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59 Cards in this Set
- Front
- Back
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What are the classifications of myocardial disease?
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Dilative cardiomyopathy
Arrhythmogenic RV cardiomyopathy Restrictive cardiomyopathy Unclassified cardiomyopathy |
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The most common types of myocardial disease in canines are...
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DCM(Dilative cardiomyopathy)
ARVC (Arrhythmogenic RV cardiomyopathy) |
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Decreased _____________ function is the major issue in myocardial disease.
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decreased SYSTOLIC function
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Genetic etiology for DCM has been found in which dog breed? What gene is affected?
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Dobies!
Pyruvate dehydrogenase kinase 4 (turns off pyruvate kinase, thus preventing energy production) |
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How does the decreased contractility in canine DCM affect the following?
End systolic volume Stroke volume Sodium levels Cardiac output |
INCREASED End systolic volume
DECREASED Stroke volume INCREASED Sodium levels REDUCED Cardiac output |
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Which dogs are more predisposed to DCM?
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BIG dogs; male>female
(Scottish deerhound, dobies, irish wolfhound, great dane, boxer) |
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How does doberman/boxer DCM differ from other dogs?
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Tend to get L-sided failure, ventricular arrthymias, and pulmonary edema while other dogs get R-sided failure, a-fib, and pleural effusion
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What is often found on physical exam of a DCM dog?
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S3 gallop heard with the bell on the apex.
Sometimes a-fib and VPCs Weak pulses/pulse deficits Ascites/Jug distention |
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What is the criterion for enlarged left atrium on echo?
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can fit >2 aortae inside the LA on the short axis view
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How is DCM diagnosed in dogs?
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Diagnosis of exclusion!
Biventricular heart on rads ECG (a-fib or v-arrthymias) PE (S3 gallop, weak pulses) Echo (Dilated LV/RV/LA, reduced EF and FS %) |
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How is canine DCM treated medically (acutely and chronically)?
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FOND (Furosemide, O2, Nitroprusside, Dobutamine)
if chornic (Furosemide, ACE inhibitor, Pimobendan/Digoxin, +/- Spirinolactone) |
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How is the a-fib from DCM medically treated? The v-arrthymias?
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a-fib (digoxin, diltiazem)
v-tach (mexiletine, atenolol) |
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T or F:
DCM in Dobermans can be reliably tested by genetic screening. |
False!
Low sensitivity! |
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What are some secondary myocardial disease that can resemble DCM?
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Taurine deficiency
Congenital hyperthyroid Chronic tachyarrthymias Chronic catecholamines Chronic volume overload Toxic cardiomyopathy (doxorubicin) |
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What is "Disease of the desmosome" in humans is also known as? In boxers, what gene is affected?
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...arrthythmogenic right ventricular cardiomyopathy.
Affects STRIATIN in boxers |
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What is the proposed mechanism of arrthymogenic RV cardiomyopathy?
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Ca dysregulation leads to decreased Na current which slows AP and causes ventricular arrhythmias
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If you see a boxer with syncope, what should be some of your top differentials?
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Arrthymogenic RV cardiomyopathy or HCM
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Describe the ECG with ARVC.
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Ventricular arrthymia
Looks like left-bundle-branch VPC with no P wave and abnormal T >100 VPC/24hr via Holter |
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How should ARVC be treated?
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Sotalol +/- mexilitene OR mexiletine w/atenolol for arrthymia w/no sytstolic dysfxn
With CHF, use Furosemide, ACE inhibition, and Pimobendan |
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In which breeds is atrioventricular cardiomyopathy seen the most?
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Springer spaniel
Old English sheepdog |
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Myocardium being replaced by fibrous tissue describes...
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...atrioventricular cardiomyopathy
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Persistent atrial standstill with HUGE left atrium is suggestive of...
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...atrioventricular cardiomyopathy
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How is atrioventricular cardiomyopathy treated?
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Pacemaker
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What are some examples of infectious myocardial diseases?
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Chaga's Disease
Parvo Toxoplasma Neospora |
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T or F:
Equine myocardial disease is rarely primary and almost always associated with infection. |
True!
(EVA, Equine Flu, EIA, Strept, Staph, Borrelia, Strongyles) |
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What is a diagnostic blood test for equine myocarditis?
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Troponin I levels <0.06ng/mL
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Ionophore toxicity is the most important in which animal?
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Cattle
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What is the pathogenesis of ionophore toxicity?
