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DON’T COMPARE DON’T COMPARE YOURSELF TO OTHERSYOURSELF TO OTHERS
““Everyone is a genius, but if you judge Everyone is a genius, but if you judge a fish by its ability to climb a tree, it a fish by its ability to climb a tree, it will live its whole life believing its will live its whole life believing its stupid.”stupid.”
-Albert Einstein-Albert Einstein
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DISEASES OF THE DISEASES OF THE CARDIOVASCULAR CARDIOVASCULAR SYSTEM:SYSTEM:
CARDIOMYOPATHIESCARDIOMYOPATHIES
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PATIENT PRESENTATIONPATIENT PRESENTATION
http://www.youtube.com/watch?v=X-wLIoYTpOU
http://www.youtube.com/watch?v=Zp7CiC7SXjk
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHYCARDIOMYOPATHY
NEUTERED MALE CATS BETWEEN 1-16 YRS. OF AGE
THE MOST COMMON CARDIOMYOPATHY IN CATS!
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CLINICAL SIGNS and CARDIOMYOPATHY: CLINICAL SIGNS and DIAGNOSISDIAGNOSIS
Soft, sytolic murmurSoft, sytolic murmur Gallop rhythms or other arrhythmiasGallop rhythms or other arrhythmias
ECG: ↑ p wave duration, ↑ QRS width, sinus ECG: ↑ p wave duration, ↑ QRS width, sinus tachycardiatachycardia
Echo: shows ↑ ventricular wall thickness, dilated Echo: shows ↑ ventricular wall thickness, dilated left atriumleft atrium
Acute onset of heart failureAcute onset of heart failure Acute onset of systemic thromboembolismAcute onset of systemic thromboembolism
Hindlimb paresisHindlimb paresis Cold rear legsCold rear legs Painful rear legsPainful rear legs
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHYCARDIOMYOPATHY
THE PREDOMINANT PATHOLOGY OF THE PREDOMINANT PATHOLOGY OF THIS DISEASE IS THIS DISEASE IS LEFT VENTRICULAR LEFT VENTRICULAR HYPERTROPHY HYPERTROPHY
CAUSE: CAUSE: GeneticsGenetics Related to abnormal myocardial myosin or Related to abnormal myocardial myosin or
calcium transport within the muscles of the calcium transport within the muscles of the heartheart
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHYCARDIOMYOPATHY
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CARDIOMYOPATHY: DIAGNOSISDIAGNOSIS
http://www.youtube.com/watch?v=yNj-lQaUBao
http://www.youtube.com/watch?v=KvUFb4qZwmw&feature=related
http://www.youtube.com/watch?v=xlsq5tJpj04&feature=related
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CARDIOMYOPATHY: PathophysiologyPathophysiology
PROBLEM #1: The walls lose compliance and resist filling during diastole! (diastolic failure)
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CARDIOMYOPATHY: PathophysiologyPathophysiology
PROBLEM #2PROBLEM #2: If the left ventricle cannot fill : If the left ventricle cannot fill adequately with blood, the blood backs up into adequately with blood, the blood backs up into the left atrium (enlargement) → pulmonary the left atrium (enlargement) → pulmonary veins → veins → pulmonary edemapulmonary edema!!
PROBLEM #3:PROBLEM #3: The left atrium becomes dilated The left atrium becomes dilated with blood → the blood becomes static → with blood → the blood becomes static → blood stasis leads to clot formation → clot blood stasis leads to clot formation → clot becomes dislodged and trapped elsewhere in becomes dislodged and trapped elsewhere in the arterial system → the arterial system → thromboembolism!thromboembolism!
***90% of thrombi become lodged in the aortic trifurcation causing “saddle thrombus”***
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUSCARDIOMYOPATHY: SADDLE THROMBUS
ACUTE, PAINFUL CONDITION CAUSINGPARESIS, COLD REAR LEGS/FEET!
