Endocardiose x CM dilatada.ppt
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Transcript of Endocardiose x CM dilatada.ppt
![Page 1: Endocardiose x CM dilatada.ppt](https://reader030.fdocument.pub/reader030/viewer/2022012406/55cf9db7550346d033aedb92/html5/thumbnails/1.jpg)
ENDOCARDIOSE
Prof. Dr. Moacir Leomil Neto
PUC Minas campus Poços de Caldas
CM DILATADAX
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CARDIOPATIAS
HAMLIM, 1994Adquiridas (95%); congênitas (5%)
LARSSON et al., 2000Valvulopatias: 50%Cardiomiopatias: 21%Cardiopatias congênitas: 2%Outras: 22%
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Sinônimos:
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ENDOCARDIOSEInsuficiência valvar, degeneração valvar, regurgitação crônica, fibrose valvar crônica
CM Dilatada
Miocardiopatia, CM do Boxer, do Doberman, do Cocker Spaniel
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Fisiopatologia:
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ENDOCARDIOSE
afeta folhetos de valvas mitral e/ou
tricúspide e cordoalhas tendíneas
60% M ; 30% M e T ; 10% T
77,2% M ; 22,8% M e T
raramente Ao e P são acometidas
folhetos com espessamento nodular
cordoalhas podem ser afetadas
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ENDOCARDIOSE
IM fluxo anterogrado volume no AE PAS pressão no AESNS fluxo renal FC, contratilidade ativa SRAA pressão vasos
pulm.e constricção arteriolar vol. plasm. perfusão sob. volume remodel. mioc. (Hipertrofia excêntrica)
BARO
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CM DILATADA
– Diminuição da contratilidade (disfunção sistólica)
– Diminuição do débito cardíaco
– Dilatação das 4 câmaras
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Incidência:
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ENDOCARDIOSE
5% (< 1 ano) até 75% (> 16 anos)
Predisposição sexual machos/fêmeas (1,5: 1,0)
Predisposição racial (?)
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– Cardiopatia adquirida mais freqüente em cães de grande porte.
– RAÇAS: Doberman, Pastor Alemão, Dogue Alemão, Boxer ,Fila Brasileiro, Mastin Napolitano, São Bernardo, Terra Nova, Cocker Spaniel*.
– IDADE: 4 a 10 anos.
– SEXO: mais freqüente em machos .
CM DILATADA
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ENDOCARDIOSE
CÃES PEQUENOS
VELHOS
MACHOS
CM DILATADA
CÃES GRANDES
ADULTOS
MACHOS
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ETIOLOGIA:
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ENDOCARDIOSE
Desconhecida
Teorias
Endocardite bacteriana
Valvulite viral
Alterações hemodinâmicas
Alterações do colágeno
Doença autoimune
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CM DILATADA
o Idiopática
o Associada à deficiência Taurina (Cocker, Golden)
o Associada à deficiência L-carnitina (Boxer, Cocker)
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ENDOCARDIOSE
DESCONHECIDA
CM DILATADA
DESCONHECIDA
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SINTOMAS:
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ENDOCARDIOSE
História e sintomasassintomáticos - sopro à auscultaçãosintomáticos:
TOSSE noturna - diferencialdispnéiaintolerância ao exercíciosíncopeaumento de volume abdominal -
ascitemorte súbita
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História e sintomas
– Baixo débito cardíaco:
fraqueza, letargia, pulso fraco, síncope
– Congestão:
dispnéia, distensão jugular, ascite,
edema de membros ... por último tosse
– Perda de peso
CM DILATADA
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ENDOCARDIOSE
TOSSE TIPO
“ENGASGO”
CM DILATADA
INTOLERÂNCIA À
EXERCÍCIOS
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AUSCULTAÇÃO:
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ENDOCARDIOSE
Sopro holossístolico de intensidade 1 a
6. Grau 1: muito suave
Grau 2: suave, mas detectado imediata/e
Grau 3: baixo a moderado
Grau 4: moderado a alto
Grau 5: alto, com frêmito pré cordial
Grau 6 : audível quando o esteto é afastado do
tórax
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– Ritmo de galope
– Arritmias
– Crepitação pulmonar
– Sopro sistólico
CM DILATADA
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ENDOCARDIOSE
SOPRO (SEM
RELAÇÃO COM
SEVERIDADE)
CM DILATADA
GALOPE
ARRITMIA
CREPTAÇÃO
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EXAME RADIOGRÁFICO:
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ENDOCARDIOSE
IM leve a moderada - leve a mod. do AE
IM severa- importante do AE
deslocamento da traquéia e brônquio E
aumento global da silhueta
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– Cardiomegalia
– Aumento severo de AE no Doberman
– Sinais de ICC
CM DILATADA
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ELETROCARDIOGRAMA:
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ENDOCARDIOSE
geralmente normal em IM discreta.
alargamento da onda P (AE) em apenas 40%
dos pacientes com IM mod.a imp.
QRS alargado ou alto ( VE) em menos que
50% dos casos de IM imp.
