Veterinary Cardiology - Failing Hearts

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Questions and Answers

Why is it important to have a quiet, cool room during a cardiac examination?

To allow for a faster examination process

To enhance the strength of the heartbeat

To avoid interference from excitement and noise (correct)

To prevent the animal from feeling cold

What does a distended jugular vein indicate in a standing animal?

Regular blood flow

High central venous pressure or obstruction (correct)

Normal venous pressure

Hypovolemia or dehydration

In assessing arterial pulse, what characteristics should be compared?

Pulsation between jugular and femoral pulses

Pulsation and heart rate only

Strength, regularity, and both left and right pulses to heart rate (correct)

Left and right pulse strength and respiratory rate

How is the compressibility of the chest wall assessed during the cardiac examination?

By percussion of the thoracic cavity to check for resonance Signup and view all the answers

What does the presence of pale mucous membranes typically indicate?

Circulatory failure or shock Signup and view all the answers

What condition may abdominal enlargement in cats initially suggest?

Congestive Heart Failure (CHF) Signup and view all the answers

Which examination finding is likely to indicate congestive heart failure in cats?

Increased heart rate Signup and view all the answers

Which observation is NOT typically associated with cardiac cachexia in cats?

Increased appetite Signup and view all the answers

During which part of the physical exam is auscultation performed?

General examination Signup and view all the answers

What does jugular distension during an examination suggest?

Potential heart failure Signup and view all the answers

What does a respiration rate exceeding 35 breaths per minute typically suggest in cats?

Potential heart failure Signup and view all the answers

What is the primary purpose of developing a differential diagnosis list in cases of suspected heart failure?

To identify potential underlying cardiac disorders Signup and view all the answers

Which of the following pulse abnormalities indicates a decreased stroke volume?

Hypokinetic pulse Signup and view all the answers

What type of arrhythmia is commonly seen in dogs with dilated cardiomyopathy (DCM)?

Atrial fibrillation Signup and view all the answers

Which blood test is useful for identifying the presence of anemia?

Erythrocyte sedimentation rate (ESR) Signup and view all the answers

What does elevation in natriuretic peptides, like BNP, indicate?

Remodelling and dilation of the heart Signup and view all the answers

Which condition might show low amplitude waves on an ECG?

Electrical alternans Signup and view all the answers

What is the primary use of a complete blood count (CBC) in the diagnostic approach?

To help establish a minimum database profile for patients Signup and view all the answers

Ventricular pre-excitation syndrome is characterized by which of the following?

Abnormal accessory pathway bypassing the AV node Signup and view all the answers

What does the presence of white blood cells (WBC) indicate in a haematological profile?

Possible inflammatory or infectious disease Signup and view all the answers

Which of the following is NOT a common marker of cardiac remodelling?

Creatinine Signup and view all the answers

What is a common sign associated with congestive heart failure (CHF) that can be observed in dogs?

Acute cough Signup and view all the answers

Which of the following factors is NOT typically evaluated when assessing a dog's exercise tolerance?

Dietary preferences Signup and view all the answers

What distinguishes syncope from a seizure in dogs?

Warning prior to the event Signup and view all the answers

What might laboured breathing in a dog indicate?

Congestive heart failure Signup and view all the answers

Which statement about coughing in dogs with heart problems is accurate?

Dogs experience chronic but mild coughing. Signup and view all the answers

Which of the following is NOT a sign of heart disease in dogs?

Increased salivation Signup and view all the answers

What causes the cough related to left atrial enlargement in dogs?

Pressure on the bronchial tubes Signup and view all the answers

Which change in behaviour might be an indication of cardiac issues in dogs?

Depression Signup and view all the answers

Which diagnostic test is NOT typically involved in diagnosing cardiac disease in animals?

Dental examination Signup and view all the answers

What aspect of the signalment is LEAST relevant to diagnosing cardiac issues?

Color of fur Signup and view all the answers

Which method is essential for assessing the heart's structure and function beyond physical examination?

Echocardiography Signup and view all the answers

Why is history taking important in diagnosing cardiac disease?

