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44 Cards in this Set
- Front
- Back
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Feline HCM Ruleouts
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Rule out:
• Hyperthyroidism • Systemic hypertension |
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What type of genetic linkage does Feline HCM have
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o Typically autosomal dominant
• Highly heritable |
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Mechanism of Feline HCM
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o Thickening of LV wall
• Chamber can’t fill during diastole Increased LAt pressure>LAt dilation Failure>Clots>(TE)>Sudden death or Saddle Thrombus • Will send microemboli to the whole body (except the lung) Thickness of the wall> v diastolic filling |
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About • Systolic Anterior Movement of Mitral (SAMM)
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Sucking in of septal leaflet of valve during systole.
Causes MR & Outflow obstruction> murmurs Cats with obstructive HCM not worse prognosis |
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CS of Feline HCM
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o NONE, usually
o Dyspnea o Lethargy o Orthopnea o Inappetitance o Hiding under the bed o Murmur in ~50% (but 20% will have murmurs anyway) • Murmur ≠ heart disease in CATS! Except gallop murmurs – almost always = dz o Saddle thrombus – as young as 6 mos! • Weak pulses • Cool extremities Progresses to swelling as ischemia lengthens • Inability to stand |
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Feline HCM radiographically
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• Nothing pathognomonic
Heart hypertrophies INWARD Chronic HCM > hypertrophied At which can be dx on rads Pulmonary edema/pulmonary effusion once in CHF, but causes are multitudinous |
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Tx for Feline HCM
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o Ignore until clinically affected
o Nothing will slow progression o If SAMM: • B-Blocker • CCB • Plavix/Aspirin – Anti-thrombotics |
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TX for Feline HCM once in HF?
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• Diuretics
• O2 supplementation • Nitro – vasodilation • Altenolol after stable • CCB - Diltiazem • ACEI - Enalapril |
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TX for Feline HCM w/Acute TE?
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• Pain meds
• Heparin • Lower K+ Insulin/glucose Bicarb Ca+2 • Be SUPER careful giving fluids! 50% of these cats will go into HF BECAUSE of the TE. |
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TX for Feline HCM w/Chronic TE?
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• Plavix/aspirin
• Surgery/Drug treatment? Hail mary pass. 50% will die. Clotbusters • Tissue Plasminogen factor (tPA) • Streptokinase • Has to be a recent clot (<6 hours) • Altenolol |
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Tx for v Contractility with Feline HCM?
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Pimo
• May WORSEN LVOT obstructions! |
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Tx for Varr w/feline HCM?
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Sotalol/Altenolol
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Tx for Afib w/Feline HCM
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Diltiazem
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PX for Feline HCM? W/ TE?
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o Directly related to LAt size
o Once in HF – 1 year, average o If thrombus: • 50% survivial • If leave hospital, 6 mos survival average o Recheck @ 2 weeks, 6 mos |
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About canine HCM
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• Usually a Mitral dysplasia, NOT true HCM
o More a result of the LVOT Obstruction>SAMM o Lside Murmur • TX o Bblockers |
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About Feline RCM
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• Decreased Ventricular compliance due to fibrosis
• Gallops common • Rare |
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Types of Feline RCM
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o Endomyocarditis - young cats
• Usually right after a stressful event • Sudden death common o Endocardial fibrosis – middle aged cats |
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PX of Feline RCM
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o High likelihood of HF, TE
o 3-6 mos |
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Most common breeds for DCM
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o Common breeds:
• Dobies • Boxer • Dane • Lab • Cocker • Golden • Wolfhound |
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Mechanism for DCM?
