Acquired Valvular Heart Disease Quiz

1. Which of the following is the most classic signalment of a dog with degenerative mitral valve disease?
a. 5-year-old male Cavalier King Charles Spaniel
b. 9-month-old female Labrador Retriever
c. 6-year-old male Dalmatian
d. 3-year-old female Chihuahua

2. This echocardiographic image is an example of which common finding associated with degenerative mitral valve disease?

a. Mitral regurgitation
b. Right atrial enlargement
c. Left ventricular concentric hypertrophy
d. Mitral stenosis

3. Which of the following is the most likely electrocardiographic finding for a dog with degenerative mitral valve disease?
a. P pulmonale
b. Decreased QRS duration
c. Small R wave in lead II (low voltage complexes)
d. P mitrale

4. Which of the following is the most common clinical presentation of symptomatic degenerative mitral valve disease?
a. Right main stem bronchus compression causing cough
b. Mid-diastolic click leading to syncope
c. Left-sided congestive heart failure (pulmonary edema)
d. Cardiac tamponade

5. What is the difference between the terms endocardiosis and endocarditis?
a. Endocardiosis is myxomatous degeneration of the valves, typically without inflammatory cells
b. Endocarditis is myxomatous degeneration of the valves, usually with a predominantly monocytic inflammatory reaction
c. Endocardiosis is usually a result of a viral infection
d. Endocarditis is usually a result of a toxic injury due to a drug or a toxic plant

6. What is the most frequent cause of congestive heart failure in dogs?
a. Bacterial endocarditis
b. Myxomatous Mitral Valvular Disease
c. Ventricular Septal Defect
d. Patent Ductus Arteriosus

7. Degenerative valvular disease most commonly affects the…
a. Mitral valve
b. Aortic valve
c. Pulmonic valve
d. Venous valves

8. Which of the following breeds is most likely to develop degenerative mitral valvular disease?
a. Irish wolfhound
b. Great Dane
c. Cavalier King Charles Spaniel
d. Newfouldland

9. Beatrice, a 7 year-old female spayed miniature Poodle, is found to have a new II/IV apical systolic murmur detected on routine physical examination What do you tell the owners?
a. The presence of a murmur indicates that Beatrice has congestive heart failure and she should start on medications such as pimobendan and furosemide.
b. Beatrice likely has advanced degenerative mitral valvular disease the minimum database should include a CBC, biochemistry profile, thoracic radiographs, echocardiogram, and NT-proBNP.
c. Beatrice likely has early degenerative mitral valvular disease, which is usually a slowly progressive disease and cardiac decompensation typically does not occur until later in life; it would be reasonable to get baseline thoracic radiographs to make sure cardiac size is still normal.
d. The presence of a II/IV murmur in a dog like Beatrice is likely an innocent murmur which will never result in cardiac enlargement of congestive heart failure.

10. Over time, the progression of degenerative (myxomatous) valvular disease affecting only the mitral valve would first lead to:
a. Concentric hypertrophy of the right ventricle
b. Concentric hypertrophy of the left ventricle
c. Eccentric hypertrophy of the right ventricle
d. Eccentric hypertrophy of the left ventricle

11. Which of the following correctly describes the pathophysiology of degenerative (myxomatous) mitral valvular disease?
a. Activation of the sympathetic nervous system and renin-angiotensin system contributes to the fluid and sodium retention
b. A centrally mediated block in release of antidiuretic hormone (vasopressin) results in both vasodilation and marked sodium retention (hypernatremia)
c. Increased activity of the parasympathetic nervous system leads to tachycardia and increased cardiac contractile state (positive inotropy).
d. Activation of the natriuretic peptide systems (ANP, BNP, etc.) results in marked fluid retention and causes cardiomegaly

12. Prior to the development of a murmur, what may be the earliest finding of degenerative (myxomatous) mitral valvular disease?
a. Mid-systolic click
b. S3 gallop
c. S4 gallop
d. Split S2

13. Cough is a common clinical manifestation of degenerative (myxomatous) mitral valve disease. Which of the following is not thought to be a common cause of cough in these dogs?
a. Poor oxygen exchange in the lungs causes cyanosis, and cyanosis is the trigger for cough
b. Congestiv heart failure with pulmonary edema can result in cough
c. A markedly enlarged left atrium can put pressure on the trachea and mainstem bronchi, and this can trigger cough
d. Many dogs have concurrent respiratory disease, such as collapsing trachea or chronic bronchitis, and these concurrent diseases can trigger a cough

14. Which of the following is true about murmurs heard in dogs with degenerative (myomatous) mitral valvular disease?
a. The intensity of the murmur is loudest on the right side of the thorax in most dogs
b. The intensity of the murmur is loudest at the left heart base in most affected dogs
c. The intensity of the murmur roughly correlates with severity of disease in most dogs
d. The intensity of the murmur is inversely correlated with severity of disease, as the onset of CHF often results in a nearly inaudible murmur in most dogs

15. Which of the following is true about pimobendan?
a. Pimobendan inhibits angiotensin-converting enzyme
b. Pimobendan was shown to delay the onset of congestive heart failure by approximately 15 months in animals with significant cardiomegaly due to chronic valvular disease
c. Studies done in people with myxomatous mitral valve disease suggest that Pimobendan may slow the progression towards CHF, though this has not yet been shown in veterinary medicine
d. Pimobendan is a loop diuretic

16. You are talking to the owners of a dog who has just been diagnosed with early degenerative (myxomatous) mitral valvular disease. They are asking you about changes to their dog’s diet. What do you tell them?
a. These dogs also get kidney disease, so dietary protein should be limited early in the disease
b. It is reasonable to initiate moderate sodium (salt) restriction once there is cardiac enlargement and/or once congestive heart failure develops
c. Potassium should be supplemented now, so there will be adequate body stores for when furosemide needs to be initiated.
d. It is desirable to get their dog overweight (body condition score of 8/9 or 9/9) to build up body energy stores as the dog will need these once CHF develops