Cardiovascular Diseases in Small Animals
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Questions and Answers

What is the main goal of heartworm treatment?

  • To prevent heartworm infection entirely without further medication
  • To eliminate all parasites without any treatment complications
  • To improve the clinical condition of the animal and eliminate all life stages of heartworm with minimal complications (correct)
  • To provide supportive therapy with no need for adulticide treatment

    • Which medication is an adulticide used for treating heartworm?

  • Melarsomine dihydrochloride (correct)
  • Selamectin
  • Doxycycline
  • Ivermectin

    • What is a key component of supportive therapy for heartworm treatment?

  • Exercise enhancement
  • Corticosteroids / Antihistamines (correct)
  • Modified Knott’s Test
  • Surgical removal of adult worms

    • Which preventative treatment is used in the USA for heartworm?

    <p>Ivermectin (Heartgard®)</p> Signup and view all the answers

    How should treatment with moxidectin be adjusted for dogs traveling abroad for more than one month?

    <p>First treatment must be given within 30 days of arrival at the destination</p> Signup and view all the answers

    What is the most common heart disease in dogs?

    <p>Myxomatous Mitral Valve Disease</p> Signup and view all the answers

    Which diagnostic tool may be required for diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?

    <p>24-hour Holter monitor</p> Signup and view all the answers

    What is an effective treatment option for dogs diagnosed with MMVD?

    <p>Sotalol</p> Signup and view all the answers

    What type of heart failure is usually observed in cats with cardiomyopathies?

    <p>Diastolic failure</p> Signup and view all the answers

    Which breed of dogs is more predisposed to Myxomatous Mitral Valve Disease?

    <p>Small breed dogs</p> Signup and view all the answers

    What is the main goal of treating a condition associated with epistaxis?

    <p>To manage the primary disease and ameliorate clinical signs</p> Signup and view all the answers

    What factor primarily influences the prognosis in conditions leading to epistaxis?

    <p>Target organ damage</p> Signup and view all the answers

    What can be deduced about the nature of treatment for diseases associated with epistaxis?

    <p>Patients require ongoing, often life-long treatment</p> Signup and view all the answers

    Which of the following is a learning objective related to systemic hypertension?

    <p>To construct a differential diagnosis list based on clinical presentations</p> Signup and view all the answers

    Which resource is mentioned for further reading on cardiovascular conditions?

    <p>Ettinger’s Textbook of Veterinary Internal Medicine</p> Signup and view all the answers

    What is a significant indicator of mitral valve disease in dogs?

    <p>Both left ventricular and left atrial diameter increase</p> Signup and view all the answers

    Which diagnostic method can identify the cause of a murmur in mitral valve disease?

    <p>Echocardiography</p> Signup and view all the answers

    What murmur grade is associated with Stage B2 of mitral valve disease?

    <p>Grade 3 or higher</p> Signup and view all the answers

    Which cardiovascular condition is NOT a differential diagnosis for MMVD?

    <p>Myocardial infarction</p> Signup and view all the answers

    How is the left atrial enlargement assessed in mitral valve disease?

    <p>LA:Ao ratio must be equal to or greater than 1.6</p> Signup and view all the answers

    Which of the following is a characteristic clinical sign of MMVD in dogs?

    <p>Murmur</p> Signup and view all the answers

    Which condition is known as a common peripheral vascular disease caused by a mosquito-borne parasite?

    <p>Dirofilariasis</p> Signup and view all the answers

    What is a typical physical examination finding in Stage C of MMVD?

    <p>Persistent coughing</p> Signup and view all the answers

    What visual characteristic distinguishes female heartworms?

    <p>Larger size compared to males</p> Signup and view all the answers

    Which statement about the increase in NT-proBNP levels is true?

    <p>It is often elevated in heart conditions.</p> Signup and view all the answers

    What is the most common cause of feline aortic thromboembolism (saddle thrombus)?

    <p>Heart disease</p> Signup and view all the answers

    Which of the following clinical signs is NOT characteristic of feline aortic thromboembolism?

    <p>Increased appetite</p> Signup and view all the answers

    What does Virchow’s Triad primarily involve in the context of thrombus formation?

