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MATTERS OF THE HEART

MATTERS OF THE HEART. “The heart has reasons that reason does not understand.” -Jacques Benigne Bossuel. DISEASES OF THE CARDIOVASCULAR SYSTEM. CARIOMYOPATHIES. CANINE DILATED CARDIOMYOPATHY. 90% of cases occur in Doberman Pinschers and Boxers.

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MATTERS OF THE HEART

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  1. MATTERS OF THE HEART “The heart has reasons that reason does not understand.” -Jacques Benigne Bossuel

  2. DISEASES OF THE CARDIOVASCULAR SYSTEM CARIOMYOPATHIES

  3. CANINE DILATED CARDIOMYOPATHY 90% of cases occur in Doberman Pinschers and Boxers OTHER BREEDS INCLUDE WOLFHOUNDS, GREAT DANES, AND COCKER SPANIELS

  4. CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY • DECREASED CONTRACTILITY FROM AN UNKNOWN CAUSE (viral?, carnitine deficiency?) • Decreased contractility = decreased cardiac output CO (CARDIAC OUTPUT) = SV (STROKE VOLUME) X HR (HEART RATE) Amt. of blood ejected with Each cardiac contraction (affected by afterload, preload, and inherent contractility) How often the heart contracts The amt. of blood that leaves The heart

  5. CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY • THE BODY COMPENSATES BY: 1.INCREASING THE HEART RATE *this is done by sympathetic nervous system stimulation 2.TRYING TO INCREASE STROKE VOLUME BY INCREASING PRELOAD (this means that the body increases filling of the heart) *This is done by activation of the Renin-angiotensin-aldosterone system which leads to sodium and water retention

  6. THE WALLS OF THE HEART ARE WEAK, FLABBY, AND DILATED – THIS DILATION MAY CAUSE SEPARATION OF THE MITRAL VALVE LEAFLETS LEADING TO MITRAL REGURGITATION

  7. CANINE DILATED CARDIOMYOPATHY: CLINICAL SIGNS LETHARGY, EXERCISE INTOLERANCE, COUGHING, WEIGHT LOSS, TACHYPNEA, SYNCOPE, SOFT MURMUR (WHERE?)

  8. CANINE DILATED CARDIOMYOPATHY:DIAGNOSIS Enlarged, round heart DOBERMANS ARE DEEP CHESTED AND MAY NOT APPEAR TO HAVE SUCH AN ENLARGED HEART ON RADIOGRAPHS

  9. CANINE DILATED CARDIOMYOPATHY: DIAGNOSIS PULMONARY EDEMA PLEURAL EFFUSION PATIENT MAY SHOW SIGNS OF LEFT-SIDED, RIGHT-SIDED, OR HEART FAILURE FROM BOTH SIDES

  10. CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY, DIAGNOSIS • Constant stimulation of the heart by the sympathetic nervous system causes ventricular arrhythmias and myocyte death • Most common arrhythmias: VPC’s and ventricular tachycardia, esp. in boxers & Dobies; other dogs may have APC’s and atrial fibrillation ONE VPC MULTIPLE VPCs CAUSING TACHY-CARDIA

  11. CANINE DILATED CARDIOMYOPATHY: DIAGNOSIS: ECHOCARDIOGRAM http://www.youtube.com/watch?v=7TWu0_Gklzo&feature=related http://www.youtube.com/watch?v=NSnh3qN2kR4&NR=1 PERFORMING AN ECHOCARDIOGRAM IS THE DEFINITIVE WAY TO DIAGNOSE DILATED CARDIOMYOPATHY

  12. CANINE DILATED CARDIOMYOPATHY: TREATMENT INCREASES CONTRACTILITY REDUCES FLUID RETENTION DIURETIC-ELIMINATES EXCESS FLUID

  13. CANINE DILATED CARDIOMYOPATHY: TREATMENT TAURINE – USED IN COCKER SPANIELS AND CATS, MAINLY L-CARNITINE COENZYME Q10 DIETARY SUPPLEMENTS THAT MAY HELP IMPROVE HEART FUNCTION, ESP IF THERE IS A DEFICIENCY

  14. FELINE DILATED CARDIOMYOPATHY A globular-shaped heart with severe dilation of all four chambers. Depressed ventricular contractile performance occurs. Ventricular dilation distorts the atrioventricular valves leading to mitral regurgitation and atrial enlargement ABNORMALLY THIN VENTRICULAR WALLS ATROPHIED PAPILLARY MUSCLES

