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205 Cards in this Set
- Front
- Back
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Another term for endocardiosis
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Chronic degenerative valvular disease
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Prevalence of CDVD in dogs aged 13 and over
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30%
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% of canine CHF cases that are attributable to CDVD
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75%!
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Components of the normal mitral valve
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Valve leaflets
Annulus fibrosus Chordae tendinae Papillary muscles Left atrium Left ventricular muscle |
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True or false: CDVD is a sterile, degenerative process unrelated to cardiac infection.
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True
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Regurgitation in this valve imposes a volume overload on the left atrium and left ventricle, causing cardiomegaly
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Mitral valve
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2 determinants of the severity and volume of MR.
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Regurgitant orifice area
LV to LA gradient pressure |
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Describe the body's compensatory processes for decrease in cardiac output.
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Increased sympathetic activity
Attenuated vagal tone RAAS Activation Natriuretic Peptide Release (LA enlargement and severe CHF) |
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How does cardiomegaly cause cough?
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Mainstem bronchial compression
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Does a cough with an enlarged heart constitute heart failure?
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No
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Regurgitation in this valve imposes a volume overload on the left atrium and left ventricle, causing cardiomegaly
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Mitral valve
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2 determinants of the severity and volume of MR.
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Regurgitant orifice area
LV to LA gradient pressure |
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Describe the body's compensatory processes for decrease in cardiac output.
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Increased sympathetic activity
Attenuated vagal tone RAAS Activation Natriuretic Peptide Release (LA enlargement and severe CHF) |
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How does cardiomegaly cause cough?
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Mainstem bronchial compression
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Does a cough with an enlarged heart constitute heart failure?
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No
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Consequences of chordae tendinae rupture
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Rapid rise in LA pressure, leading to pulmonary edema
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Pulmonary edema may result when pressure increases in this chamber of the heart
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Left atrium
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SIgns of poor cardiac output
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Syncope
Weakness Collapse Pale mucous membranes Poor femoral arterial pulse quality |
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Consequences of atrial tearing
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Cardiac tamponade
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Classification of CDVD where patient is at high risk, with no known injury or clinical signs
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Stage A
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Classification of CDVD where patient has injury to cardiac structure but no clinical signs.
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Stage B
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Classification of CDVD where patient has injury to cardiac structure and clinical signs responsive to treatment.
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Stage C
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Classification of CDVD where patient has injury to cardiac structureand clinical signs that are refractory to treatment.
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Stage D
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Typical signalment for CDVD
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Many toy and miniature breeds, typically over 10 years old
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In which breed does CDVD manifest itself in dogs under 5 years?
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Cavalier King Charles Spaniel
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PMI for mitral valve regurgitation
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Left apex
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Mitral valve regurgitation results in a murmur during what phase of the cardiac cycle?
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Systolic
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Significance of a loud murmur >4/6 and a gallop rhythm
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Clinically important heart disease
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What is a gallop heart rhythm?
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Heart rhythm when S3 is heard
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How common is tachycardia with CHF?
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Common
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Criteria for refractory heart disease
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CS no longer controlled by current therapy, including furosemide >6 mg/kg q 12h
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Diagnostics for CDVD
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Thoracic rads
Echocardiography EKG Brain natriuretic peptide |
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Diagnostic evaluation for a dog in Stage A CDVD.
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Yearly physical examinations
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Diagnostic evaluation for a dog in Stage B CDVD (structural abnormalities without CS).
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TXR and BP
Echo in larger breeds |
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Diagnostic evaluation for a dog in Stage C CDVD (structural abnormalities with CS).
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TXR, BP
Echo if not responsive to therapy |
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Normal VHS for dog is under...
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10.5
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Normal VHS for cat is under...
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8.1
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At what stage in CDVD is ACE inhibition therapy indicated?
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Stage B2
(ACEI and Beta blocker in large dogs) |
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Recommendations for treatment of symptomatic CDVD
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Furosemide (decrease preload)
ACEI (decrease preload and afterload) Pimobendan (ionodilator) Spironolactone |
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MOA for pimobendan
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Positive ionotrope and vasodilator
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Tx for acute CHF
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IV furosemide
Remove effusions Increase pimobendan to tid Amlodipine (Ca channel blocker) Hydralazine (vasodilator) Nitroprusside (venodilator) Dobutamine (ionotrope) Mechanical ventilation |
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MOA for amlodipine
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Ca channel blocker to reduce afterload
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MOA of hydralazine
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Vasodilator
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MOA for nitroprusside
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Venodilator
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MOA for dobutamine
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Ionotrope
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In the event of refractory CHF, what is the treatment for afterload reduction?
