Small Ani. Med 2- Cardio 4

wilsbach's version from 2016-02-03 01:30

Canine heart Dzs: Intro + Valvular Endocardiosis + Bacterial Endocarditis

Question Answer
7 acquired canine heart dzs (read over)**Valvular Endocardiosis, Bacterial endocarditis, Dilated Cardiomyopathy, Myocarditis, Pericardial Disease, Pulmonary Hypertension, arrhythmias
4 congenital canine heart dzs (read over)Sub-Aortic Stenosis, Patent Ductus Arteriosis, Pulmonic stenosis, septal defects
for the love of science, what is the diff between endocardiosis and Endocarditis?endocardiosis is due to DEGENERATIVE valve dz (DVD). endocarditis is due to infection
how would you describe the appearance of an endocardiOSIS valve?clubbed and chunky (thick and pulled away)
WHERE do dogs most often get valvular endocardiosis?Mitral**** and tricuspid
what is the murmur like for dog with valvular endocardiosis?(most often in MITRAL, second most common is tricuspid...but almost always mitral) Holosystolic plateau murmur at left apex (can also be midsystolic)
7 main Sequellae of valvular endocardiosis in the dog?Volume overload, Endocardial fibrosis, CHF, Left bronchial compression, Chordae tendinae rupture, Left atrial tears and rupture, Atrial fibrillation
does Valvular Endocardiosis cause volume or pressure overload?volume overload
what chronic changes happen to the endocardium in valvular endocardiosis?fibrosis
V.Eosis dogs can get CHF... when does it often occur?Usually before myocardial pump function decreases
which bronchi is affected by V.Eosis, and how/by what?Left bronchial compression due to L atrial enlargement (bc usually the mitral valve affected)
which arrhythmias are V/Eosis dogs prone to?atrial fibrillation ((bad mitral valve--> blood goes backwards--> atrial enlargement--> irreg shape of atria leads to cells being farther apart, get fibrillation)
Degenerative V.Eosis--> how do dogs get it/ which dogs are more prone? age associated?probably genetic--> Predisposed older small-mid breed dogs: Poodles, Shih Tzu, Yorkies, Schnauzers, Chihuahuas, Poms, Cockers, Pekes, Bostons, CKCS (cavalier king charles spaniel esp. prone)
*how would you describe the degenerative process of V.Eosis?Myxomatous (Myxomatous degeneration refers to a pathological weakening of connective tissue. The term is most often used in the context of mitral valve prolapse, which is known more technically as "myxomatous mitral valve degeneration." The word has its origin in the combining form myxo- (relating to connective tissue))
what are different factors which might contribute to V.Eosis?Valve stress, endothelial dysfunction --> Myxomatous degeneration--> Nodular thickening, deformity and weakening
what path changes does myxomatous degeneration of the mitral valve in V.Eosis lead to?Nodular thickening, deformity and weakening (look clubby and chunky)
if you suspect Valvular Endocardiosis, you should do a ___ and base your medical therapy on ___do Cardiac and Systemic workup ( thoracic rads, BP, echo, ecg ), and base therapy on staging you get from your workup
**what should you absolutely client educate owners about if their dog is dx with V.Eosis?***teach them how to monitor resp rate at rest!! This is bc an inc RR at rest is the EARLIEST sign of pulmonary edema which you can then tx for in early stages
Bacterial Endocarditis effects which two valves most often?Often aortic and mitral (V.Eosis is mitral and tricuspid so don't confuse)