    <p>Damage to vascular endothelium, sluggish blood flow, hypercoagulability</p> Signup and view all the answers

    Which diagnostic tool is used to check for an increased left atrium size in suspected cases of aortic thromboembolism?

    <p>Echocardiography</p> Signup and view all the answers

    What role does hypercoagulability play in feline aortic thromboembolism?

    <p>It leads to increased blood clot formation.</p> Signup and view all the answers

    Which of the following is a characteristic of the pulse in cats with feline aortic thromboembolism?

    <p>Very poor or absent pulse</p> Signup and view all the answers

    What underlying condition should be assessed in a cat suffering from aortic thromboembolism?

    <p>Underlying heart disease</p> Signup and view all the answers

    Which of the following is NOT typically assessed when diagnosing underlying heart disease in cats?

    <p>Skin hydration status</p> Signup and view all the answers

    What is a common clinical sign in dogs with severe heartworm infections?

    <p>Coughing</p> Signup and view all the answers

    What hematological finding is most commonly associated with heartworm infections?

    <p>Eosinophilia</p> Signup and view all the answers

    Which diagnostic method shows enlarged main pulmonary arteries in heartworm infections?

    <p>Radiography</p> Signup and view all the answers

    What is one of the main reasons for false negative results in heartworm antigen tests?

    <p>Presence of mature male worms only</p> Signup and view all the answers

    What is NOT a clinical sign of heartworm infection in cats?

    <p>Syncope</p> Signup and view all the answers

    At what point in the life cycle do clinical signs typically develop in dogs?

    <p>3-6 months after infection</p> Signup and view all the answers

    What echocardiographic finding indicates severe heartworm disease?

    <p>Dilated right ventricle</p> Signup and view all the answers

    Which species has a hyper-acute clinical sign associated with heartworm infection?

    <p>Cats</p> Signup and view all the answers

    What type of pulmonary pattern may be observed on radiographic diagnosis of heartworm infection?

    <p>Diffuse interstitial to alveolar pattern</p> Signup and view all the answers

    What condition can develop acutely with the death of worms in dogs infected with heartworm?

    <p>Pulmonary thromboembolism</p> Signup and view all the answers

    Study Notes

    Cardiovascular Diseases in Small Animals

    • Diseases discussed include cardiomyopathies, valvular disease, diseases of the peripheral vasculature, and systemic hypertension.
    • Learning objectives for each section focus on creating differential diagnosis lists, determining appropriate medical/surgical interventions, and prognosis.

    Cardiomyopathies

    • Cardiomyopathy is defined as "disease of the myocardium."
    • Cardiomyopathies should be differentiated from heart disease with known causes like hypertension, ischemia (coronary heart disease), viral myocarditis, septic myocarditis, hyperthyroidism, and neoplastic infiltrative disease of the myocardium.
    • Four types of cardiomyopathy discussed are: dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), restrictive cardiomyopathy (RCM), and arrhythmogenic right ventricular cardiomyopathy (ARVC).
    • DCM is common in dogs and characterized by ventricular dilation and a thin, hypomotile ventricular wall.
    • HCM is prevalent in cats, marked by ventricular wall hypertrophy and a restricted ventricular lumen.
    • RCM results in a stiff ventricular wall with atrial dilation.
    • ARVC, prevalent in boxers, is characterized by a fibrofatty infiltrate primarily affecting the right ventricle.
    • The cause of DCM is often multifactorial, with potential contributing factors like taurine deficiency, carnitine deficiency, toxic agents (like doxorubicin), and potentially grain-free or lamb-based/vegan diets. Some breeds show high prevalence.
    • HCM can be familial, often exhibiting mutation A31P in the cardiac myosin binding protein C gene, especially amongst Maine Coon cats. The prevalence of this in this breed is significantly high (up to about 42% in Europe and 46% in Australia) and increases with age. Some cats with HCM do not have the mutation.
    • Ragdoll cats are also affected by another mutation that is associated with HCM.
    • Most cases of HCM are in domestic short-hair cats, and the genetic aspect is still under research.
    • Physical findings and clinical presentations, including murmur, gallop rhythm, pulse deficits, diastolic gallop, and jugular vein distension, are discussed.
    • Radiography and echocardiography are detailed as crucial diagnostic tools. Echocardiography is the standard for diagnosis of DCM.
    • Treatment approaches for cardiomyopathies are mentioned in general terms, with a promise to cover them in future lectures.

