Cardio - Hypertrophic CM Flashcards Preview

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Flashcards in Cardio - Hypertrophic CM Deck (35)
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1
Q

What is HOCM?

A

Disease of the myocardial sarcomere caused by/characteristic of:

genetic mutations in MyBPC, dietary/environmental factors, impaired LV myocardial relaxation, and concentric hypertrophy

2
Q

What cat breeds are prone to HOCM?

A

Maine Coons and Ragdolls

3
Q

HOCM is a disease of _____ dysfunction.

A

diastolic

4
Q

What do HOCM hearts look like?

A

Myofiber disarray, replacement fibrosis, arteriosclerosis (small vessel disease)

5
Q

What does the O in HOCM stand for?

A

obstructive

6
Q

Where is the obstruction in HOCM?

A

At area where blood leaves LV as it crosses the aorta

7
Q

What role does the MV play in HOCM?

A

It is anatomically near the obstruction location, and can swing and get in the way of the outflow tract, contributing to HOCM

8
Q

What is the signalment for HOCM?

A

Cats (Maine Coons, Ragdolls), males (75%), middle-age (~6 yr)

9
Q

What is the prevalence of HOCM in cats?

A

15%

10
Q

What is part of the breeder screening for HOCM?

A

Echo and genetic testing

11
Q

What is part of the veterinarian screening for HOCM?

A

Murmur, arrhythmia, cardiac biomarkers (NT-proBNP)

12
Q

What can HOCM be a complication of?

A

CHF, ATE

13
Q

How is HOCM definitively diagnosed?

A

Echo

14
Q

What are signs of HOCM seen on echo?

A

LV hypertrophy, LV diastolic function, +/- LA enlargement

15
Q

What are DDx for LV hypertrophy in cats?

A

4H/4 “hypers”

HCM, hypertension, hyperthyroidism, hypersomatotropism (acromegaly)

16
Q

How does hypertension cause LV hypertrophy?

A

Ventricle is working harder to pump blood out due to increased afterload

17
Q

How can hyperthyroidism cause LV hypertrophy?

A

Thyroid hormone can directly cause hypertrophy –> hypertension

18
Q

What causes a heart murmur in HOCM?

A

Dynamic LVOT obstruction +/- mild mitral regurg

19
Q

What is easier to diagnose, HOCM or HCM? Why?

A

HOCM because most HCM cats don’t have murmurs and HOCM cats do

20
Q

What are DDx for murmurs in adult cats?

A

HOCM, hyperthyroidism/SHT, physiologic, anemia

21
Q

What are the 3 complications of HOCM and which is most common?

A

L-CHF (most common), ATE, sudden cardiac death

22
Q

What CS come with HOCM due to L-CHF?

A

Dyspnea, tachypnea, inappetance, ADR, hiding

23
Q

What CS come with HOCM due to ATE?

A

acute paresis/pain, bilateral hindlimb > other

24
Q

Where does fluid go in cats with L-CHF?

A

Pulmonary edema, pleural eff, pericardial eff

25
Q

T/F: Most cats with HOCM are never diagnosed or treated

A

True

26
Q

___% of cats who are diagnosed will progress and experience a complication.

A

50

27
Q

What is the average survival in asymptomatic HOCM cats?

A

~5 years

28
Q

What is the average survival of HOCM cats following an episode of CHF?

A

6 months - 2 years

29
Q

What is the average survival of HOCM cats following an ATE?

A

3-6 months

30
Q

What are negative prognostic indicators of HOCM?

A

Severe LA enlargement, severe LV hypertrophy, older age

31
Q

Do HOCM cats or HCM cats have better prognosis?

A

HOCM because they have murmurs and so get detected earlier

32
Q

What drugs are important in HOCM and why?

A

Clopidogrel, aspirin, heparin, tPA

(Anti-coagulants bc HOCM cats love to form clots)

33
Q

What meds are used in asymptomatic (stage B) HOCM?

A

Atenolol, ACEi, clopidogrel

34
Q

What meds are used in CHF HOCM (stage C)?

A

Acutely = sedation, oxygen, +/- thoracocentesis

Furosemide, ACEi, Pimobendan, Spironolactone

35
Q

What meds are used in ATE?

A

Analgesia (opioids), clopidogrel, heparin/low mol weight heparin, tPA for thrombolysis

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