which bacteria are most likely to cause bacterial endocarditis?Strep/Staph/E.coli. suspect Bartonella esp if culture negative.. can happen with Transient or persistent bacteremia
**concurrent or recent infections can predispose to B.Eitis-- what are some types of infections commonly leading to this?Skin, Mouth, Urinary tract, Prostate, Lungs
So you have a 8 year old mini poodle with a mitral valve problem and a 1 year old lab with a mitral valve problem-- which one do you think has what based on signalment?Valvular endocardiosis is small breed older dogs. Bacterial endocarditis isnt really restricted to age or breed (infections happen, yo) but often in young, large breed dogs because they tend to roam and get weird infections
If i say "shifting leg lameness/polyarthritis" you say...bacterial endocarditis
a newly diagnose "to and fro" murmur might mean what?aortic bacterial endocarditis.... "To and fro" meaning hearing in systole and diastole bc valve not closing/opening correctly
what would the pulse of a dog with bacterial endocarditis be like? why?Hyperkinetic, aka bounding pulse-- because pulse pressure vastly different between systole and diastole-- the systolic pressure going up and diastole pressure going down leads to a big difference. (diastolic pressure going down bc aorta not closing all the way, with high pressure, so blood flows backwards into ventricle)
what is a weird radiographic finding you might see with bacterial endocarditis?calcified aortic or mitral valves
Infective Endocarditis causes valve _________insufficiency
does infective/bacterial endocarditis happen quickly or slowly?rapid development
Infective Endocarditis dogs are predisposed to getting what two problems later?SAS (sub aortic stenosis) and valvular endocardiosis (lol it can lead to this anyway)....also beware of Embolization of septic thrombi
why might an AV block be associated with bacterial endocarditis?Infection can proceed to AV node and block
uuhh why would a prostate infection lead to a heart valve infection?transient or persistent
Bacterial Endocarditis--> you will want to give supportive care for what two conditions associated with this?CHF/ arrhythmias
so bacterial endocarditis obv comes from a bacterial infxn... so abx are a pretty good idea. how do you determine which ones? How should you administer? 3 good choices? how long should you tx?culture based decision would be best (type of abx to use would make a big diff), you can def do combo tx too. you will want to be IV for at least the first week! but you must treat at least 6-8 weeks. Consider ampicillin, enrofloxacin, can also consider Azithromycin but keep in mind it's high risk of developing resistance
why would you want to use abx for so long with a bacterial endocarditis? (how long again?)at least 6-8 weeks and IV for the first week- this is bc blood supply to valves is POOR. so getting high enogh abx conc in tissues is super hard to do. so gonna tx for a longgggg time (often times die from heart failure before can get a hold of the infection)
What is going on here/ what would you possibly deduce from this? in bacterial endocardITIS the valves will appear white and shiney on U/S