Ritmo: RSN, AS, TS, APCs, VPCs ou FA
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– Aumento de câmaras cardíacas
– Arritmias atriais e ventriculares: FA, CVP, TV
CM DILATADA
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ENDOCARDIOSE
PROVAVELMENTE
NORMAL
CM DILATADA
ARRITMIAS
GRAVES
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ECOCARDIOGRAMA:
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ENDOCARDIOSE
diagnóstico definitivo da endocardiose
severidade da regurgitação
conseqüências hemodinämicas - dilatação
atrial e ventricular
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– Dilatação atrial e ventricular
– Hipocinesia do VE
– função sistólica do miocárdio
– Regurgitação mitral / tricúspide
CM DILATADA
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ENDOCARDIOSE
DIAGNÓSTICO
DEFINITIVO
MENSURA A
REGURGITAÇÃO
CM DILATADA
DIAGNÓSTICO
DEFINITIVO
MENSURA A FÇ
MIOCÁRDICA
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NECRÓPSIA:
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TRATAMENTO:
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TRATAMENTO INICIAL
ENDOCARDIOSE IECA
IM ou FC elevada digitálico
CM DILATADA IECA Digitálico Suplementação
Arritmias Avaliar e tratar
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Vasodilatadores
Inibidores da ECA
– captopril, lisinopril, enalapril,
benazepril
– diminui a formação da AII
TRATAMENTO
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Inibidores da ECA– Dose:
• enalapril: 0,5 mg/kg BID• benazepril: 0,25/0,5 mg/kg SID
– Efeitos adversos• hipotensão• hipercalemia• azotemia - monitorizar a função renal em 5-7 dias após o início da terapia
TRATAMENTO
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Digitálicos
– ação inotrópica positiva
– uso em taquicardia supraventricular
– dose 0,005 a 0,01 mg/kg/BID VO
TRATAMENTO
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Digitálicos
Intoxicação digitálica
– Clínica - anorexia e vômito
– ECG – bradicardia e bloqueio
atrioventricular
TRATAMENTO
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Com ICC
– ACRESCENTAR
• DIURÉTICO:
furosemida: 2 - 4 mg/kg BID-TID
ENDOCARDIOSE E CM DILATADA
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DiuréticosFurosemide luz célula
interstício
Na+
K+
2Cl -
Na+ K+
TRATAMENTO
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Furosemide– Doses: 1 mg/kg EDA a 4 mg/kg TID– diurético + inibidor da ECA: avaliar função
renal
– edema pulmonar 2-8 mg/kg cada 1-2 horas
controlar de acordo com os sinais clínicos
TRATAMENTO
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Espironolactona
– inibe a ação da aldosterona
– reduz fibrose miocárdica
– restaura função de baroreceptores
– Dose: 2-4 mg/kg SID
TRATAMENTO
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Diuréticos tiazídicos
– diminui a permeabilidade ao NaCl por
ação no cotransportador
– 1/3 a 1/2 da ação dos diuréticos de alça
– ineficaz em fluxo renal baixo (ICC severa)
– ação sinérgica
TRATAMENTO
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Diuréticos tiazídicos
Hidroclorotiazida
– ação em 2 horas
– pico em 4 horas
– duração de 12 horas
– Dose: 2 a 4 mg/kg BID VO
TRATAMENTO
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Dieta hipossódica– reduzir o Na+ sérico e a retenção
hídrica reduzir a pré-carga
– pouco palatável
TRATAMENTO
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TRATAMENTO(particularidades)
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ENDOCARDIOSE
Vasodilatadores
Amlodipina
– bloqueador de canais de cálcio
– vasodilatador arterial
– dose: 0,05 a 0,2 mg/kg BID
– associar com IECA
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VasodilatadoresHidralazina
–vasodilatador arteriolar potente–diminui o fluxo regurgitante– suspender amlodipina – associar com IECA– mensurar PA
ENDOCARDIOSE
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Hidralazina– Dose: 0,5 a 2 mg/kg BID VO– Efeitos adversos:
• vômitos• hipotensão• taquicardia reflexa
ENDOCARDIOSE
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SUPLEMENTAÇÃO:
• TAURINA (Cocker)
500 mg BID-TID, VO
• L-CARNITINA (Boxer, Cocker)
50 - 100 mg/kg, TID, VO
CM DILATADA
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Arritmia ventricular: quando tratar
– Síncope
– Taquicardia ventricular
– CVPs com formatos diferentes
– Mais do que 20 CVPs / min
CM DILATADA
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Como tratar ?
– MEXILETINE: 4 - 8 mg/kg TID, VO
– SOTALOL: 0,5 - 2 mg/kg BID, VO
– AMIODARONA: 10 - 20 mg/kg SID, VO, 7 a 10 dias, após: 3 - 15 mg/kg SID, VO
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Fibrilação atrial:
– DIGOXINA
Adicionar:
– DILTIAZEM : 0,5 - 2,5 mg/kg TID, VO
– PROPRANOLOL: 0,2 - 1 mg/kg TID, VO
– ATENOLOL: 6,25 - 12,5 mg/cão BID-SID, VO
CM DILATADA
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PROGNÓSTICO:
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Prognóstico
Bom a reservado, dependendo da
classe funcional da IC
ENDOCARDIOSE
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Prognóstico– Doença fatal
– Cães com ICC - 6 meses a 2 anos
– Doberman: pior prognóstico
CM DILATADA
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VALVA AFETADA
BUCHANAN (1979)M (62%); M e T (32,5%); T (1,3%)
LARSSON (1994); n= 854 casosMitral: 428 (50,11%)Mitral e tricúspide: 22 (2,57%)Tricúspide: 20 (2,34%)