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUSCARDIOMYOPATHY: SADDLE THROMBUS
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATMENTCARDIOMYOPATHY: TREATMENT
OR
PROPRANOLOL (B-BLOCKER) DILTIAZEM (CALCIUM CHANNEL BLOCKER)
FUROSEMIDE (DIURETIC)
ANTICOAGULANT
ASPIRIN
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATEMENTCARDIOMYOPATHY: TREATEMENT LASIX (furosemide):LASIX (furosemide): a diuretic used to treat a diuretic used to treat
pulmonary edemapulmonary edema DILTIAZEMDILTIAZEM: a calcium channel blocker used to : a calcium channel blocker used to
inhibit cardiac and vascular smooth muscle inhibit cardiac and vascular smooth muscle contractility; reduces blood pressure and cardiac contractility; reduces blood pressure and cardiac afterload; overall improvement in diastolic functionafterload; overall improvement in diastolic function Or Or Propranolol:Propranolol: a beta-blocker to decrease heart rate a beta-blocker to decrease heart rate
and myocardial oxygen demandand myocardial oxygen demand ASPIRIN: ASPIRIN: an anticoagulant used to thin blood and an anticoagulant used to thin blood and
help prevent clot formation in HCMhelp prevent clot formation in HCM TPA (Activase): TPA (Activase): serves as a fibrolysin resulting in serves as a fibrolysin resulting in
the breakdown of clots that have already formedthe breakdown of clots that have already formed Or Heparin, Warfarin: acts on the coagulation factors to Or Heparin, Warfarin: acts on the coagulation factors to
inhibit the formation of a stable clotinhibit the formation of a stable clot
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FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CLIENT INFOCARDIOMYOPATHY: CLIENT INFO
There is no cure!There is no cure! Cats with HCM may experience heart failure, Cats with HCM may experience heart failure,
arterial embolism, or SUDDEN DEATH!arterial embolism, or SUDDEN DEATH! Cats whose heart rates stay below 200 Cats whose heart rates stay below 200
beats/min have a better prognosis than beats/min have a better prognosis than those whose heart rate is >200 beats/minthose whose heart rate is >200 beats/min
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CANINE HYPERTROPHIC CANINE HYPERTROPHIC CARDIOMYOPATHY:CARDIOMYOPATHY: An UNCOMMON canine disease, but the An UNCOMMON canine disease, but the
cause appears to be heritablecause appears to be heritable CLINICAL SIGNS:CLINICAL SIGNS:
FatigueFatigue Sudden deathSudden death TachypneaTachypnea SyncopeSyncope Cough Cough
BREEDS: German Shepherds, Rottweilers, BREEDS: German Shepherds, Rottweilers, Cocker Spaniels, and othersCocker Spaniels, and others
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DISEASES OF THE DISEASES OF THE CARDIOVASCULAR CARDIOVASCULAR SYSTEM:SYSTEM:
CONGENITAL DEFECTSCONGENITAL DEFECTS
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CONGENITAL DEFECTS: PATENT CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUSDUCTUS ARTERIOSUS
CHIHUAHUAS, MALTESE, POODLE, POMERANIAN, SHELTIE PUPPIES COMMONLY AFFECTED
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CONGENITAL DEFECTS: PATENT DUCTUS CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUSARTERIOSUS
Normally, the ductus arteriosus carries blood from the pulmonary artery to the aorta during fetal development. It bypasses the lungs of the fetus.
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CONGENITAL DEFECTS: PATENT DUCTUS CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUSARTERIOSUS
The duct should close in the first 12-24 hours after birth. If it does not, the blood begins to shunt from the aorta into the pulmonary artery and hyperperfuse the lungs.The left side of the heart will have an increase in blood return and become volume overloaded.
THIS IS CALLED A LEFT-TO-RIGHT SHUNT
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LOL!LOL!
““People who think they know People who think they know everything are a great annoyance everything are a great annoyance to those of us who do.”to those of us who do.”
