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Cardiology
Endocarditis, etc
33
Veterinary Medicine
Graduate
11/07/2011

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Cards

Term
Systolic Murmur in Dogs
Definition
PMI is mitral area
Acquired defects:
Endocardiosis of mitral valve
Endocarditis of mitral valve
DCM
Congenital defects:
Mitral regurg/ Mitral valve dysplasia
Term
Systolic Murmur in Cats
Definition
PMI is mitral area
Acquired defects:
Endocardiosis of mitral valve
Endocarditis of mitral valve
DCM
HCM
Congenital defects:
Mitral valve dysplasia
Term
Referred to mitral area systolic murmur (not as PMI) in Dogs and Cats
Definition
Acquired:
Endocardiosis of tricuspid valve
Congenital:
VSD
PDA
Term
Systolic Murmur in Horses
Definition
PMI is mitral area
Acquired defects:
Endocardiosis of mitral valve
Endocarditis of mitral valve
DCM
Congenital defects:
Uncommon alone
Term
Referred to mitral area systolic murmur in Horses
Definition
Aquired defects:
Uncommon
Congenital defects:
VSD
PDA
Term
Systolic murmur in Cattle
Definition
PMI is mitral area
Aquired defects:
DCM
Congenital defects:
Uncommon alone
Term
Referred to mitral area systolic murmur in Cattle
Definition
Acquired defects:
Lymphosarcoma of RV with tricuspid
murmur
Bacterial endocarditis of tricuspid
valve
Congenital defects:
VSD
PDA
Term
Chronic Valvular Heart Disease (CVHD)
Definition
slowly progressive and unpredictable
mitral and tricuspid valves commonly affected (more commonly mitral)
1.5x more common in males
cavaliers get it younger
herited in cavaliers and dachshunds
Term
Histologic and Gross lesions of CVHD
-Structures Affected
Definition
Mitral valve and annulus
chordae tendinae
papillary muscles
Term
Histologic and Gross lesions of CVHD
-Findings
Definition
Short, thickened valve leaflets (thick and white)
Fibrosis of papillary mm
Dilatation of LV and LA with secondary dilatation of valve annulus, followed by eccentric hypertrophy
Jet lesions in LA
Term
Jet lesions
Definition
Endocardial sclerosis due to mechanical irritation or regurgitant streams of blood
area can calcify
Term
Pathophysiology of CVHD
Definition
Mitral valve becomes deformed so that regurg occurs from LV into LA
the LA gets an increased volume so it dilates
*Mitral regurg is a Volume Overload of Left Heart*
Term
Mitral regurg as Volume Overload
Definition
-Causes LA dilataion and some hypertrophy
-As severity of regurg increases, so does LA pressure
Term
Due to increased LA pressure and volume...
Definition
-LV dilates and later hypertrophies
-Pulm vv, then capillaries, and then pulm aa, have increased pulm pressure
-Lead to Chronic Volume Overload of Left Heart
-Also, LAE causes compression of left mainstem bronchus which results in COUGHING
Term
Chronic Volume Overload of Left Heart leads to...
Definition
Increased LV and LA diastolic pressures and Decreased LV output
-when the heart fails, the LV diastolic pressure if greater than 10mmHg
-Arrhythmias can develop
Term
Left Heart Failure from this includes:
Definition
Pulmonary edema
Prerenal azotemia
Decreased coronary blood flow
Term
More characteristics of CVHD
Definition
Affected dogs do NOT throw thrombi from these valves and are NOT more prone to developing bacterial endocarditis of these valves
Prevalence increases with AGE
Term
Outcomes of CHVD
Definition
70% are incidental findings
Coughing due to LAE
LHF
Arrhythmias
Term
Stage A CVHD dogs
Definition
Dogs at risk of developing CVHD (any small dog)
Recommendations:
-yearly PE
-no drug therapy
-no dietary restrictions
-if dog is <6-8yo when murmur develops, DO NOT BREED
Term
Stage B CVHD dogs
Definition
B1: Asymptomatic dogs with no cardiac remodeling
B2: Asymptomatic dogs with with hemodynamically significant mitral regurgitation with left heart enlargement
Term
Stage B1 recommendations
Definition
Thoracic rads yearly
BP yearly
Minimum BW: PCV/TP, Creatinine + UA
Do an echo if:
-moderate to severe cardiomegaly
-cause of murmur not apparent
-severity can't be determined with rads
-lg breed dog
Recheck lg breeds every 6mo and small breeds every 1y
Term
Stage B2 recommendations
Definition
ACE inihbitors considered (but they do not stop progressions!) if:
-Left heart is very big
-Dramatic increase in size since last rads
-Lg breed
Mild Na restriction
Highly palatable diets with adequate protein and calories (heart diet not indicated)
Term
Stage C CVHD DOGS
Definition
Dogs who have past or current signs of left sided CHF associated with structural heart disease
Term
Stage D CHVD dogs
Definition
Dogs with end-stage disease that is refractory to standard tx
Term
Stage C recommendations
Definition
Thoracic rads when dog is stable
Echo
CBC, Chem panel with lytes(K,Mg), UA
Serum NT-pro BNP
Term
Stage C Therapy
Definition
Furosemide
Cage rest with Oxgen
Pimonemdan
Remove ascites and/or pleural effusion to relieve dyspnea
TLC
Enalapril
Treat Arrhyythmias
Avoid low protein diets, use a HEART DIET)
Omega-3 supplemention
(+/- beta blockers, nitrol ointment, spironolactone, digoxin)
Term
Acute Therapy for Stage C CVHD
Definition
Sodium nitroprusside CRI for 48hrs in nonresponsive patients
Nitroglycerine ointment (no side effects so won't hurt to try!)
ACE inhibitors (only if heart is not grossly enlarged and w/o cordae tendonae rupture)
Term
Common lab abnormalities with Stage C CVHD
Definition
mild polycythemia
small # nRBCs
monocytosis
slight resp. alkalosis
decreased pO2
prerenal azotemia
mild elevation of ALP and ALT
Small decrease in plasma proteins and albumin
K increased (later decreased from furosemide)
Na and Cl decreased
casts (due to prerenal azotemia)
proteinuria
Serum NT-pro BNP (due to strecth in ventricles, BNP is elevated in the blood)
Term
BNP
Definition
If very high: dog has HF or soon will have HF
If low, dog's resp problem is NOT due to Heart Dz
Term
Stage D monitoring and Therapy
Definition
Diagnostics as for Stage C
Continued Standard therapy:
-Furosemide
-ACE inhibitor
-Pimobendan
-Arrhythmia meds
-Na restriction
Term
Acute Therapy for Stage D
Definition
Furosemide IV
Drain pleural effusion
Oxygen cage
Reduce afterload rigorously
-Na Nitroprusside
-Hydralazine
-Amlodipine
-Continue Pimobendan and ACE inhibitor with one of above
Avoid BP <85mmHg
Measure Cr before therapy and 72hrs later
ECG continuously
+/- Na Nitroprusside and Dobutamine CRI
+/- Sildenafil (to reduce pulm hypertension, which may not be useful)
+/- bronchodilators
Term
Chronic Therapy for Stage D
Definition
Same as Stage C plus:
Increase furosemide
Start SPrionolactone
Carvedilol
Thiazide
Increase pimoendan to TID
Digoxin
Sildenafil
Reduce beta blockers (if dog is on them)
Term
Prognoses
Definition
A - normal life span
B1 - may never have a problem
B2 - may develop HF
C - life span 1y or longer, dependent on how big heart is
D - 3-6mo up to a year - very guarded
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