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Allows for Na or K to move down concentration gradient, preventing ATP production
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Most myocardial disease in cats is in which classification? Then next is...
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HCM is 60-70%
Restrictive CM is 15-20% Unclassified CM is the rest |
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Which of the following has NOT been shown in cats:
a) autosomal dominant HCM in ragdolls b) taurine is essential to HCM prevention c) Maine Coons have a myosin binding protein C mutation leading to HCM d) feline RCM is idiopathic |
a) autosomal dominant HCM in (MAINE COONS; ragdolls have unknown inheritance)
b) taurine is essential to not HCM but DCM prevention |
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A cat with thickened walls and myocyte diararray on histo has...
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...HCM
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A cat with fibrotic endocardium and HUGE atria has...
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...RCM
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A cat with thin flabby ventricles, a round heart, and a big left auricle has...
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...DCM
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What murmur is commonly heard in cats with myocardial disease?
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S4 gallop rhythm d/t atrial contraction
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What are the 2 classes of murmurs in feline HCM and how can they be distinguished?
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LV outflow tract obstruction
RV outflow tract obstruction (cannot be distinguished by PE) |
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SAM + HCM =
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HoCM
(Systolic Anterior Motion of the mitral valve; Hypertrophic/Obstructive Cardiomyopathy) |
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What appearance is seen on the pressure waves of a SAM on echo?
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daggers!
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Describe the hemodynamic effects concurrent to LVOT. How 'bout RVOT.
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LVOT (LV pressure overload d/t outflow turbulence + LV volume overload d/t regurg)
RVOT (little hemodynamic effects) |
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What is an important sequel to all cardiomyopathies in cats?
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thromboembolism
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How does feline HCM present on radiography?
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Patchy pulmonary edema
LA and LV enlargement (Mr. Peanut) maybe valentine heart |
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How is feline HCM treated?
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Furosemide, ACE inhibitor +/- spirinolactone
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How is feline HoCM treated?
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add atenolol OR Ca blocker to HCM protocol (reduces HR and contractile force thus getting rid of SAM)
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Which feline mycoardial disease has the best prognosis with treatment?
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DCM (with taurine)
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What are cardiac changes manifest in a cat w/hyperthyroidism?
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Increased heartrate and contractility
Myocardial hypertrophy |
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What are the 3 main factors leading to thromboemboli?
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Blood stasis
Endothelial injury Hypercoagulable state |
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What are the P's associated with saddle thrombi?
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Pain, Paresis, Pallor, Poikilothermia, Pulselessness
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If you see "smoke" in the atria, what gives?
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This is blood stasis
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When working-up a thromboembolic case, what clin-path parameters should be assessed?
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Renal function
K level Acid/base balance Clotting factors |
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What is the treatment for acute thromboembolic disease?
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If <12h and a decent anesthetic candidate, surgical removal of thrombi or embolectomy catheters
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What pharmaceuticals are directed against the thrombus in thromboembolic disease?
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Anticoagulants (heparin/coumarin)
Thrombolytics (streptokinase/tissue plasminogen activator) |
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What are favorable signs when treating thromboembolic disease?
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Resolution of CHF
Lack of atrial thrombi appetite Normal renal/electrolyte values Return of limb fxn Femoral pulse No self mutilation Seriously committed owner! |
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Approximately _____ % 1-year survivability has been reported with systemic thromboemboli.
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37%
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What are some PREVENTIVE pharmaceuticals used to prevent systemic thromboemboli? How do they work?
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Aspirin (COX blocker, preventing thromboxane A2 formation)
Clopidogrel (blocks ADP) Dipyridamole (blocks prostacyclin) |
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Acute development of R heart dilation/failure d/t sudden increase in pulmonary vascular resistance describes...
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...Cor pulmonale
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Which of the following are clinical signs of cor pulmonale?
a) hemoptysis b) gallop rhythm c) split S2 d) fever e) a-fib |
a) hemoptysis
c) split S2 d) fever (also sinus tachycardia, syncope, tachypnea/dyspnea, sudden death) |
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What is the incidence for bovine vena caval thrombosis?
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1.3%
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Bovine vena caval thrombosis is due to...
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...septic hepatic abscesses eroding the vena cava
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What are the respiratory issues associated with pulmonary thromboemboli? Which is the most important?
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Arterial hypoxemia (most import)
V/Q mismatch Alveolar dead space |
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What do you think if an animal presents with sudden tachypnea, dyspnea, arterial hypoxemia and normal thoracic rads...
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...pulmonary thromboembolism!
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