It helps prioritize which diagnostic tests to conduct. Signup and view all the answers

What is a common characteristic observed in young animals regarding cardiac disease?

They are more likely to have congenital defects. Signup and view all the answers

Which of the following could indicate a sex predilection in cardiac diseases?

Patent ductus arteriosus is more common in females. Signup and view all the answers

Which of the following is critical to use when listening to a pet owner's concerns?

Both open and closed questions Signup and view all the answers

How can negative findings be utilized in the diagnostic process?

They can help clarify the clinical picture. Signup and view all the answers

Which of the following is a marker of myocardial tissue injury or necrosis?

Cardiac troponin Signup and view all the answers

What treatment focuses on optimizing preload, afterload, heart rate, and contractility in heart failure?

Pharmacological therapy Signup and view all the answers

Which class of medication is NOT mentioned as a key manipulation in heart failure treatment?

Statins Signup and view all the answers

Which factor would NOT typically influence the prognosis of heart failure in companion animals?

Owner's financial status Signup and view all the answers

Elevated NT-proBNP levels are associated with which condition?

Renal insufficiency Signup and view all the answers

Which of the following is a common progression after recurrence of clinical signs in heart failure?

Rapid progression of disease Signup and view all the answers

What is the typical prognosis for heart failure in horses once overt heart failure is present?

Guarded to poor Signup and view all the answers

Which treatment approach is aimed primarily at alleviating symptoms of heart failure?

Supportive approach Signup and view all the answers

Study Notes

Failing Heart 2 - Learning Outcomes

Describe the diagnostic approach for failing hearts and expected outcomes
Outline an evidence-based treatment plan for congestive heart failure, aligning with ACVIM consensus statements
Determine the prognosis for congestive heart failure

The Veterinary Consultation

Diagnostic tests for cardiac disease in animals may include:
- Signalment of the animal
- History taking
- Physical examination
- Thoracic radiography
- Electrocardiography
- Laboratory testing
- Echocardiography
- Cardiac catheterisation
- Blood pressure measurement
- Post-mortem examination

The Veterinary Consultation - Signalment

Species: Hypertrophic cardiomyopathy is more common in cats, while dilated cardiomyopathy is more common in dogs
Breed: Acquired valvular endocardiosis is more prevalent in smaller breeds and idiopathic dilated cardiomyopathy is more common in larger breeds
Age: Young animals are more likely to have congenital defects
Sex: Some diseases, such as patent ductus arteriosus, are more common in females, while others, like hypertrophic cardiomyopathy, are more common in males

History Taking

Start with general history and use communication skills
Listen carefully to owner concerns, using both open and closed questions
Negative findings are as important as positive ones
Use clinical and medical knowledge to categorize data into clinically relevant information
Move to specific questions focused on the cardiovascular system
Focus on vaccination, preventative healthcare (e.g., heartworm, deworming) and WH questions (when, what, how, who, where) in the history taking process.

History Taking for Cardiac Cases

Look for changes in:
- Attitude, behaviour, and activity level (e.g., exercise intolerance, depression, fatigue)
- Breathing (e.g., labored breathing, increased resting respiratory rate)
- Appetite and weight
- Coughing (e.g., acute cough, intermittent cough)
- Sleeping habits (e.g., restlessness at night)
- Previous evidence of heart disease (e.g., heart murmurs, radiographic changes, enlarged heart)
Assess exercise tolerance (vigorous, free exercise, etc)
Assess syncope (transient loss of consciousness)
Assess breathlessness (details of coughing)
- Sound? Timing? Occurring with changes?
Appetite, body condition, weight loss: abdominal enlargement could be a first sign
Negative answers are equally pertinent to positive answers

Physical Exam for Cardiac Cases

Be thorough in auscultation
Use a quality stethoscope
Conduct the examination in a quiet, cool room minimizing noise and excitement
Position animal for auscultation, avoiding factors such as purring and panting

Physical Exam for Cardiac Cases - Arterial Pulse

Assess femoral pulse: strength, regularity, and rate (e.g., hypokinetic vs hyperkinetic)
Compare left and right
Strength, rate (normal, irregular, fast, slow)
Compare to heart rate

