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106 Cards in this Set
- Front
- Back
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What are the most common acquired cardiac diseases in the cat?
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primary and secondary (specific cardiomyopathies
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How often does acquired valvular or pericardial disease explain clinical signs in the cat?
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SELDOM
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What is a cardiomyopathy?
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a heart muscle disease associated with dysfunction
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What is primary heart disease?
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idiopathic --> classified on a functional or morphological basis
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What are the functional designations of cardiomyopathies?
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HCM
RCM DCM ARVC (arrhythmogenic right ventricular cardiomyopathy) Unclassified |
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What are the secondary cardiomyopathies?
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thyrotoxic heart disease
hypertensive heart disease |
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What is HCM?
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-hypertrophy of a nondialated ventricle in the absence of outflow tract obstruction
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What ventricle does HCM most commonly affect?
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left
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What breed is HCM heritable in?
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Maine coon
Ragdoll cats |
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What is HCM characterized by?
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diastolic dysfunction - systolic performance is normal or hyperdynamic
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What 2 things are impaired by HCM?
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(1) myocardial relaxation is impaired because the hypertropied ventricle is very stiff and coronary perfusion is impaired
(2) reduced compliance |
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What does dyastolic function depend on?
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myocardial relaxation and compliance
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Ventricular filling is impaired when....?
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(1) relaxation is prolonged
(2) compliance is reduced |
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In HCM, diastolic dysfunction leads to what?
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-high filling pressures (during dyastole) thereby causing congestive signs
-small SV causing low CO -can also result in mitral valve incompetence because of the hypertrophy |
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atrial dilation that is disproportionate to ventricular volume suggests what?
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diastolic dysfunction
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Which way do the mitral valve leaflets move during systolic anterior motion of the MV (SAM)?
-what may this cause obstruction of? |
cranial
-dynamic left ventricular outflow tract --> causing a subvalvular pressure gradient and potentially a murmur |
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What almost always accompanies a SAM?
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mitral valve regurgitation
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What is the signalment of HCM?
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-male predisposition, mean age is 6 years old but any age including kittens
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What is the clinical presentation of HCM?
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(1) incidentally detected murmur/gallop due to mitral valve regurgitation or left ventricular outflow tract obstruction (SAM)
(2) clinical signs related to CHF, systemic thromboembolism, SCD |
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What are the main PE findings of a cat with HCM?
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(1) mitral valve regurg or SAM murmur
(2) gallop rhythm --> always indicated the presence of clinically important heart disease |
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Is tachycardia a consistent deature in feline patients with CHF?
cough? |
no
no |
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In cats, what is a common manifestation of heart failure (primarily with LEFT ventricular disease)?
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pleural effusion in the absence of ascites
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What would a thoracic radiography show in a cat with HCM?
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-variable degrees of cardiomegaly with or without pulmonary edema
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What is needed to diagnose feline myocardial disease?
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ECHO
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What is a therapy for HCM in cats?
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preload reduction - when pulmonary edema/pleural effusion is present
(1) diuretics - furosemide (2) thoracocentesis when respiratory distress results from pleural effusion |
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What is the optimal dose of furosemide in cats?
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the lowest dose because they tend to tolerate overly aggressive therapy poorly
-0.5-1.0mg/kg q 12-24 hours |
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When you want to provide a therapy of diastolic dysfunction, what 2 things would you focus on?
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(1) slow heart rate
(2) speed myocardial relaxation -overall improve ventricular filling beta-blockers, calcium channel blockers |
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Would you give enalapril, an ACE inhibitor to cats with HCM?
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yes, maybe
-when atrial dilation is present BUT there is no EVIDENCE of efficacy for any agent other than furosemide |
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What is restrictive cardiomyopathy?
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ATRIAL dilation with normal or nearly normal ventricular dimensions and wall thickness - systolic ventricular performmance is normal
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What is right ventricular arrhythmogenic cardiomyopathy?
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fatty or fibrofatty replacement of right ventricular myocardium (sometimes left)
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What is common with right ventricular arrhytmogenic cardiomyopathy?
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-arrhythmias
-in some, marked right ventricular dilation |
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What has been associated with the development of heart failure in cats?
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corticosteroids
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When a gallop rhythm or murmur is heard, what is suggested if the patient is older than 7 years old?
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a serum T4 level
-ECHO -maybe thoracic rads (if T4 is elevated) |
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What is FATE?
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feline arterial thromboembolism
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Feline patients with cardiomyopathy are predisposed to the development of what and where?
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thrombi in the left atrium
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With FATE and the development of intra-atrial thrombi, embolized of what occurs? What are the signs associated with this?
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-embolization of the caudal aorta
-pain, paresis/paralysis, absent arterial pulse |
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What is released from the clot during FATE that causes the syndrome?
