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Degenerative Mitral Valve Disease (view source)

Revision as of 23:16, 15 November 2010

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*Exercise Intolerance

*Cough

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* Dyspnoea

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*Dyspnoea

*Sudden death due to left atrial tear and pulmonary oedema

===Clinical Signs===

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*Cardiomegaly with dorsal displacement of the trachea

*Pulmonary Venous Congestion (Enlarged pulmonary Arteries and Veins)

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* Pulmonary Oedema

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*Pulmonary Oedema

Evidence of Right sided congestive heart failure maybe evident in severe cases e.g. distended caudal vena cava, hepatomegaly, ascites, pleural effusions.

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===Electrocardiogram (ECG)===

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* Enlarged Left Atrium (Wide P Wave)

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*Enlarged Left Atrium (Wide P Wave)

*Enlarged Left Ventricle (Tall R wave, wide QRS complex, shift of mean electrical axis to the left)

*Rhythm disturbances - Sinus Tacchycardia, Atrial Fibrillation, Atrial premature complexes,Atrial Tacchycardia.

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==Treatment==

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No treatment is recommended prior to the onset of heart failure. ~~Treatment~~ is ~~aimed at managing~~ congestive heart failure through a combination of drugs.

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No treatment is recommended prior to the onset of heart failure. Once there is evidence of congestive heart failure, treatment is aimed at its management through a combination of drugs.

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The aims of treatment are to:

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# '''Reduce Preload'''

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1. '''Reduce Preload'''

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*Diuretics to reduce circulating fluid volume (Frusemide, Benzofluazide, Spironolactone, Amiloride)

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::Diuretics to reduce circulating fluid volume (Frusemide, Benzofluazide, Spironolactone, Amiloride)

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*Vasodilators to reduce venous return (Nitrates, ACE inhibitors, Alpha antagonists)

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::Vasodilators to reduce venous return (Nitrates, ACE inhibitors, Alpha antagonists)

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# '''Reduce Afterload

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2. '''Reduce Afterload

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*Vasodilators to decrease systemic vascular resistance

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::Vasodilators to decrease systemic vascular resistance

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**ACE inhibitors e.g. Enalapril, Benzapril, Imidopril ,

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:::ACE inhibitors e.g. Enalapril, Benzapril, Imidopril ,

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**Pimobendan

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:::Pimobendan

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**Calcium channel blockers e.g. Amlodipine

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:::Calcium channel blockers e.g. Amlodipine

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**Nitrates e.g. Nitropusside

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:::Nitrates e.g. Nitropusside

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# '''Enhance Systolic function

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3. '''Enhance Systolic function

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*Positive Inotropes to increase cardiac contractility and increase cardiac output.

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::Positive Inotropes to increase cardiac contractility and increase cardiac output.

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**Pimobendan

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:::Pimobendan

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** Digoxin

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:::Digoxin

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**Dobutamine

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:::Dobutamine

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**Xanthines

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:::Xanthines

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# '''Improve Diastolic function

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4. '''Improve Diastolic function

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*Negative Chronotropes to increase the length of diastole (digoxin, atenolol)

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::Negative Chronotropes to increase the length of diastole (digoxin, atenolol)

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*Calcium channel blockers to improve relaxation (amlodipine)

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::Calcium channel blockers to improve relaxation (amlodipine)

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# '''Control cardiac arrhythmias using anti-arrhythmic drugs

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5. '''Control cardiac arrhythmias using anti-arrhythmic drugs

==Prognosis==

Bara

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