The Physical Exam for Cardiac Cases - Palpating the Precordium

Palpate intercostal spaces 5th and 6th
Assess strength, weakness, and thrills

Physical Exam for Cardiac Cases - Chest Wall and Thoracic Percussion

Chest wall compressibility
Resonant sound, hollow

Physical Exam for Cardiac Cases - Abdomen and Ballottement

Assess for fluid wave, organomegally

Thoracic Auscultation

Evaluate heart rate and rhythm
Mitral valve best heard in the left 5th intercostal space close to the sternum
Aortic valve best heard in the left 4th intercostal space close to the sternum
Pulmonic valve best heard in the left 3rd intercostal space close to the sternum
Tricuspid valve best heard in the right 3rd or 4th intercostal space close to the sternum
Evaluate cardiac sounds (S1, S2, S3, S4) and murmurs.

Cardiac Murmurs - Grade

Grade I: very soft murmur
Grade II: soft murmur (quiet than S1 and S2)
Grade III: moderate murmur (as loud as S1 and S2)
Grade IV: louder than S1 and S2, but no palpable thrill
Grade V: very loud murmur with palpable thrill
Grade VI: very loud murmur with palpable thrill, still audible when the stethoscope is removed from the chest

Is it an Innocent Murmur?

Intensity of the murmur doesn't always correlate with severity, thus serial examination is crucial
Young animals (pups and kittens) - murmurs could be innocent (low grade, typically systolic, louder when heart rate increase)
Typically disappear by 4-5 months of age

Diagnostic Approach - Radiography

Chest X-rays (dorsal ventral and lateral views)
- Evaluate extra-thoracic structures, pleural space, pulmonary parenchyma, cardiac silhouette, shape, size, and vessels
Vertebral Heart Score (VHS): 8.5-10.5 for dogs and 7.5 for cats (note breed variations)

Diagnostic Approach - Echocardiography

Assess heart function (size, shape, volume, performance)
Use transthoracic imaging (parasternal windows)
Right and left thoracic sides (intercostal spaces), sternum to costochondral junctions
- Provide Two-dimensional, M-mode, Colour Doppler, and Spectral Doppler images
- Provides a critical view of the heart

Diagnostic Approach - ECG

Assess cardiac rhythm disturbances
Evaluate chamber enlargement (atrial premature complexes)
Look for atrial fibrillation (commonly in dogs and cats)
Check for ventricular tachyarrhythmias
May help detect conditions like heart failure

Diagnostic Approach - Haematology and Blood Biomarkers

Establish minimum database profile
Identify abnormalities (anaemia, immune-mediated conditions, inflammatory/infectious disease)
Assess other organ function (liver, kidney, etc)
Note protein, albumin, and globulin
Natriuretic peptides (e.g. NT-proBNP/NT-proANP) indicative of cardiac status.
BNP/ANP (Natriuretic peptides): used for ventricular dilation
Cardiac troponin: for myocarditis

Prognosis

Companion animals: average survival time 1-2 years
Recurrent signs can lead to rapid progression
Prognosis for horses is poor once overt heart failure is diagnosed
Euthanasia may be the treatment option

Treatment Plan

Regulate haemodynamic status with monitoring and pharmacological optimization (preload, afterload heart rate, contractility)
Use vasodilatory therapy, ACE inhibitions, diuretics, and positive inotropes
Use beta blockers, dietary modifications, and lifestyle changes

Treatment examples (Diuretics)

Furosemide (0.5-4 mg/kg PO, IV or q8-12h); CRI (0.3-0.5 mg/kg/h)
Spironolactone (0.5-2 mg/kg PO q12-24h)
Hydrochlorothiazide (0.5-1 mg/kg PO q12-24h)

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Description

This quiz focuses on the diagnostic approach and treatment plans for congestive heart failure in animals. You'll learn about evidence-based treatment guidelines and the expected outcomes for various cardiac diseases in veterinary practice. Prepare to assess the prognosis based on different diagnostic methods and animal signalment.