Cardiomyopathies and Heart Disease

whats wrong

nothing, normal heart

whats wrong

dilated cardiomyopathy

whats wrong

hypertropic cardiomyopathy

define heart failure

An inability of the heart to deliver enough blood to tissues to meet the metabolic demands of the tissues

define Congestive Heart Failure

The volume of blood delivered to the heart is more than the hearts capacity to move the blood along.

If the left ventricle is failing, the congestion occurs in the —

lungs, pulmonary edema

If the right ventricle is failing, the congestion occurs in the —-, and is known as

liver, ascites

define class A of Heart failure/disease

Patient at high risk for developing heart disease

define class B of Heart failure/disease

Structural heart disease (murmur) but no clinical signs

define class C of Heart failure/disease

Patient with past or current clinical signs of heart failure associated with structural heart disease

define class D of Heart failure/disease

Patients with end-stage heart failure exhibiting clinical signs that do not respond to therapy

define class B1 of heart failure/disease

asymptomatic patient, no radiographic or U/S evidence of heart enlargement

define class B2 of heart failure/disease

asymptomatic patient, radiographic or U/S evidence of heart enlargement

define Cardiomyopathy

a primary disease of the myocardium

cardiomyopathies are classified as (4)

1. Dilated cardiomyopathy

2. Hypertrophic cardiomyopathy

3. Arrhythmogenic right ventricular cardiomyopathy

4. Restrictive cardiomyopathy

— — is the Primary disease of heart muscle

Dilated Cardiomyopathy

Dilated Cardiomyopathy is more prominent in —(gender), — - — yrs

male, 4 - 10yrs

Canine Dilated Cardiomyopathy is caused by …

by thinning and weakening of the myocardium

Canine Dilated Cardiomyopathy decreases — —

cardiac output

Canine Dilated Cardiomyopathy increases — —

cardiac afterload

define cardiac afterload

blood left in the heart in diastole

clinical signs of Canine Dilated Cardiomyopathy (14)

1. Right-sided heart failure

2. Left-sided heart failure

3. Sudden Death

4. cough

5. Exercise intolerance

6. weakness

7. Anorexia

8. muscle wasting

9. weight loss

10. murmur

11. arrhythmia

12. weak pulses

13. pulse deficits

14. murmur

stage A treatment for Canine Dilated Cardiomyopathy

nothing

stage B1 treatment for Canine Dilated Cardiomyopathy

nothing

stage B2 treatment for Canine Dilated Cardiomyopathy (2)

1. Ace inhibitors

2. Pimobendan

stage C treatment for Canine Dilated Cardiomyopathy (3)

1. Diuretic such as furosemide

2. Ace inhibitors

3. Pimobendan

stage D treatment for Canine Dilated Cardiomyopathy (3)

1. Increase furosemide dose +/- spironolactone

2. Increase Ace inhibition dose

3. Increase pimobendan

define hypertrophy

the enlargement of an organ or tissue caused by an increase in the size of its existing cells, rather than an increase in the number of cells

define Feline Hypertrophic Cardiomyopathy

Left ventricular hypertrophy

clinical signs of Feline Hypertrophic Cardiomyopathy (7)

1. Soft, systolic murmur

2. Gallop rhythms or other arrhythmias

3. Sudden death

4. Dyspnea and cyanotic

5. Exercise intolerance

6. Syncope

7. Thromboembolic disease

how to treat Feline Hypertrophic Cardiomyopathy (7)

1. Treat signs of CHF

2. ACE inhibitors

3. Beta blockers

4. calcium channel blocker

5. Low dose heparin or aspirin

6. Furosemide

7. Felycin

Boxer Right Ventricular Cardiomyopathy presents with (5)

1. Ventricular arrhythmias

2. Syncope - may be associated with exercise

3. Heart failure

4. Sudden death

5. none

how to diagonse Boxer Right Ventricular Cardiomyopathy (11)

1. May have elevated cardiac biomarkers

2. VPC’s

3. Holter monitor may be useful

4. Typically normal but may have left ventricular dilation

5. Left ventricular dilation

6. systolic dysfunction

7. +/- right ventricular enlargement

8. Many will have normal PE

9. Tachyarrhythmia

10. Ascites

11. Heart murmur

how to diagnose Feline Hypertrophic Cardiomyopathy (11)

1. May show normal sized heart, or mild left atrial enlargement

2. May see a “valentine” heart shape in the DV view

3. Increased P-wave duration

4. increased QRS width

5. Sinus tachycardia

6. Increased left ventricular wall thickness

7. dilated left atrium

8. elevated BNP

9. elevated pro-BNP

10. CTn1 will be elevated

11. MRI

how to treat Boxer Right Ventricular Cardiomyopathy (3)

1. Mexiletine to decrease VPCs

2. Pimobendan

3. ACE inhibitors

define Arrhythmia

as deviations from the normal heart rate rhythm or rhythms originating from abnormal locations within the heart.

Deviations from normal rhythm result from either (2)

1. Abnormal impulse formation

2. Abnormal impulse conduction

Abnormal impulse formation can be from (5)

1. Ischemia

2. Hypo or hypercalcemia

3. Cardiomyopathy

4. Catecholamines

5. Reperfusion injury

Abnormal impulse conduction are from

Alternate pathways develop for depolarization of cardiac muscle