Tori Greer

LI: Degenerative Valve Disease

Overview

- Most common cause of heart failure in dog is chronic degenerative AV valve disease
- Aka endocardiosis, mucoid, or myxomatous valvular degeneration
- Mitral valve is most commonly affected (but can involve both AV valves)
- Clinically important degenerative valve lesions are rare in cats

Pathophysiology

- valve becomes thickened with formation of small nodules on the edges of the leaflets
- nodules prevent complete closure of valve and results in blood that can flow backwards
- resultant backflow = regurgitation
- overtime, the atrium and ventricles compensate by enlarging
- Increasing volume of leak + long-term compensatory mechanisms -> lead to increase pressure in
atrium
- Increase in pressure is transmitted upstream to lungs leading to fluid exuding from capillaries in
the lungs -> aka congestive heart failure

Other Important Adverse Effects

- Increase in pressure of atrium can happen suddenly if the chordae tendonae rupture producing
an unanchored valve. (aka valve prolapse)
- Arrhythmias

Clinical Features

Heart murmur
 - Generally earliest to identify dz
- symptoms generally do not appear for 3-4 yrs after detection of a murmur
- Mitral valve: holosystolic murmur best heard at left apex (can radiate in any direction)
- Tricuspid valve: holosystolic murmur best heard at right apex

Differentiate Tricuspid from Mitral

- Presence of jugular vein pulsations
- Precordial thrill over right apex
- Different quality to murmur heard over tricuspid region

First clinical sign of worsening -> cough

- 1st possible reasoning of cough development: heart enlargement has occurred and is pushing on
airways, causing a cough
- 2nd possible reasoning of cough development: congestion in the lungs/CHF

Initial signs of heart failure from Mitral Regurgitation

- Reduced exercise intolerance
- Cough
- Tachypnea with exertion

Initial signs of heart failure from Tricuspid Regurgitation

- Abdominal distension (ascites, hepatomegaly)
- Respiratory distress from pleural effusion
- (rarely) peripheral tissue edema

Diagnosis

Hearing a murmur during an exam

- Diagnosis and confirmation via echocardiogram
- Leak of valve detected by color flow Doppler echocardiography

Chest X-rays
- Severity of disease by looking at heart size
- Definitive means of diagnosing CHF

Blood tests (BNP or NT-proBNP)

- Level of blood hormone that is elevated when heart is enlarged
- Determining severity of Degenerative Valve Disease

Diagnostic Examples
Treatment/Prognosis

Treatment
 - Goals: control signs of congestion, enhance forward blood flow while reducing regurgitant
volume, and modulate excessive NH activation
- Diuretics, vasodilators, or positive inotropic agents -> reduce regurgitant volume by decreasing
mitral annulus size
- Arteriolar vasodilators -> enhance cardiac output and reduce regurgitant volume by reducing
systemic arteriolar resistance

Prognosis
- Average time of first heard murmur to CHF = approx. 4yrs
- CHF has developed = average survival is 12-14 months
- Most frequent cause of death for DVD = euthanasia due to inability to control signs of congestion
or inability of patient to tolerate medication

Resources:

- Ware Cardiovascular Disease in Small Animal Medicine p. 263-272

- http://www.acvim.org/Portals/0/PDF/Animal%20Owner%20Fact%20Sheets/Cardiology/Cardio
%20Myxomatous%20Mitral%20Valve%20Degeneration.pdf