47
Q

Describe the typical appearance of L1 Angiostrongylus vasorum

A

~0.4 mm long and 15 micrometers thick.
Their tail is typically curved, with a dorsal spine.

48
Q

How is Angiostrongylus vasorum treated?

A
  • Fenbendazole
  • Moxidectin
  • Milbemycin oxime

Y4 SA - Cardio-Respiratory (10 decks)

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