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o Due to an inherent abnormality of the myocardium that leads to decreased contractility
• Leads to LV dilation>thinning of LV walls o Prevalence ^ with age (except Portuguese Water Dog) o Lots of associated abnormalities, but most probably 2ndary to disease process o Heart dilates to compensate for poor contractility |
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CS of DCM
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o Syncope
o Sudden death o HF • Right – Ascites, Abdominal effusion • Left (most common)– Pulmonary edema, pleural effusion o Dyspnea o Orthopnea o +/- Systolic murmur (soft) o +/- Gallop o Arrhythmia • Afib • VPC • VTach o Weak systemic pulses |
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DX of DCM
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o ECG
o Holter • >50 VPC suggestive in Dobies o Thoracic Rads • Globoid heart • Effusion/edema o Echo • Dilation, thin walls o Bloodwork • Pre-renal azotemia • Hyponatremia • Troponin increase (again, non-specific) • NT-proBNP (again, not time-effective) Can be used to differentiate between dyspnea from heart vs. lung disease |
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TX of DCM
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o Pre-CS
• Pimo - + inotrope Prolongs survival – EVEN IF NO CS • ACEI – slows onset • Bblockers – no FX in pre-dcm Carvedilol |
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TX of DCM + Acute HF
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• Diuretics
• O2 • Pimo • Dobutamine infusion • Be careful with vasodilation |
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TX of DCM + Chronic HF
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• Diuretics
• ACEI • Pimo/Dig – Dig rarely • Spironolactone Slows remodeling |
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TX of DCM + rapid Afib
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• BCD
Diltiazem/Dig |
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TX of DCM + VArr
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• Acute
Lidocaine/Procainamide • Chronic Sotalol • Could hypothetically decrease contractility Mexilitine Amiodarone • Tend to show signs of liver failure (reversible) |
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About Taurine deficient DCM
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• Rare
• Measure in anything on a homemade diet Cockers Goldens Cats Portuguese Water dogs • Blood taurine = myocardial carnitine |
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About carnitine deficient DCM
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• Rare
• Blood carnitine ≠ myocardial carnitine |
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About Doberman DCM
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o Subclinical for 2-4 years pre-CS
o <1yr prognosis |
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Mechanism for ARVC
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o Fibrofatty replacement of RV myocardium
• Disrupts electrical conduction • Triggers VArr due to weird conduction |
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Categories for ARVC
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• 3 categories
o 1: mild VArr; no CS o 2: severe VArr w/Syncope o 3: LV dysfunction/DCM w/Varr |
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Genotype for ARVC
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o Autosomal dominant
o Striatin mutation |
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DX ARVC
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o Grossly normal
o Echo • Pretty normal o ECG • VPCs from RV • ALWAYS causes Positive VPCs (upright in I, II, III, and AVF - Pathognomonic • “upright? RV.” o Holter • Upright VPCs 1K – ARVC 100-1K – Probable ARVC 25-100 – Maybe early ARVC <25 – normal |
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CS for ARVC
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o Syncope
o +/-Varr o +/- Murmur o Owner reports seizures? |
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TX/PX for ARVC
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o Cannot remove risk of sudden death
• Trying to prolong o Acute • Lidocaine/Procainamide • Sotalol • Also, treat HF if present o Chronic (can last for years) • Will probably die suddenly, chasing a squirrel • Exercise restriction up to owner • No increased risk for HF |
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About Tachycardia induced CM
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• Can lead to HF
• Associated w/SVTs • Reversible |
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About Doxorubicin induced CM
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• Chemotherapeutic agent
• Known to be cardiotoxic • Dose-dependent • Irreversible • Low incidence (10%) • Can be prevented, but ^ cost of chemo 2x |
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TX of Monensin Associated CM
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• Remove contaminated feed
• MgSO4/Charcoal to bind • DO NOT USE DIG TO IMPROVE contractility – it potentiates Monensin! • Diuretics • ACEI |
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About Atrial CM
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• Dogs mainly
• Have to have pacemaker • PX o Guarded – leads to HF in <2 yr |
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About Duchenne CM
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• X-linked muscular dystrophy of Goldens
• DX – Echo • PX – Guarded |
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Common causes of Myocarditis - Dog, cat, horse
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o Dog
• T. cruzi • Leishmania • Parvo • Lyme o Cat • Toxo o Horse • UResp Infection o Should be suspected in any animal with arrhythmia not explained by cardiac or extra-cardiac causes. |
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PX/TX of Myocarditis (all)
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• DX
o Troponin good to test • TX o Aim at underlying o Doxy o 1-2 mo no exercise • PX o Dogs – guarded o Horses - good |
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About Feline DCM
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• Pretty much non-existent since 1987 when they started putting Taurine in cat food
• If they survive 2-3 weeks, they’ll make it. • If they don’t respond to Taurine, they won’t respond. • Taurine takes 3-5 months to see full effects and days to see any benefit • All other reasons = poor prognosis |