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Furosemide q8h
Hydrochlorothiazide sid Spironolactone (Sequential nephron blockade) |
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When are thiazide diuretics contraindicated?
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Diabetics
Azotemic patient |
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Blood pressure is a product of what two factors?
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CO X SVR
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Cardiac output is a product of what two factors?
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HR X SV
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MOA of hydralazine
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Direct arteriolar vasodilator
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Where does amlodipine act as a Ca channel blocker?
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Blood vessels (vasodilation)
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What can help distringuish a cardiac cough from respiratory cough?
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Thin BW
Rapid HR Regular heart rhythm unless pathological arrhythmia Loud murmur |
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On short axis echo, the normal right atrium should be what proportion of the aortic diameter?
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1.5 times
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Why should cats with HCM be treated with anticoagulant therapy?
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Blood stasis causes thrombus formation and possibly PTE
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Hypertrophy of a nondilated ventricle in the absence of outflow tract obstruction, SH, hyperthyroidism, etc.
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HCM
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HCM has been shown to be genetic in these cat breeds.
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Maine coon
Ragdoll cats |
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How frequently does hyperthyroidism cause heart failure?
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Rarely
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Does HCM cause systolic or diastolic dysfunction?
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Diastolic
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Describe the systolic function of the heart during HCM compared to in a normal heart.
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Normal to increased systolic function
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Inability of the ventricles to fill without an inordinate increase in pressure
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Diastolic dysfunction
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The two factors upon which diastolic function relies.
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Myocardial relaxation (energy needed)
Compliance |
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When is ventricular filling impaired?
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When relaxation is prolonged or when compliance is reduced.
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Crainial movement of the mitral valve lealets during systole
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Systolic anterior motion
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Why is SAM an issue?
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Occludes left ventricular outflow tract and creates a subvalvular pressure gradient
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Regurgitation of this valve often accompanies SAM
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Mitral valve
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Is HCM more common in male or female cats?
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Males
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Are cats with cardiac murmurs more likely associated with dynamic or fixed phenomena?
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Dynamic
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This chamber of the heart is enlarged with HCM.
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Left atrium
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List some causes of pseudo-HCM and misdiagnosis
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Ketamine
Hypovolemia |
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Drug protocol for use in HCM cases
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Diltiazem (Ca channel blocker)
Beta blockers (propanolol or atenolol) Enalapril |
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MOA of diltiazem
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Ca channel blocker speeds myocardial relaxation
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Indications for using beta blockers in HCM.
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SAM with high pressure gradient
Ventricular arrhythmias High HR |
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Pulse pressure is the result of...
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Difference between systolic and diastolic pressure.
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PDA causes what kind of murmur?
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Continuous
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PDA allows direct communication between what two vessels?
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Aorta
Pulmonary artery |
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The "three bulges" associated with PDA on a VD radiograph are...
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Aorta (most consistent)
Pulmonary artery LA appendage |
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Tall R waves on an EKG are indicative of enlargement of the...
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Left ventricle
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Dogs with PDA often have this EKG abnormality.
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Tall T waves
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Treatment for PDA
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Ligation following left lateral thoracotomy
OR Transcatheter ductal occlusion |
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Consequence of untreated PDA
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Congestive heart failure
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Two devices used to occlude a PDA via catheter
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Dacron tufted Gianturco steel coils (dacron is thrombogenic)
ACDO |
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In what % of cases can Gianturco coils achieve acute resolution of PDA?
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50-60%
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Transcatheter occlusion of a PDA is done through which blood vessel?
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Femoral artery
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Amplatz canine occluder devices (ACDOs) are limited to use in dogs over what weight?
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3 kg
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Complications of transcatheter occlusion of PDA include...
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Post-procedural hemolysis
Device migration Vessel access in small patients |
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Pulmonic stenosis causes what kind of murmur?
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Systolic
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Increased sternal contact of heart on lateral radiograph is indicative of enlargement of what chamber?
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Right ventricle
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Normal pressure across any cardiac valve.
