DISEASES OF THE CARDIOVASCULAR SYSTEM:
CardiomyopathiesCogenital malformation
CHFAcquired Valvular disease
Infectious
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
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.
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
MITRAL VALVE INSUFFICIENCY
THIS IS THE OPEN LEFTVENTRICLE SHOWING THEMITRAL VALVE LEAFLETS. WHAT ARE THE STRING-LIKESTRUCTURES THAT ATTACHTHE VALVES TO THE PAPILLARY MUSCLES?
MITRAL VALVE INSUFFICIENCYCHORDAE TENDINEAE
MITRAL VALVE INSUFFICIENCY
BOTTOM LEAFLET ISTHICKENED AND NODULAR. THISIS DUE TO INCREASED FIBROBLASTIC TISSUE WITHINTHE VALVE LEAFLETS
L HR
TOP LEAFLET IS NORMAL
CHRONIC MITRAL VALVE INSUFFICIENCY
DURING LEFT VENTRICULARCONTRACTION, BLOOD FLOWSBACK INTO THE LEFT ATRIUM
THE STIFF MALFORMED VALVE FAILS TO CLOSE SUFFICIENTLYDURING SYSTOLE.
MITRAL VALVE INSUFFICIENCY
IF BLOOD CONTIUES THIS BACKWARDFLOW, THE ANIMAL MAY EXPERIENCELEFT-SIDED HEART FAILURE CHARACTERIZED BY PULMONARY EDEMA
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)
– Enalapril (avoids retention of fluid): ACE inhibitor, vasodilator
– Pimobendan: Helps pump blood efficiently
– Diet change: low sodium
TRICUSPID VALVE INSUFFICIENCY
TRICUSPID VALVE INSUFFICIENCY
TRICUSPID INSUFFICIENCY RESULTSIN RIGHT-SIDED HEART FAILURECHARACTERIZED BY PLEURAL EFFUSION
TRICUSPID VALVE INSUFFICIENCY
RIGHT-SIDED HEART FAILURE ALSOLEADS TO pleural effusion andASCITES
NOTE: THE LOSS OF ABDOMINALDETAIL
Ascites. Blood backs up in vena cava and this back up causes back overload, liver overloaded with fluids. Vascular permeability, leaky vessels.
TRICUSPID VALVE INSUFFICIENCY
• Treatment and client info are the same as for mtiral insufficiency; repeated abdominocentesis may be needed in these cases.
• Lasix: Diuretics
• Enalapril: Reduces retention of fluids
LIVE LIFE TO THE FULLEST!
“You only live once, but if you work it right, once is enough.”
-Joe E. Lewis, comedian
DISEASES OF THE CARDIOVASCULAR SYSTEM:
CardiomyopathiesCogenital malformation
CHFAcquired Valvular disease
Infectious
DISEASES OF THE CARDIOVASCULAR SYSTEM
HEARTWORM DISEASE
CATS HWD
DISTRIBUTION OF CANINE HEARTWORM DISEASE
CANINE HEARTWORM DISEASE• PARASITE CAUSING HEARTWORM
DISEASE: DIROFILARIA IMMITIS
MICROFILARIA OF D. IMMITIS ADULT HEARTWORMS
CANINE HEARTWORM DISEASE
ONLY FEMALE MOSQUITOES BITE
Mosquito transmits L3 stage.L1 – L3 develops in the mosquito.Dog mff goes to mosquito. Dog L3 – L5
CANINE HEARTWORM DISEASE
Intermediate host
Definitive host
CANINE HEARTWORM DISEASE
ADULT HEARTWORMS LIVEIN THE PULMONARY ARTERIES. THE HEART MUSTWORK EXTRA HARD TO PUMP AGAINST THIS OBSTRUCTION.
ADULT HEARTWORMS INRIGHT VENTRICLE AND PULMONARY ARTERY
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
GRADING
• Class 1: No symptoms or mild symptoms such as an occasional cough.
• Class 2: Mild to moderate symptoms such as an occasional cough and tiredness after moderate activity.
• Class 3: General loss of body condition, a persistent cough, and tiredness after mild activity. Trouble breathing and signs of heart failure are common. For class 2 and 3 heartworm disease, heart and lung changes are usually seen on chest x-rays.
• Class 4: Caval syndrome. There is such a heavy worm burden that blood flowing back to the heart is physically blocked by a large mass of worms. Caval syndrome is life-threatening and quick surgical removal of the heartworms is the only treatment option. The surgery is risky, and even with surgery, most dogs with caval syndrome die.
• The yellow arrows point to the tortuous and severely enlarged pulmonary arteries.
• There is a mild increase in the size of the right atrium. • The pulmonary parenchyma also has a slight interstitial pattern.
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
Heartworm embolectomy procedure. Basket forceps placed throught he right jugular vein and into the right heart were used to retrieve the heartworms from this Rottweiler with caval syndrome. Seventy-one worms were removed from this patient's right heart
CANINE HEARTWORM DISEASE
IDEXX SNAP TEST
ADULT FEMALE ANTIGEN
CANINE HEARTWORM DISEASE
CANINE HEARTWORM DISEASE
CANINE HEARTWORM DISEASE: PREVENTION
• HEARTGARD/IVERHEART– Ivermectin/pyrantel pamoate
• INTERCEPTOR/SENTINEL– Milbemycin oxime
• REVOLUTION– Selamectin
• ADVANTAGE MULTI/PROHEART 6– Moxidectin– Q 6 month injectable
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 (WOLBACHIA)
Heartworm Treatment – Slow Kill Method – VTI
Team: Dr. B, Dr. Dev, Miss Kennar, Miss Foitnik
•Doxycycline: 5 – 10 mg/ kg (SID or BID)
•Prednisone: 1 mg/kg : BID X 7 days; SID X 7 days, EOD X 7 days
•DAY 1
– Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection
– Famotidine 0.5 mg/kg SQ: before melarsomine injection
– Melarsormine: 0.1 mls/ kg IM
•DAY 30
– Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection;
– Famotidine 0.5 mg/kg SQ: before melarsomine injection
– Melarsormine: 0.1 mls/ kg IM
•DAY 31
– Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection;
– Famotidine 0.5 mg/kg SQ: before melarsomine injection
– Melarsormine: 0.1 mls/ kg IM
THANK YOU ROYALS 2011
References• Alleice Summers, Common Diseases of Companion
Animals
• http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=156665
• VIN: Robert Prosek DVM, MS, DACVIM-Cardiology, DECVIM-CA
• Echocardiography in the Dog, Cat and Horse: Dr. Francesco Porciello, 2009
• http://www.vin.com/WebLink.plx?URL=http://www.vmth.ucdavis.edu/cardio/cases/
References
• http://cardiology.vetmed.lsu.edu/Education/AcquiredCardiacDiseases/HeartwormDisease/tabid/448/Default.aspx
• http://www.heartwormsociety.org/
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