-Isaac Asimov-Isaac Asimov
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CONGENITAL DEFECTS: PATENT CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUS (PDA)DUCTUS ARTERIOSUS (PDA)
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CONGENITAL DEFECTS: PATENT CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUSDUCTUS ARTERIOSUS CLINICAL SIGNS:CLINICAL SIGNS:
A loud murmur best heard over the left baseA loud murmur best heard over the left base Sometimes called a “machinery” murmur or a continuous Sometimes called a “machinery” murmur or a continuous
murmurmurmur If the shunt is small some animals may be asymptomaticIf the shunt is small some animals may be asymptomatic In large shunts the animal will develop In large shunts the animal will develop left-sided heart left-sided heart
failurefailure Pulmonary edemaPulmonary edema CoughCough Exercise intoleranceExercise intolerance TachypneaTachypnea Weight lossWeight loss
ECG: wide range of arrhythmias including APCs and ECG: wide range of arrhythmias including APCs and VPCsVPCs
Echocardiography (ultrasound)Echocardiography (ultrasound) Radiographs: left atrial and ventricular enlargementRadiographs: left atrial and ventricular enlargement
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PATENT DUCTUS ARTERIOSUS: PATENT DUCTUS ARTERIOSUS: TREATMENTTREATMENT
EXCELLENT PROGNOSIS WITH SURGICAL CORRECTION: LIGATION OF THE DUCTUS ARTERIOSUS
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PATENT DUCTUS PATENT DUCTUS ARTERIOSUS: TREATMENTARTERIOSUS: TREATMENT
CLIENT INFO:CLIENT INFO: 64% OF ANIMALS WILL DIE WITHIN 1 64% OF ANIMALS WILL DIE WITHIN 1
YEAR IF NOT TREATED SURGICALLYYEAR IF NOT TREATED SURGICALLY Dogs with this condition should not be used Dogs with this condition should not be used
for breedingfor breeding
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CONGENITAL DEFECTS: ATRIAL AND CONGENITAL DEFECTS: ATRIAL AND VENTRICULAR SEPTAL DEFECTSVENTRICULAR SEPTAL DEFECTS
During fetal life, the foramen ovale is an openingi n the interatrial septum, allowing shunting of blood from the right atrium to the left atrium in order to bypass the nonfunctioning fetal lungs. It should close at birth. If it doesn’t, after birth, the blood will shunt from left to right resulting in overload of the right side of the heart.
Atrial Septal Defect
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CONGENITAL DEFECTS: ATRIAL AND CONGENITAL DEFECTS: ATRIAL AND VENTRICULAR SEPTAL DEFECTSVENTRICULAR SEPTAL DEFECTS
CLINICAL SIGNS: ATRIAL SEPTAL CLINICAL SIGNS: ATRIAL SEPTAL DEFECTSDEFECTS Result in overload of the right side of the Result in overload of the right side of the
heart → dilation and hypertrophy of the right-heart → dilation and hypertrophy of the right-sided chamberssided chambers
Systolic murmurSystolic murmur Right-sided heart failureRight-sided heart failure Radiographs: right ventricular enlargementRadiographs: right ventricular enlargement Echo: right ventricular dilatationEcho: right ventricular dilatation
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CONGENITAL DEFECTS: ATRIAL AND CONGENITAL DEFECTS: ATRIAL AND VENTRICULAR SEPTAL DEFECTSVENTRICULAR SEPTAL DEFECTS
Blood is shunted from the oxygen-rich left ventricle into the right ventricle. The blood goes through pulmonary circulation and right back into the left atrium and ventricleresulting in volume overload of the left side of the heart. The right ventricle may dilate as well.
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CONGENITAL DEFECTS: ATRIAL AND CONGENITAL DEFECTS: ATRIAL AND VENTRICULAR SEPTAL DEFECTSVENTRICULAR SEPTAL DEFECTS
CLINICAL SIGNS: VENTRICULAR SEPTAL CLINICAL SIGNS: VENTRICULAR SEPTAL DEFECTS:DEFECTS: Animals with small defects may have minimal or no Animals with small defects may have minimal or no
signssigns Larger defects may result in acute left-sided heart Larger defects may result in acute left-sided heart
failure, usually by 8 weeks of agefailure, usually by 8 weeks of age A harsh holosystolic murmurA harsh holosystolic murmur
CLIENT INFO:CLIENT INFO: Repair of these defects requires open-heart surgery or Repair of these defects requires open-heart surgery or
cardiopulmonary bypass. These procedures are cardiopulmonary bypass. These procedures are uncommon in the dog and catuncommon in the dog and cat
Most of these animals will eventually experience Most of these animals will eventually experience development of congestive heart failuredevelopment of congestive heart failure
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PULMONIC STENOSISPULMONIC STENOSIS
Chihuahuas, English Bulldogs, are commonly affected. CAUSE: polygenic inheritance
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PULMONIC STENOSISPULMONIC STENOSIS
In pulmonic stenosis, the right ventricular outflow tract is narrowed, either at the valve itself, just below it, or just after it.
