Acquired Valvular Disease II- CardioRush

Small to medium breeds, middle age or older, males more common, history of murmur or click, dyspnea at night with CHF, syncope, cough with advanced disease (sudden death uncommon compared to other CMs)
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Small to medium breeds, middle age or older, males more common, history of murmur or click, dyspnea at night with CHF, syncope, cough with advanced disease (sudden death uncommon compared to other CMs)
What is the typical signalment and history associated with DMVD?
Mid systolic click
What is often the first auscultation finding with DMVD?
Click occurs during systole, gallops in diastole
How can you tell a midsystolic click from a gallop?
Mitral or tricuspid prolapse
What is a midsystolic click generally associated with?
False (later obscured by murmur but never resolves)
True or false: later in the disease the midsystolic click resolves but is replaced by a murmur
True
True or false: the severity of the murmur roughly correlates with severity of disease in DMVD
Left side, apical, loud S1, holosystolic
What are the characteristics of the murmur associated with DMVD?
False (only correlates with severity of regurg)
True or false: the severity of the murmur in DMVD correlates with how large the heart is and how close they are to CHF
Normal or abbreviated
What is the arterial pulse quality in DMVD?
Pulmonary crackles, dyspnea, sometimes S3 gallop, cough on tracheal palpation, relative tachycardia, jugular vein distension
What are the PE findings consistent with CHF in DMVD?
MM, CRTWhat PE findings reflect the severity of edema in CHF?RadsWhat is a key diagnostic tool for assessing the severity of CHFF?LA enlargement, generalized cardiomegaly, tracheal elevation, L mainstem bronchus elevation, possibly venous dilation, perihilar interstitial pattern, sometimes enlarged CVC or liver if RCHFWhat are the findings on rads consistent with CHF from DMVD?LAA bulge at 3, bow legged cowboy from separation of mainstem bronchi, tracheal elevation and LA bulge on lateral viewWhat are the earliest signs of LA enlargement from DMVD on radiographs?LAWhat are the yellow arrows pointing to?DMVDWhat is this finding indicative of?Cardiomegaly, compression of mainstem bronchiWhat is the finding on this radiograph?P mitrale, prolonged QRS, LVE pattern, ST segment slurring or depression, arrhythmiasWhat ECG findings are consistent with DMVD?P wave >0.04sec, M shapeWhat is the ECG finding consistent with P mitrale?>0.05-0.06 secWhat is the ECG finding consistent with QRS prolongation?Large R wave, >2.5-3mVWhat is the ECG finding consistent with LVE?Sinus tachycardia, a fib, APC, SVT, ventricular tachycardiaWhat type of arrhythmias are most common for DMVD?LVPCWhat is this ECG finding?A fibWhat is this ECG finding?P mitrale, LA enlargementWhat is this ECG finding?Tall R wave, LVEWhat is this ECG finding?Thickened mitral leaflets, prolapse, regurg, LV and LA volume overload and dilationWhat are the echo findings consistent with DMVD?Pulmonary artery, right heart dilation, pericardial effusion, pleural effusionWhat are the echo findings consistent with right heart involvement with DMVD?Dilated in diastole, hyperdynamic contraction (this differentiates it from DCM)What is the characteristic short axis view through the LV on echo in DMVD?LAWhat chamber is enlarged?Renal values, electrolytes, PCV/TSWhat is the minimum data base you should get before starting meds for DMVD?NT proBNPWhat lab test can be done to assess stage disease severity and predict or diagnose CHF in DMVD?TrueTrue or false: DMVD is typically a slowly progressive disease, with years before the LA is severely enlargedCompensated MR, early decompensation, decompensation and dysfunction, severe LCHF or biventricular CHFWhat are the stages of clinical progression of DMVD?Murmur only, no pulmonary or systemic signs, normal exercise tolerance, mild LA dilationWhat are the signs consistent with compensated mitral regurgitation in DMVD?Compensated (not enlarged heart or LA, no infiltrates)These are the findings of a dog with DMVD. What stage of clinical progression are they in?Occasional cough, mild pulmonary congestion with exercise, normal R heart, LV and LA dilation with loss of caudal waistWhat are the signs consistent with early decompensation of DMVD?Early decompensation (mild pulmonary congestion, normal R heart, loss of caudal waist, LA dilation)These are the findings of a dog with DMVD. What stage of clinical progression are they in?Cough and pulmonary congestion at night or with exercise, widening angle between mainstem bronchi on DV, generalized cardiomegaly, LA dilationWhat are the signs consistent with decompensation and dysfunction in DMVD?Decompensation and dysfunctionThese are the findings of a dog with DMVD. What stage of clinical progression are they in?Clinical signs at rest, pulmonary edema, RCHF signs, severe generalized cardiomegaly, pulmonary congestion, marked LA dilationWhat are the signs consistent with severe left sided or biventricular CHF in DMVD?Severe LCHF or biventricular CHFThese are the findings of a dog with DMVD. What stage of clinical progression are they in?TrueTrue or false: most dogs with DMVD don't present with clinical signs initially, just an asymptomatic murmur or clickCough from LA enlargement and bronchi compression, LCHF, ruptured chordae tendinae causing acute LCHF, syncope, endocardial split or LA tear causing hemopericardiumWhat are the clinical syndrome associated with DMVD?Mainstem bronchi compression, cardiomegalyWhat is the radiographic finding?Fluid in lungsWhen do you start treating with diuretics for DMVD?Pericardial effusionWhat is the main finding on this echo?Aggressive treatment to lower pressure in LA, allow clottingWhat is the treatment for LA tear?Allows extra volume in LA, failure to move enough blood forwardHow does a ruptured chordae tendinae cause acute LCHF?False (they typically have a long period from when they first show the problem to developing CHF)True or false: There is a very short time between when an animal first shows sign of a problem in DMVD and when they develop CHFQuestionable benefit before onset of CHF, add if systemic hypertension or proteinuria, start with advanced LAE close to CHFWhat is the current recommendation to starting an ACE inhibitor before the onset of CHF?PimobendanWhat drug should you absolutely start before the onset of CHF in dogs with DMVD?Murmur grade 3 or higher, VHS >10.5 and echo L heart enlargementWhen should you start pimobendan for dogs with DMVD?