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Zero
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Treatment for pulmonic stenosis and its efficacy
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Balloon valvuloplasty
Does not cure, but lessens the stenosis |
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In pulmonic stenosis, what pressure across the valve necesitates baloon valvuloplasty even without CS?
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80 mm Hg
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True or false: Almost all patients with congenital heart disease have a murmur
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True
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Definitive dx of congenital heart disease is made via...
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Doppler echocardiography
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Heart muscle disease associated with dysfunction
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Cardiomyopathy
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Hyperthyroidism causes what kind of cardiomyopathy?
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Metabolic cardiomyopathy
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In this kind of cardiomyopathy, wall thickness and ventricular dimensions are nearly normal but there is atrial enlargement and diastolic disfuntion. Systolic function is normal.
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Restrictive cardiomyopathy
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Which disease is more common: RCM or HCM?
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HCM
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Prevalence of RCM among cardiomyopathies can reach as much as...
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30%!
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Possible causes of RCM include...
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Endocardial fibrosis
Diastolic myocardial dysfunction |
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On an echo a patient has normal LV size, normay systolic function, but an enlarged LA. This is classic for...
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RCM
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Normal echocardiographic ratio of LA to aorta diameter.
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1.5 X or less
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On doppler echocardiography, when the HR is under 150, how does the ventricular inflow look?
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Biphasic
(Early diastolic decelleration) |
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When measuring myocardial velocity, what feature indicates diastolic dysfunction?
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Rapid deceleration of myocardial ventricular filling
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Atrial dilation disproportionate to ventricular volume is indicative of...
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Diastolic dysfunction
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Condition in which the myocytes of the right ventricle are replaced by fatty or fibrofatty tissue.
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Right ventricular arrhythmogenic cardiomyopathy
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Seen in felines, this cardiomyopathy involves hypertrophy and ventricular dilation that don't fit easily into the basic categories set forth by the WHO.
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Unclassified cardiomyopathy
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DCM in felines is associated with what nutritional deficiency?
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Taurine
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Treatment protocol for diastolic dysfunction
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Diltiazem (Ca channel blocker to speed myocardial relaxation)
Propranolol/atenolol (Beta blocker, slows HR) Enalapril (blunts RAAS) |
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When are beta blockers indicated for HCM?
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SAM with high gradient
Ventricular arrhythmias High HR |
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Ischemic neuromyopathy generally affecting the hind legs of cats
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Feline Arterial Thromboembolism (FATE)
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CS of FATE in the caudal aorta
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Pain
Paresis/paralysis Absent arterial pulse |
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Maturation of L1 to L3 of heartworm larvae in the mosquito requires an average daily temperature at minimum of...
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57 degrees F
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L5 of heartworm can live in the dog for how long? In the cat?
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Dog: 7 years
Cat: 2-3 years |
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Prepatent period of heartworm in the dog and cat
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6-7 months up to 2.5 years in the dog
7-8 months in the cat |
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Causes of false negative results on heartworm antigen test
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Prepatent infection
Low worm burden Immature females All male infection Kit not warmed to room temperature |
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Where in the host do heartworms actually reside?
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Pulmonary artery
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True or false: Heartworm infection is linked to pulmonary thromboemboli
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True
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Describe the 3 injection protocol for melarsomine (immiticide) heartworm treatment.
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After diagnosis, treat with macrolide for 3 months to kill larvae. Inject immiticide. Rest for 1 month. Then give 2 injections of immiticide 24h apart.
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Potential complications of HW adulticide therapy.
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Pain and swelling at injection site (epaxial muscles)
Anorexia Lethargy (smaller > larger dogs) +/- neurologic signs +/- PTE |
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How long after HW adulticide treatment does PTE usually present?
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7-10 days after injection
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CS of PTE
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Cough, fever, hemoptysis
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Factors influencing the probability of post-adulticide thromboembolic complications in a heartworm case.
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Extent of pulmonary vascular disease
Severity of infection Activity level of dog |
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Aside from melarsomine, what are some alternative therapies for heartworm disease?
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Continuous monthly treatment with ivermectin, moxidectin, or selamectin at preventative levels to reduce lifespan of adult worms (Can take over 2 years)
Ivermectin+ pyrantel (6 months) and doxycycline (30d) |
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In dogs with HW microfilariae in the blood, how is the first dose of macrolide administered?