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PULMONIC STENOSISPULMONIC STENOSISThe most common form of pulmonic stenosis involvesa deformed pulmonary valve such that the valve leafletsare too thick, the opening is too narrow, or the valve cuspsare fused.
The heart must pump extra hard to get blood throughThis unusually narrow, stiff valve.
The right ventricle becomes thickened from all this extra work. The right atriumMay become dilated and hypertrophied.
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PULMONIC STENOSISPULMONIC STENOSIS
NORMAL CANINE CHEST RADS
THIS DOG HAS PULMONIC STENOSIS –THE HEART LOOKS “PREGNANT” IN THEFRONT DUE TO RIGHT VENTRICULARENLARGEMENT
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CONGENITAL DEFECTS: PULMONIC CONGENITAL DEFECTS: PULMONIC STENOSISSTENOSIS CLINICAL SIGNS:CLINICAL SIGNS:
SyncopeSyncope Tiring on exerciseTiring on exercise RightRight-sided congested heart failure-sided congested heart failure Left basilar (base) murmurLeft basilar (base) murmur Right ventricular enlargementRight ventricular enlargement Radiographs: right ventricular enlargement, dilation Radiographs: right ventricular enlargement, dilation
of the pulmonary artery, pulmonary underperfusionof the pulmonary artery, pulmonary underperfusion Echo: right ventricular hypertrophy and Echo: right ventricular hypertrophy and
enlargement, dilation of the main pulmonary arteryenlargement, dilation of the main pulmonary artery
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PULMONIC STENOSIS: PULMONIC STENOSIS: TREATMENTTREATMENT
A special balloon is inserted into the valve where it is inflated and the obstruction is broken down.
Unfortunately, medical management is notvery beneficial in these cases. Beta-blockersmay be used to relax the heart muscle and possibly dilate the stenosis.
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: SUBAORTIC STENOSISSUBAORTIC STENOSIS
LESION DEVELOPS IN THE FIRST 4-8 WEEKS OF LIFE
Newfoundland, Boxer, Golden Retriever, and Bull Terrier are most commonly affected
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: SUBAORTIC STENOSISSUBAORTIC STENOSIS There is a scar-like There is a scar-like
narrowing just below the narrowing just below the aortic valve. The heart aortic valve. The heart must pump extra hard to must pump extra hard to get blood through the get blood through the narrowed area. The narrowed area. The blood is pushed through blood is pushed through in a turbulent fashion in a turbulent fashion creating a heart murmur.creating a heart murmur.
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CONGENITAL DEFECTS: SUBAORTIC CONGENITAL DEFECTS: SUBAORTIC STENOSISSTENOSIS
THE HARD WORK RESULTS IN LEFT VENTRICULAR HYPERTROPHY, LEFT ATRIAL ENLARGEMENT, AORTIC DILATION
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CONGENITAL DEFECTS: SUBAORTIC CONGENITAL DEFECTS: SUBAORTIC STENOSIS:STENOSIS:
CLINICAL SIGNS:CLINICAL SIGNS: FatigueFatigue Exercise intolerance (low cardiac output)Exercise intolerance (low cardiac output) SyncopeSyncope Systolic murmur at the left heart baseSystolic murmur at the left heart base ECG: evidence of left ventricular ECG: evidence of left ventricular
enlargement enlargement - ↑ QRS height- ↑ QRS height Echo: left ventricular hypertrophy, Echo: left ventricular hypertrophy,
subvalvular fibrous ring, aortic dilationsubvalvular fibrous ring, aortic dilation
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ALWAYS FORGIVEALWAYS FORGIVE
““The person with no forgiveness in his The person with no forgiveness in his heart, lives in even worse punishment than heart, lives in even worse punishment than death.”death.”