Canine heart dzs: myocardial dzs: Dilated cardiomyopathy (DCM)

Question Answer
what are the five MYOcardial dzs?Dilated Cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, Nutritional Deficiencies, Toxins, Myocarditis
why does DCM happen in DOGS?idiopathic or nutritional (dobies and portugese water dogs have genetic factors)
what is the main problem with the myocardium in DCM?it is a problem of poor contractility
what are some CS of DCM that owners might notice?weakness, syncope
would a DCM dog possibly have arrhythmias?yes, because heart is stretching out... atrial fibrillation is common w/DCM. VPC's also happen
which breeds are predisposed to DCM?Large and giant breeds! Dobies* largest prevalence, St. Bernards, Irish Wolfhounds, Boxers, Newfies, Afghans, Dalmatians... in Danes—X-linked, and in Portugese water dogs—autosomal recessive
who is X-linked for DCM?Dobies!
who is autosomal recessive for DCM? Portugese water dogs
what is the way to definitively dx DCM? When would you do this?since DCM is a problem with poor contractility, you would use ULTRASOUND (echocardiogram) to definitively dx it. HOWEVER, you should always do CHEST RADDS FIRST!!( and bp)
Why is there a murmur with DCM? how would you describe the murmur of a pt with DCM?as gets bigger, the annulus (the structure of the heart) will start pulling apart. so valve leaflets are normal but get pulled apart from each other so then get a murmur. the murmur will be systolic and +/- diastolic and there may or may not be a gallop.
what kinda CHF can DCM dogs get?get BIVENTRICULAR CHF (bc whole heart on both sides it just stretching out)
why might DCM lead to sudden death?can get TBE (Stretched out heart-->turbulence--> high chance for throwing clots)
which DOGS have a specific dietary deficiency which can lead to DCM, and what is the dietary item?L-carnitine deficiency in cockers
why do CATS get DCM? (general and specific)Nutritional issues-- they can have a primary taurine deficiency or they have some metabolic error which doesn't allow them to process taurine properly
DCM leads to low CO because of poor contractility (Which is a myocardial issue, which is the root of the problem) so, what are some nasty sequelae which can happen?there is low co--> Sympathetic activation, hormonal, renal compensatory mechanisms (stress out the heart more) --> Low output heart failure and CHF. Atrial Fibrillation and VPC’s common sequella
what is "occult" DCMowners dont notice anything, NO CLINICAL SIGNS, and then drop dead
list some clinical signs that can be due to DCMFirst sign can be sudden death! Weakness, lethargy, tachypnea, dyspena, Exercise intolerance, cough/gagging, anorexia, ascites, syncope, tall R waves, ventricular ( just says ventricular in the notes idk man. Maybe she means changes in the ventricular parts of the ECG)
how might DCM appear on an ecg?TALL R waves (taller bc heart more stretched out)
what should you make sure owners know how to do at home, and why?make sure they know how to monitor and keep track of resting resp rate-- if it inc, that is one of the first signs for complications.
what are the two drugs you'd want to start a DCM dog on, and why?ACE inhibitors and Pimobendan. This is bc ACE will decrease the afterload (since it inhibits the RASS system and dec pressure the heart is pushing against) and the pimobendan which helps inc the contractility (all of this allows it to be easier for blood to flow forawrd)
would you give digoxin to a DCM dog? why?you can, it will help with the atrial fibrillation and also helps boost contracility (slow down conduction in AV node to stop fibrillation and also
would you give beta blockers to a DCM pt? explainyou MIGHT want to. Downside: might relax heart when it needs to actually be working harder. Upside: helps with arrythmias. In these cases you might want to pick Carvedilol, Sotalol, which are "dirty beta blockers" in that they don't just hit beta receptors--they also do work on other receptors such as alphas. (tho she said in class if it's a cat, just use atenolol)
what are Carvedilol, Sotalol?"dirty" beta blockers (hit more than just beta receptors)
do you want to use Diltiazem for your DCM patient?it's +/-. Useful for atrial fibrillation or if the HR is too fast (it's a Ca++ channel blocker which can also be used as an antiarrhythmic
If the DCM dog is in CHF... tx?tx according to staging discussed before
what kinda drug is Pimobendan? what are the two major things it does?It is a Phosphodiesterase III inhibitor which increases contractility by increasing sensitivity of Ca++ (positive inotropic) and also acts as a peripheral vasodilator (which means it's an inodilator). Overall it dec afterall and inc contracility to help inc CO of the heart. Being on this drug will prolong survival.
which drug will prolong survival of DCM dogs?pimobendan
DCM and heart failure--> what are the things going on in this radiograph? the caudodorsal lungs look like they have an interstitial pattern. The L atria is enlarged (bulge on caudosorsal aspect) there is an alveolar pattern around the perihilar region (indicative of CHF), and the trachea is sloping up instead of down, indicating the heart is pushing it up.
what will a DCM heart look like on an echocardiogram (ultersound)?it will be twitching but wont have full normal contractions/movements
DCM prog? expected survival time? guarded to poor- Some dogs respond well to therapy and may have good QOL. upon diagnosis survival is often 6-12 months (some < 3 mos). If they are in CHF upon first presentation, they usually have <7weeks survival (in class she said: if have dobie with DCM-- 30% dead in 3mo, 30% more in 6, 30%in 9)
how many dobermans have DCM?20-40%!!! (like a third to almost half)