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In the hospital, premedicated with prednisone and benadryl
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CS of an anaphylactic response to HW die-off when macrolide tx is initiated
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Lethargy
Inappetance Salivation Retching Hypotension/Tachycardia/Collapse |
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Occurs when HW get into the right ventricle and antangle int he tricuspid valve, causing near-occlusion. Results include hemolysis and ascites.
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Caval syndrome
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Tx for caval syndrome associated with heartworm disease
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Surgical extraction of worms
Adulticide therapy once pt is stable |
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Common rickettsial organism that lives in over 80% heartworms
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Wolbachia
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Why give doxycycline to a heartworm patient before adulticide therapy?
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Kill off Wolbachia to decrease post-adulticide complications and increase worm kill efficacy
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HW macrolides safe for use in Collie breeds
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Milbemycin
Selamectin |
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Most effective microfilaricidal used to prevent HW disease
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Milbemycin oxime
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When is it necessary to do a HW Ag test?
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Never recieved preventative
Extended break in HW preventative and it is over 6 months past end of transmission period Product switch |
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Tru or false: Cats are actually more susceptible to HW infection than dogs.
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False. More resistant
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How long do circulating HW microfilariae last in the cat?
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<30 days
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When in the course of a heartworm infection do CS develop?
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When HW enter pulmonary vasculature (3-4 months post infection)
Death of adult heartworms (2-3 years post infection) |
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CS of feline HW infection.
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Asthma-like signs: Wheezing, coughing, exercise intolerance
Vomiting Neurologic Syncope Sudden death |
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Acute vascular and parenchymal inflammatory response to arrival of immature worms in the cat lung
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Feline HW associated respiratory disease
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Tx for felines with heartworm disease
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2 mg/kg for 14 days--> then decrease to 0.5 mg/kg/day for 14 days
Adulticide tx not indicated |
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HW patients should be recheked how often?
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Every 6-12 months
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Criteria used to declare that a cat with HW is no longer infected
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Seroconversion
Regression of radiographic signs |
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HW prevention in cats includes:
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Ivermectin (24ug/kg)
Milbemycin oxime (2 mg/kg) Selamectin (15-45mg/kg) |
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Why treat all the cats in a house for HW?
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Many cats that are AB positive have been transiently infected to 4th larval stage and this reinforces need for chemoprophylaxis to prevent HARD.
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Most common congenital pericardial disorder
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Peritoneopericardial hernias
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Most common cause of pericardial disease in the dog
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Pericardial effusion
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Most clinically significant pericardial effusions (60-70%) are secondary to...
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Neoplasia
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Top 4 neoplastic causes of pericardial effusion
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Hemangiosarcoma
Chemodectoma Mesothelioma Mesothelioma Ectopic thyroid carcinoma |
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In cats, the top three causes of pericardial effusion
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FIP
CHF Neoplasia (lymphosarcoma) |
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Pericardial effusion interferes with which phase of the cardiac cycle?
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Diastole
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How does pericardial effusion affect systemic venous return?
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Decreases
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What factors affect the outcome of pericardial effusion?
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Rate of fluid accumulation
Compliance of pericardium |
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Clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise.
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Cardiac tamponade
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Which pressure is higher: Venous pressures resulting in systemic congestion or pulmonary congestion?
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Pressures resulting in pulmonary congestion
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Pericardial disease is seen most frequently in which two dog breeds?
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Mature Golden Retrievers
German Shepherd Dogs |
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CS of pericardial disease
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Ascites
Weakness/syncope Lethargy Inappetance Cough Occasionally circulatory collapse |
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PE findings for an animal in cardiac tamponade
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Tachycardia (sinus tachycardia)
Quiet heart sounds Ascites/ Jugular distension Weak arterial pulses Pulsus paradoxus |
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What would you see in a thoracic radiograph in a dog with cardiac tamponade?
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Enlarged cardiac silhouette without contour
Small pulmonary vessels |
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How common is pulmonary edema with cardiac tamponade?
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Uncommon
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EKG signs seen in a dog with cadiac tamponade
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SInus tachycardia +/- QRS alternans or small QRS complexes
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Best diagnostic test for cardiac tamponade
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Echocardiography
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Initial therapy for cardiac tamponade
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Pericardiocentesis
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What is the role of diuretics in cardiac taponade?
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CONTRAINDICATED b/c further reduce ventricular filling
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How should a patient be positioned for pericardiocentesis?