- Mr. Miyagi, - Mr. Miyagi, The Karate Kid 2The Karate Kid 2
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CONGENITIAL DEFECTS: CONGENITIAL DEFECTS: SUBAORTIC STENOSISSUBAORTIC STENOSIS
TREATMENTTREATMENT Balloon catheter dilation – has been done with Balloon catheter dilation – has been done with
variable and temporary resultsvariable and temporary results Medical management: THE GOAL IS TO SLOW Medical management: THE GOAL IS TO SLOW
THE HEART RATE AND DECREASE THE HEART RATE AND DECREASE CONTRACTILITY; PROPRANOLOL (BETA-CONTRACTILITY; PROPRANOLOL (BETA-BLOCKER WILL DO THIS)BLOCKER WILL DO THIS)
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: SUBAORTIC STENOSISSUBAORTIC STENOSIS
CLIENT INFO:CLIENT INFO: Should not be used for breedingShould not be used for breeding Acute, left-sided congestive heart failure is Acute, left-sided congestive heart failure is
possiblepossible Sudden death is not uncommonSudden death is not uncommon
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DCM HCM PDA Aortic stenosis
Pulmonic stenosis
•1 – dogs•Enlarged Heart bronchoconstriction•Dilated Flappy muscle•Nutritional: no taurin in cats
•1 – Cats•Saddle thrombus•Rarely in dogs (hereditary)•Noncompliant heart muscle
•Aorta – pulmonary a – lungs back L side
•Stenotic aortic valve causes LV hypertrophy•High pressure in aortic valve can lead to aortic dilatation
•Stenotic pulmonic valve•Pregnant heart
•L sided heart failure (HF)
•LV hypertrophy •RV hypertrophy•R sided HF
•Increased HR•Cough
•Increased HR•Weakness in hindlimbs, acute pain, rear cold feet
•Pulmonary edema
•Sudden death if aorta ruptures
•Digoxin: increased contractibility
•Beta blocker: Slow HR•Diuretic•Blood thinner•No cure
•Treat surgically or die
•No breeding •Balloon valvuloplasty
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: TETRALOGY OF FALLOTTETRALOGY OF FALLOT
Keeshonds are the most commonly affected breed, but bulldogs and cats have increased incidence as well. Cause: polygenic inheritance
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: TETRALOGY OF FALLOTTETRALOGY OF FALLOT
THERE ARE 4 MAIN ANATOMICAL THERE ARE 4 MAIN ANATOMICAL ABNORMALITIES IN THIS DISEASE!ABNORMALITIES IN THIS DISEASE! Pulmonic stenosisPulmonic stenosis Right ventricular hypertrophyRight ventricular hypertrophy Ventricular septal defectVentricular septal defect Overriding aortaOverriding aorta
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: TETRALOGY OF FALLOTTETRALOGY OF FALLOT
CLINICAL SIGNS and DIAGNOSIS:CLINICAL SIGNS and DIAGNOSIS: Affected puppies are smaller than littermatesAffected puppies are smaller than littermates Exercise intoleranceExercise intolerance Dyspnea, tachypneaDyspnea, tachypnea SyncopeSyncope CyanosisCyanosis Polycythemia:Polycythemia: occurs as a response to the large occurs as a response to the large
amount of deoxygenated blood going to the amount of deoxygenated blood going to the systemic circulationsystemic circulation
Systolic murmur over the pulmonic areaSystolic murmur over the pulmonic area ECHO: right ventricular hypertrophy, subaortic ECHO: right ventricular hypertrophy, subaortic
ventricular septal defect, right outflow tract ventricular septal defect, right outflow tract obstructionobstruction
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: TETRALOGY OF FALLOTTETRALOGY OF FALLOT
TREATMENT:TREATMENT: Phlebotomy: to keep PCV below 65%Phlebotomy: to keep PCV below 65% Surgery:Surgery:
Create a left–to–right shunt by doing systemic Create a left–to–right shunt by doing systemic artery to pulmonary artery anastamosisartery to pulmonary artery anastamosis
Complete correction requires cardiopulmonary Complete correction requires cardiopulmonary bypass which is uncommon in animalsbypass which is uncommon in animals
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: TETRALOGY OF FALLOTTETRALOGY OF FALLOT
CLIENT INFO:CLIENT INFO: These dogs should not be bredThese dogs should not be bred Congestive heart failure rarely developsCongestive heart failure rarely develops Affected animals need regular phlebotomyAffected animals need regular phlebotomy Limit stress and exerciseLimit stress and exercise
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PERSISTENT RIGHT 4PERSISTENT RIGHT 4THTH AORTIC AORTIC ARCHARCH
Great Danes, German Shepherds, Irish Settersare most commonly affected
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PERSISTENT RIGHT 4PERSISTENT RIGHT 4THTH AORTIC AORTIC ARCHARCH
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PERSISTENT RIGHT 4PERSISTENT RIGHT 4THTH AORTIC AORTIC ARCHARCH
Clinical signs include regurgitation due to megaesophagus, aspiration pneumonia, dyspnea, weight loss
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CONGENITAL DEFECTS: CONGENITAL DEFECTS: PERSISTENT RIGHT 4PERSISTENT RIGHT 4THTH AORTIC AORTIC ARCHARCH
TREATMENT: Early surgical correctionTREATMENT: Early surgical correction Prognosis is poor without surgeryPrognosis is poor without surgery Even with surgery, some esophageal dilation Even with surgery, some esophageal dilation
may persistmay persist
CLIENT INFO:CLIENT INFO: These dogs should not be used for breedingThese dogs should not be used for breeding
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DISEASES OF THE CARDIOVASCULAR SYSTEM
ACQUIRED VALVULAR DISEASES
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CHRONIC MITRAL VALVE INSUFFECIENCY
SMALL BREED/TOY BREED DOGS, USUASLLY OLDER THAN 10 YEARS
THE PREVALENCE OF THIS DISEASE INCREASES WITH AGE, AND IS PROGRESSIVE. IT ACCOUNTS FOR ~95% OF ALL HEART FAILURE CASES
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CHRONIC MITRAL VALVE INSUFFICIENCY
ONE OF THE MOST COMMONCAUSES IS CHRONIC PERIODONTALDISEASE!
BACTERIA THAT LIVE IN TARTAR,GET SHOWERED INTO THE BLOODSTREAM AND COLONIZE IN THEVALVE LEAFLETS.
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CHRONIC MITRAL VALVE INSUFFICIENCY
1.Lungs: Pulmonary fibrosis, bronchitis, and chronic obstructive pulmonary
disease.
2.Heart: Endocarditis, mitral valve regurgitation, and myocardial
degeneration.
3.Liver: Hepatic parenchymal inflammation and hepatopathy.
4.Kidneys: Interstitial nephritis and glomerulonephritis.
CHRONIC PERIODONTAL DISEASE CAN AFFECT SEVERAL ORGAN SYSTEMS
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MITRAL VALVE INSUFFICIENCY
THIS IS THE OPEN LEFTVENTRICLE SHOWING THEMITRAL VALVE LEAFLETS. WHAT ARE THE STRING-LIKESTRUCTURES THAT ATTACHTHE VALVES TO THE PAPILLARY MUSCLES?
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MITRAL VALVE INSUFFICIENCY
CHORDAE TENDINEAE
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MITRAL VALVE INSUFFICIENCY
BOTTOM LEAFLET ISTHICKENED AND NODULAR. THISIS DUE TO INCREASED FIBROBLASTIC TISSUE WITHINTHE VALVE LEAFLETS
TOP LEAFLET IS NORMAL
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CHRONIC MITRAL VALVE INSUFFICIENCY
DURING LEFT VENTRICULARCONTRACTION, BLOOD FLOWSBACK INTO THE LEFT ATRIUM
THE STIFF MALFORMED VALVE FAILS TO CLOSE SUFFICIENTLYDURING SYSTOLE.