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serotonin
prostaglandins |
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What is the therapy for FATE?
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-analgesis
-heparin -vasodilators? |
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Clinical signs of feline cardiovascular disease are most often related to what?
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CHF or embolism
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What type of diagnosis is DCM?
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morphological
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What does DCM result in?
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cardiac dilation and systolic myocardial failure
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What breeds has an autosomal dominant transmission been reported in DCM dogs?
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Irish Wolfhounds, Newfoundlands, Dobermans
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What type of hypertrophy do dogs with DCM have?
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eccentric - sarcomeric hypertrophy in series
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Which chambers of the heart are enlarged with DCM?
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all - walls appear thin
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What happens to the mitral and tricuspid valves in DCM?
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annular circumference of mitral and tricuspid valves in increased
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What % of male and female Dobermans develop DCM?
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male - 50% (wide age range 2-15)
female - 33% (at an older age) -sudden death in 30-50% of those that develop CHF |
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What is the difference in heart failure between Dobermans and Giant Breeds with DCM?
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giant breeds - right heart failure (ascites, anorexia, weight loss, fatigue)
Dobermans - left heart failure (cough, exercise intolerance, dyspnea, syncope) |
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How many stages are there of heart disease?
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3
1=normal heart, no clinical signs 2=abnormal heart, no clinical signs 3=abnormal heart, clinical signs/CHF |
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What is seen in stage 2 of DCM?
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-soft systolic murmur
-GALLOP SOUND- S3 -arrhythmia (ventricular ectopy and atrial fib) |
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What type of monitoring can be used to screen and assess DCM?
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Holter Monitoring
-finding >100 VPCs during a 24 hours Holter recording predicts the development of overt DCM in Dobermans |
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What additional lab tests could be done to diagnose DCM?
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plasma carnitine - boxers, cokers
plasma taurine - godlies and newies |
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In patients with stage 2 DCM, what is the treatment?
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-ACE inhibitor
-beta blocker -no high sodium diets -no heavy exercises -recheck in 6-12 months |
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In patients with stage 3 DCM, what is the treatment?
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(1) treat for CHF --> ACE-inhibitor, pimobendan, furosemide
(2) treat arrhythmias --> -atrail fib (digoxin, beta or calcium channel blocker -V Tach (Sotalol or mexiletine, beta blocker) |
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What is a common finding on a ECG with dogs having DCM?
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atrial fibrillation (70-80% of some giants)
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In stage 3 of DCM, when do you give a beta blocker and why?
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-once signs of congestion and marked exercice intolerance are ameliorated with standard treatment of CHF (ACE inhibitor, pimobendan, furosemide)
-to aid in diminishing maladaptive neurohormaonal effects on the myocardium |
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Why is the prognosis of Dobermans with DCM poorer than others?
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usually biventricular failure (pulmonary edema AND ascites)
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What breed is ARVC most common in?
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Boxer, Bulldogs
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What are the possible outcomes of dogs with ARVC?
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(1) lethal ventricular arrhythmia and sudden death
(2) systolic myocardial dysfunction and CHF (3) live normal life |
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What are historical findings of ARVC?
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-asymptomatic
-syncope -exercise intolerance |
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What type of murmur might be found in dogs with ARVC?
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left APICAL systolic murmur
(many Boxers may have a normal left BASILAR systolic ejection murmur because of SAS or a small AA) |
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Along with a left apical systolic murmur in Boxers with ARVC, what else may be present?
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PVC - intermittent to sustained ventricular ectopy
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What can be done to confirm diagnosis of ARVC?
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Holter monitor - because VPCs may be intermittent
-greater than 100VPCs over 24 hous in an adult Boxer is strongly suggestive of a ARVC |
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What is the main direction for ARCV treatment?
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use of ventricular antiarrhythmics to decrease VPCs, the complexity and syncopal episodes
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What are two drugs you could give to treat ARVC in dogs?
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Sotalol
Mexiletine |
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What are the unique features of AV myopathy AKA silent atria, persistent atrial standstill?
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-dilated, thin atria with little or no visible muscle - due to myocardial destruction and fibrosis
-bradyarrhythmia |
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What breed gets atrioventricular myopathy most commonly?
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English springer spaniels, old English sheepdogs
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What are the clinical and historical signs of atrioventricular myopathy?
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-weakness, collapse, syncope due to severe bradycardia
-signs of right or biventricular congestive heart failure |
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What is the most common ECG finding in animals with atrioventricular myopathy?
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persistent atrial standstill characterized by absent P waves and idioventricular rhythm
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What is the treatment of atrioventricular myopathy?
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(1) Bradyarrythmia --> pacemaker
(2) CHF --> furosemide, Enalapril, Pimobendan |
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CDVD accounts for what percentage of all dogs with signs of congestive heart failure?
