Term
|
Definition
PMI is mitral area
Acquired defects:
Endocardiosis of mitral valve
Endocarditis of mitral valve
DCM
Congenital defects:
Mitral regurg/ Mitral valve dysplasia |
|
|
Term
|
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
|
Definition
Endocardial sclerosis due to mechanical irritation or regurgitant streams of blood
area can calcify |
|
|
Term
|
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
|
Definition
70% are incidental findings
Coughing due to LAE
LHF
Arrhythmias |
|
|
Term
|
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
|
Definition
B1: Asymptomatic dogs with no cardiac remodeling
B2: Asymptomatic dogs with with hemodynamically significant mitral regurgitation with left heart enlargement |
|
|
Term
|
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
|
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
|
Definition
| Dogs who have past or current signs of left sided CHF associated with structural heart disease |
|
|
Term
|
Definition
| Dogs with end-stage disease that is refractory to standard tx |
|
|
Term
|
Definition
Thoracic rads when dog is stable
Echo
CBC, Chem panel with lytes(K,Mg), UA
Serum NT-pro BNP |
|
|
Term
|
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
|
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
|
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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