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Left lateral recumbency to avoid coronary vessel laceration
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Complications of pericardiocentesis
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Cardiac puncture
Arrhythmias (use an ECG to see PVC's) Laceration of tumor or coronary artery |
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Significance of an elevated cardiac troponin I level in a dog with pericardial effusion
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Likely neoplastic
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Long term therapy for pericardial effusion
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Subtotal pericardectomy
Chemotherapy for cardiac HSA |
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When may subtotal pericardectomy be curative in cases of pericardial effusion?
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Idiopathic
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Cause of echogenic "smoke" on an echocardiogram.
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Blood stasis
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Is primary pericardial disease more common in large breed or small breed dogs?
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Large breed dogs
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CS of this set of disorders are related to high central venous pressure and low cardiac output
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Pericardial disease
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Normal RA pressure
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0-5 mmHg
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Normal RV pressure
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15-25 mmHg
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Normal LV pressure at systole
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120 mmHg
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Normal LA pressure
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5-8 mmHg
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Normal pulmonary artery pressure
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15-25/5
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Normal CO for a dog per minute
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100-200 mL/kg
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Pulmonary hypertension occurs when systolic pulmonary arterial pressure exceeds..
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30 mmHg
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Three causes of pulmonary hypertension
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Left heart disease
Intrinsic lung disease Thromboembolic disease |
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2 left heart diseases that can cause pulmonary hypertension
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Mitral valve disease
DCM |
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Why would a dog with pulmonary hypertension get ascited?
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Right side of heart has to work harder to push blood thru lungs, causing fluid backup
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In cats, the top 3 causes of pulmonary thromboembolism and hypertension include...
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Neoplasia
Anemia Pancreatitis |
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Cutoff range for mild pulmonary hypertension
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Systolic PA pressure 30-55 mmHg
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Cutoff range for moderate pulmonary hypertension
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56-79 mmHg
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Pressure at which pulmonary hypertension is considered severe
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80 mmHg
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Deep S waves indicate...
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Right sided heart enlargement
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Significance of the R wave on EKG
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Depolarization of L ventricle
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Significance of the S wave on EKG
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Depolarization of R ventricle
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Normally on echo how does the LV size compare to the RV size?
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LV 3X as large
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What area of the heart is used to gauge pulmonary arterial pressure?
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RV pressure at systole
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Acute therapy for pulmonary hypertension
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Supplemental oxygen
Sildenafil Theophylline for bronchodilation |
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List some classes of drugs used for vasodilation in pulmonary hypertension
|
PDE inhibitors
Prostanoids Endothelin receptor antagonists |
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MOA of sildenafil
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PDE-V inhibitor
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How can DCM cause pulmonary hypertension?
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High left ventricular end diastolic pressure
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Condition in which structures composed of platelets, fibrin, microbes, and inflammatory cells adhere to heart valves, septal defects, chordae tendinae, or the mural endocardium
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Vegetative endocarditis
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In most cases of infective endocarditis, are the left heart valves or right heart valves affected most commonly?
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Left
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Sterile, degenerative process affecting the heart valves. Grossly they still look shiny and smooth.
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Endocardiosis
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Is infective endocarditis more common in dogs or cats?
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Dogs (still uncommon)
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Is infective endocarditis more common in large or small dog breeds?
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Large
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Antibiotics used to treat infective endocarditis.
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Enrofloxacin, CLavamox, Azithromycin
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How long should antibiotic therapy be used to treat infective endocarditis?
|
3 months or longer
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List some reasons why infective endocarditis is difficult to cure
|
Poor penetration of antimicrobials
Altered metabolic state of bacteria within the lesion Absence of adequate host-defense response |
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Px of infective endocarditis
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Very poor to grave
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Mean survival time for infective endocarditis
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2 months
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Key to prevention of infective endocarditis
|
Prevention of persistent bacteremia in predisposed animals (Subaortic stenosis, immunocompromise, etc)
Appropriate abx selection for type of infection that may gain access to systemic circulation |
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Types of infections that can lead to bacteremia and infective endocarditis.
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Oral disease
Skin disease UTI etc. |
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Describe the protocol for blood culture in cases of infective endocarditis.
|
2 positive blood cultures obtained by separate venipuncture at least 1 hr apart
OR 3 cultures 5-10 minutes apart are performed. |
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Significance of the S3 heart sound
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Early diastolic ventricular filling
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