    Valvular Disease (Myxomatous Mitral Valve Disease - MMVD)

    • MMVD is the most common form of heart disease in dogs, accounting for at least 75% of cases.
    • It predominantly affects small breeds (<20 kg) and large breeds, with larger breeds experiencing quicker progression.
    • The disease mainly affects the left atrioventricular valve, although tricuspid involvement is observed in some cases (30% in some studies).
    • The cause is unknown but may have a genetic component affecting affected breeds.
    • Pathophysiology focuses on mitral valve leaflet damage (expansion from ECM, proteoglycans, GAGs, fibrosis, degradation of endothelium).
    • Increased cardiac workload leads to volume overload and eccentric hypertrophy of the left ventricle.
    • The condition often progresses to congestive heart failure.
    • Diagnosis uses clinical signs, auscultation, blood pressure, thoracic radiography, and echocardiography.
    • Stage-dependent medical management (including Pimobendan and furosemide; or ACE inhibitors with pimobendan) is detailed.
    • Echocardiography is crucial for diagnosis and measuring LA:Ao ratio to confirm the condition and for evaluating severity.
    • Prognosis is connected to the target organ damage; treatment is generally life-long.

    Diseases of Peripheral Vasculature (Dirofilariasis, Aortic Thromboembolism, Systemic Hypertension)

    • Dirofilariasis (heartworm) is caused by the nematode Dirofilaria immitis, transmitted by mosquitos.
    • Clinical signs of dirofilariasis in dogs and cats often only manifest several months after infection as L5 larvae migrate to the lungs where adult worms cause damage.
    • Diagnosis methods include blood tests (eosinophilia, microfilaria, antigen tests) and radiography (enlarged main pulmonary artery, right ventricular enlargement, and enlarged tortuous caudal lobar pulmonary arteries).
    • Recommended prevention methods involve ivermectin, selamectin, milbemycin oxime, and moxidectin.
    • Aortic thromboembolism (ATE) can be catastrophic in cats, often caused by underlying heart disease, particularly HCM and left atrial enlargement.
    • The condition presents with bilateral leg dysfunction (paresis, paralysis) accompanied by other symptoms like pain, pulselessness, pallor (or cyanosis), and poikilothermia (cold limbs).
    • Understanding cardiac conditions, including heart rate and rhythm, murmur, and hypothermia is required for appropriate diagnosis and treatment recommendations.
    • Echocardiography is key to assessing left atrial enlargement.
    • The 5Ps are common symptoms: Posterior paresis/paralysis, Pain, Pulselessness, Pallor, Poikilothermia.
    • Systemic hypertension is a sustained elevation in systolic blood pressure, and can be primary or secondary.
    • Secondary hypertension can arise from complications from various diseases like kidney disease, hyperadrenocorticism, adrenal tumors, hyperthyroidism, diabetes mellitus, and cardiovascular diseases.
    • Diagnosis involves identifying the presence and severity of hypertension and associated cardiac conditions alongside the use of dopler and oscillometric methods for measuring blood pressure.

    Further Reading

    • Recommended references for cardiovascular diseases include Ettinger's Textbook of Veterinary Internal Medicine and Small Animal Cardiovascular Medicine (Kittleson and Kienle).
    • The American Heartworm Society (https://www.heartwormsociety.org) is also recommended for additional information.

    Case Studies

    Two specific cases, Flynn and others, were presented. These cases involved clinical findings, differentials, and subsequent diagnosis or treatment considerations.

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    Description

    This quiz covers various cardiovascular diseases affecting small animals, including cardiomyopathies, valvular disease, and systemic hypertension. It emphasizes differential diagnosis and interventions for each condition, enhancing your knowledge of veterinary cardiology.

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