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75%
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How many structures make up a normal mitral valve?
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6 structures
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What does the mitral valve look like during early stage CDVD?
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elongated chordae tendineae and enlarged tickened leaflets with areas showing bulging, ballooning, prolapse toward the atrial side
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What breeds are predisposed to CDVD?
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Cavalier King Charles Spaniel and Dachshunds
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How is the severity and volume of reguritation of MV determined?
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Regurgitant orifice area (ROA)
left ventricular to left atrial pressure gradient |
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How does the heart enlarge in a patient with MR?
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left atrial enlargement and eccentriuc hypertrophy of the left ventricle
-maintain CO for a indefinite period of time |
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Severe MR can result in what types of clinical signs?
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-raised pulmonary venous pressure and cardiogenic pulmonary edema
-occur especially when the regurgitant orifice is large and the afterload is high |
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What is the primary clinical sign first observed in dogs with CDVD?
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cough
-mainstem brochial compression -pulmonary edema |
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charcterize the murmur of a dog with CDVD.
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holosystolic, constant in intensity, of mixed frequency and loudest at the left apex
-as the disease progresses, a gallop may be audible (S3) and the second heart sound is less audible |
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What is characteristic on a thoracic radiograph of a dog with CDVD?
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-left atrial enlargement
-vertebral heart score -pulmonary vein distention -pulmonary edema |
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What is the treatment of dogs with CDVD if asymptomatic and cardiomegaly is present?
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enalapril
-beta blockers (optional) |
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What type of murmur is heard with endocaritis?
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diastolic murmur (aortic valve) with increased arterial pulse pressure
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How would you diagnosie endocarditis in normal and acutely ill patients?
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-2 pos blood cultures from 2 different sites 1 hour apart
- 3 cultures, 5-10 minutes apart |
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When dealing with PH, what is the first clinical category composed of?
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pulmonary arterial hypertension
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When dealing with PH, what is the second clinical category composed of?
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PH with left heart disease
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When dealing with PH, what is the third clinical category composed of?
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PH due to intrinsic lung disease
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When dealing with PH, what is the fourth clinical category composed of?
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PH due to thrombotic or embolic disease
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When dealing with PH, what is the fifth clinical category composed of?
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PH due to mic disorders
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Pericardial diseases causes what in the dog?
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right sided heart failure
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The parietal pericardium consists of the...
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fibrous pericardium and the serousal layer
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Disease of the pericardium is an important cause of what type of dysfunction?
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diastolic dysfunction and CHF
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Name the 2 types of acquired pericardial disease.
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-pericardial effusion
-pericardial constriction |
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Name the 3 congenital pericardia diseases.
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PPDH
absence intrapericardial cysts |
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In dogs, most pericardial effusions are what?
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hemorrhagic and greater than 50% are neoplastic (hemangiosarcoma chemodectoma, mesothelioma, ectopic thyroid carcinoma)
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What two things does the effect of PE depend on?
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-volume of effusate
-compliance characteristics of the pericardium |
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What is tamponade?
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a syndrome of impaired ventricular filling due to the presence of intrapericardial fluid - a continuum of hemodynamic abnormalities
-right side is initially affected |
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What are the clinical signs of cardiac tamponade?
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low CO and elevated central venous pressure
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Are venous pressures that result in systemic congestion higher or lower than venous pressures that result in pulmonary congestion?
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lower
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What is the signalment of dogs with pericardial disease - effusion?
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large breed dogs - GSD, retrievers
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What is the clinical presentation of dogs with pericardial disease?
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-abdominal distension resulting from ascites
-weakness/syncope -lethargy -inappetance -occasionaly, circulatory collapse |
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What are the PE findings of an animal with tamponade?
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-tachycardia
-muffled heart sounds -ascites (jugular distension) -pulsus paradoxux - pathonomonic -quiet heart sounds -hypokinetic arterial pulse |
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What is pulsus paradoxus?
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a noticable decrease in the strength of the arterial pulse occurs with respiration
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How is pericardial disease diagnosed?
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thoracic radiographs demonstrate enlargement of the cardiac silhouette with no contour
-pulmonary edema is rare |
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What does the ECG normally show with pericardial disease?
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sinus tachycardia +/- QRS alternans, small QRS complexes
-pathologic tachycardia is uncommon |
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What is evident on an ECHO of an animal with pericardial disease?
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-circumcardiac echo free space that is generally not visible caudal to the left atrial parietal wall
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What is the appropriate therapy for an animal with PE?
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pericardiocentesis
NOT diuretic agents - they reduce venous pressure and may further limit ventricular filling |
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What is the recommended treatment for animals with PE and the PE returns after two centeses?
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subtotal pericardiectomy for chemodctoma associated PE
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