What is the structural component of DCM?
Primary myocardial disease, defect in cytoskeleton or metabolism
How does DCM affect general heart function?
Decreased LV systolic function (decreased contractility)
What is the cause for primary DCM?
What breed gets primary DCM?
What are secondary causes of DCM?
Nutritional deficiencies (taurine/carnitine), infectious/inflammatory, tachycardia-induced, sepsis-induced myocardial dysfunction, doxorubicin cardiotoxicity
What do DCM hearts look like?
Attenuated (shrinking) wavy myofibers, myocardial fibrosis and fatty replacement, myocyte atrophy/degeneration/necrosis
What is the most common arrhythmia seen with DCM? When do they occur in relation to changes seen on echo?
OFTEN precede echo changes (esp. Dobermans)
What other arrhythmia can happen with DCM? When does this happen in relation to changes seen on echo?
atrial fibrillation (due to large atrium);
OFTEN precedes echo changes (esp. in Irish Wolfhounds) and is common in advanced DCM/CHF in all breeds
What is the average age that DCM occurs?
How prevalent is DCM in Dobermans?
50% of them have it >6 years
What historically causes DCM in cats?
What sex gets DCM more often?
Males > females
What are 3 ways by which DCM can be detected?
Breeder screening, veterinarian screening, Dx following a complication
What 3 things can be used in a breeder screening to detect DCM?
Echo/holter monitor, cardiac biomarkers (NT-proBNP, cTnI), genetic testing
How is DCM diagnosed on echo?
Decreased LV systolic function (FS%, EF%), increased LV size
What is the gold standard for diagnosis of ventricular arrhythmias?
Holter (>50 VPCs/24 hours)
How can ventricular arrhythmias be diagnosed with ECG?
1+ VPCs/5 min
Severity of ventricular arrhythmias is correlated with severity of _____ _____.
Other than ventricular arrhythmias, what else can ECGs/Holter monitors detect when DCM is suspected?
What are the 2 biomarkers for DCM?
NT-proBNP and cTnI
What does increased NT-proBNP mean and what is the cutoff?
myocardial stretch; >450 pmol/L
What does increased cTnI mean and what is the cutoff?
myocardial damage; >0.22 ng/ml
How can nutritional deficiency be ruled out as a secondary cause of DCM?
consider diet history and supplement taurine if low
How can infection/inflammation be ruled out as a secondary cause of DCM?
Consider history and test for infectious diseases such as Trypanosoma, Toxo/Neospora, Bartonella, Borrelia, Ehrlichia, Lepto
How can tachycardia-induced myopathy be ruled out as a secondary cause of DCM?
Treat tacharrhythmia and recheck
How can sepsis-induced myocardial dysfunction be ruled out as a secondary cause of DCM?
treat sepsis and recheck
How can Doxorubicin cardiotoxicity be ruled out as a secondary cause of DCM?
What are CS associated with DCM?
Signs of CHF: dyspnea/tachypnea, cough exercise intolerance/inappetence/ADR, abdominal distention
____ breed dogs hide CHF better than _____ breed dogs
Other than signs of CHF, what 2 things can happen in DCM?
Syncope, sudden cardiac death (arrhythmic)