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MITRAL VALVE INSUFFICIENCY
IF BLOOD CONTIUES THIS BACKWARDFLOW, THE ANIMAL MAY EXPERIENCELEFT-SIDED HEART FAILURE CHARACTERIZED BY PULMONARY EDEMA
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CHRONIC MITRAL VALVE INSUFFICIENCY
DIAGNOSIS: Radiographs Echo Systolic murmur at left apex; “whooping” quality
There is no treatment to delay the onset of clinical signs. Treatment is aimed at improving symptoms of heart failure Diuretics (lasix) ACE inhibitor, vasodilator (Enalapril) Diet change: low sodium
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TRICUSPID VALVE INSUFFICIENCY
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TRICUSPID VALVE INSUFFICIENCY
TRICUSPID INSUFFICIENCY RESULTSIN RIGHT-SIDED HEART FAILURECHARACTERIZED BY PLEURAL EFFUSION
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TRICUSPID VALVE INSUFFICIENCY
RIGHT-SIDED HEART FAILURE ALSOLEADS TO ASCITES
NOTE: THE LOSS OF ABDOMINALDETAIL
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TRICUSPID VALVE INSUFFICIENCY
Treatment and client info are the same as for mtiral insufficiency; repeated abdominocentesis may be needed in these cases.
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LIVE LIFE TO THE FULLEST!
“You only live once, but if you work it right, once is enough.”
-Joe E. Lewis, comedian
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DISEASES OF THE CARDIOVASCULAR SYSTEM
HEARTWORM DISEASE
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CANINE HEARTWORM DISEASE PARASITE CAUSING HEARTWORM
DISEASE: DIROFILARIA IMMITIS
MICROFILARIA OF D. IMMITIS ADULT HEARTWORMS
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CANINE HEARTWORM DISEASE
ONLY FEMALE MOSQUITOES BITE
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DISTRIBUTION OF CANINE HEARTWORM DISEASE
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CANINE HEARTWORM DISEASE
ADULT HEARTWORMS LIVEIN THE PULMONARY ARTERIES. THE HEART MUSTWORK EXTRA HARD TO PUMP AGAINST THIS OBSTRUCTION.
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CANINE HEARTWORM DISEASE
ADULT HEARTWORMS INRIGHT VENTRICLE AND PULMONARY ARTERY
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CANINE HEARTWORM DISEASE
PREDOMINANT PATHOLOGY: DAMAGE TO THE PULMONARY ARTERY FROM ADULT HEARTWORMS Endothelial damage and sloughing Inflammation (leukocytes, platelets)
Risk of thromboemboli Pulmonary hypertension Disruption of vascular integrity
Thickened, fibrosed
RIGHT VENTRICULAR HYPERTROPHY AND RIGHT-SIDED HEART FAILURE The right ventricle compensates by dilating and
increasing muscle thickness Ultimately, there is decompensation and heart failure
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CANINE HEARTWORM DISEASE Severe infection can lead to CAVAL
SYNDROME Worms back up into the right atrium and
venae cavae Found in heavy worm burdens (>60) Associated with a poor prognosis Surgical treatment: pull worms from the right heart
and venae cavae via jugular venotomy
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CANINE HEARTWORM DISEASE
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CANINE HEARTWORM DISEASE
IDEXX SNAP TEST
ADULT FEMALE ANTIGEN
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CANINE HEARTWORM DISEASE
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CANINE HEARTWORM DISEASE
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CANINE HEARTWORM DISEASE: PREVENTION HEARTGARD/IVERHEART
Ivermectin/pyrantel pamoate INTERCEPTOR/SENTINEL
Milbemycin oxime/ milbemycin oxime+lufeneron REVOLUTION
Selamectin ADVANTAGE MULTI/PROHEART 6
Moxidectin Q 6 month injectable
TRIFEXIS Milbemycin oxime + spinosad
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CANINE HEARTWORM DISEASE: TREATMENT
STANDARD PROTOCOL: 1 epaxial injection, followedBy a second injection on the opposite side 24 hours later
ALTERNATIVE PROTOCOL: 1 Injection given followed in 4-6 weeks by 2 injections given 24 hours apart
ONLY KILLS ADULT (L5) STAGE WORMS; DOXYCYCLINE IS REC. AS COMPLIMENTARY TX