  15. FELINE DILATED CARDIOMYOPATHY • In the 1980’s DCM in cats was one of the most commonly diagnosed heart diseases. It was discovered that this was caused by a deficiency of TAURINE, an amino acid. • Since that time commercial foods have added taurine to feline diets, which has significantly decreased the number of cases of feline DCM

  16. DISEASES OF THE CARDIOVASCULAR SYSTEM CARDIOMYOPATHIES

  17. PATIENT PRESENTATION http://www.youtube.com/watch?v=X-wLIoYTpOU http://www.youtube.com/watch?v=Zp7CiC7SXjk

  18. FELINE HYPERTROPHIC CARDIOMYOPATHY NEUTERED MALE CATS BETWEEN 1-16 YRS. OF AGE THE MOST COMMON CARDIOMYOPATHY IN CATS!

  19. FELINE HYPERTROPHIC CARDIOMYOPATHY: CLINICAL SIGNS and DIAGNOSIS • Soft, sytolic murmur • Gallop rhythms or other arrhythmias • ECG: ↑ p wave duration, ↑ QRS width, sinus tachycardia • Echo: shows ↑ ventricular wall thickness, dilated left atrium • Acute onset of heart failure • Acute onset of systemic thromboembolism • Hindlimb paresis • Cold rear legs • Painful rear legs

  20. FELINE HYPERTROPHIC CARDIOMYOPATHY • THE PREDOMINANT PATHOLOGY OF THIS DISEASE IS LEFT VENTRICULAR HYPERTROPHY • CAUSE: • Genetics • Related to abnormal myocardial myosin or calcium transport within the muscles of the heart

  21. FELINE HYPERTROPHIC CARDIOMYOPATHY

  22. FELINE HYPERTROPHIC CARDIOMYOPATHY: DIAGNOSIS http://www.youtube.com/watch?v=yNj-lQaUBao http://www.youtube.com/watch?v=KvUFb4qZwmw&feature=related http://www.youtube.com/watch?v=xlsq5tJpj04&feature=related

  23. FELINE HYPERTROPHIC CARDIOMYOPATHY: Pathophysiology PROBLEM #1: The walls lose compliance and resist filling during diastole! (diastolic failure)

  24. FELINE HYPERTROPHIC CARDIOMYOPATHY: Pathophysiology • PROBLEM #2: If the left ventricle cannot fill adequately with blood, the blood backs up into the left atrium (enlargement) → pulmonary veins → pulmonary edema! • PROBLEM #3: The left atrium becomes dilated with blood → the blood becomes static → blood stasis leads to clot formation → clot becomes dislodged and trapped elsewhere in the arterial system → thromboembolism! ***90% of thrombi become lodged in the aortic trifurcation causing “saddle thrombus”***

  25. FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUS ACUTE, PAINFUL CONDITION CAUSING PARESIS, COLD REAR LEGS/FEET!

  26. FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUS

  27. FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATMENT FUROSEMIDE (DIURETIC) ASPIRIN ANTICOAGULANT OR DILTIAZEM (CALCIUM CHANNEL BLOCKER) PROPRANOLOL (B-BLOCKER)

  28. FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATEMENT • LASIX (furosemide): a diuretic used to treat pulmonary edema • DILTIAZEM: a calcium channel blocker used to inhibit cardiac and vascular smooth muscle contractility; reduces blood pressure and cardiac afterload; overall improvement in diastolic function • Or Propranolol: a beta-blocker to decrease heart rate and myocardial oxygen demand • ASPIRIN: an anticoagulant used to thin blood and help prevent clot formation in HCM • TPA (Activase): serves as a fibrolysin resulting in the breakdown of clots that have already formed • Or Heparin, Warfarin: acts on the coagulation factors to inhibit the formation of a stable clot

  29. FELINE HYPERTROPHIC CARDIOMYOPATHY: CLIENT INFO • There is no cure! • Cats with HCM may experience heart failure, arterial embolism, or SUDDEN DEATH! • Cats whose heart rates stay below 200 beats/min have a better prognosis than those whose heart rate is >200 beats/min

  30. CANINE HYPERTROPHIC CARDIOMYOPATHY: • An UNCOMMON canine disease, but the cause appears to be heritable • CLINICAL SIGNS: • Fatigue • Sudden death • Tachypnea • Syncope • Cough • BREEDS: German Shepherds, Rottweilers, Cocker Spaniels, and others

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