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Dr. Khaled M. Al-Qudah

Veterinary Internal Medicine

Cardiology

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Pericarditis; Endocarditis; Myocarditis

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Pericarditis

Dr. Khaled M. Al-Qudah

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Audible friction rub in early

stage

Muffling of the heart

sounds in advance stage

C.H.F

Inflammation of the pericardial sac,

characterized by:

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• May be septic, nonseptic, neoplastic, or

idiopathic

• Common bacteria are Streptococcus and

gram negatives in horses, plus anaerobes

and Actinomycosis in cattle

• Horses with pleuropneumonia or EHV1

• Cattle with hardware

Etiology:

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Pericardial disease causes diastolic cardiac

dysfunction with minimal alterations in systolic

function

Accumulation of fluid in pericardial sac and

thickened and inflamed pericardium cause

cardiac tamponade and restrictive pericarditis,

which restrict diastolic filling resulting in

cardiac insufficiency

Etiology…

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1. Early stage of inflammation hyperemia and

deposition of fibrinous exudate

Friction rub when the pericardium and epicardium

rub together during cardiac movements.

2. As effusion develops the inflamed surfaces

are separated, and the friction rub is replaced

by muffling of the heart sounds.

Pathogenesis

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fibrinous exudate

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3. The accumulation of the fluid will compress

the atria and

ventricles preventing their complete filling

C.H.F.

4. Toxemia is present in case of suppurative

pericarditis.

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Fibrinous Pericarditis

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In case of non-suppurative pericarditis,

resorbtion of the fluid followed by adhesion

between the pericardium and the epicardium.

This kind of adhesion is not strong to impair

cardiac movement.

In suppurative pericarditis the adhesions are

more serious and may cause complete

attachment between the epicardium and the

pericardium, which restrict the cardiac

movement followed by C.H.F.

5. In the recovery stage:

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• Fever, depression, anorexia

Nonspecific signs:

• Pleurodynia (intercostal muscular pain)

• Colic in horses

• Cardiac tamponade

Most specific signs:

1) Jugular distention, edema

2) Pleural effusion

3) Splashy or muffled heart sounds and/or

pericardial friction rubs

• May also have arrhythmias

Clinical signs and physical findings:

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• Pain

The animal avoid to move

Abduction of the elbows

Arching of the back

Shallow abdominal respiration

The animal lies down carefully

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Diagnosis:

Most specific diagnostic test is an echocardiogram

demonstrating pericardial fluid and collapsed RA.

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Aspirate of pericardial fluid for cytology and

culture

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Other nonspecific findings:

Laboratory evidence of infection or inflammation:

Leukocytosis

Hyperfibrinogenemia

hyperglobulinemia

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• Pericardial drainage and lavage is very

important

• Antimicrobial therapy based on cytology

and culture

• Anti-inflammatory and analgesic therapy

• Rumenotomy or pericardiotomy to remove

foreign body in cattle if present with

hardware disease

• Treat arrhythmias and cardiac failure if

present

Treatment:

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Endocarditis

DR. Khaled M. Al-Qudah

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Inflammation of the endocardium may

interfere with the ejection of blood from

the heart by causing insufficiency or

stenosis of the valves.

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Etiology

[streptococcus spp

Cattle [corynebacterium pyogenes

[clostridium chauvoci (Black leg)

[ myoplasma mycoides

[actinobacillus equali

Horses [streptococcus spp

[strongylus spp (larvae)

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Etiology….

Focus of infection anywhere in the body that embolizes to the valves

1)Actinomyces and Streptococcus most

common in cattle

2) Pasturella, Actinobacillus, and Streptococcus most common in horses

Pre-existing valve lesions may predispose to bacterial colonization

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Pathogenesis:

Bacteremia

M.O. colonize the heart valves and

endocardium

Bacterial endocarditis

Vegetative and ulcerative lesions

1. this will interfere with normal

blood passage through the cardiac orfices

CHF

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Pathogenesis…..

Fragments of vegetative lesions may become

detached circulation.

arteritis

miliary pulmonary abscesses

myocardial abscesses

kidneys and joint abscesses

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Pathogenesis…..

Impaired valve function from bacterial

colonization can lead to heart failure

1) Signs depend on valve (s) affected

2) Aortic and mitral valves (LAV) more

common in horse

3) Tricuspid valve (RAV) more common in

cattle

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Clinical Findings:

Depend on valve (s) affected and severity

May be subclinical …Cattle !!

May cause heart failure

The clinical signs of right-sided C.H.F.

Tachycardia

Jugular and mammary vein distention with palpable pulses.

Ventral and submandibular edema

Systolic murmur only 50% have detectable murmurs.

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Clinical Findings...

Cyclic fever

Tachycardia

Anorexia

Reduced performance

Chest pain

Often younger animals (< 5 years)

50% of cattle also have shifting leg

lameness .

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Diagnosis:

1. The history and physical examination.

2. Blood culture is the single most useful

procedure for the diagnosis of BE.

Three venous blood samples should be

collected aseptically during one or two hour

period.

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Necropsy photograph of the heart of the above calf.

Note the large vegetation on the TV (arrow)

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Most specific would be visualization of abnormal

valves on an echocardiogram

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Endocarditis Left AV valve

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Vegetative Endocarditis

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Vegetative Endocarditis

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Nodular Endocarditis

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Endocarditis in a calf about 6 months old

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Treatment

Not highly successful

Antimicrobial therapy (4-6 wks) based on

culture

The thickness of the lesions prevents

adequate penetration of the drugs.

It is hard to treat before the isolation of the

M.O. and the selection of the drug should be

based on the sensitivity.

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Treatment

In case of negative culture:

Penicillin with gentamicin

or

Potentiated sulfonamide for long period...

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Prognosis

Fair to good if treated early before significant

valve lesions

Poor to grave if significant valve lesions

causing failure

80% of horses with aortic or mitral valve

endocarditis, die

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Myocardial disease

Dr. Khaled M. Al-Qudah

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Etiology

Inflammation of cardiac muscle caused by

1) Endotoxemia

2) Viral infection, EIA, EVA, FMD, AHS

3) Parasitic migration (Strongylosis, Neospora canium,

sarcocystis, cysticercosis infection)

4) Bacterial endocarditis (Clostridium chauvoei, Strep

spp, Mycobacterium spp, Staph aureus, Borelia

burgdorferi and Spirochete)

5) Idiopathic cardiomyopathy

6) Fungal. Blastomycosis (very rare)

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Etiology…

Electrolyte abnormalities

1) GI disease, esp. colic or colitis

2) K, Mg, Ca important

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Etiology…

Nutritional:

1. Vitamin E or selenium deficiencies (horse and ruminants)

2. hypervitaminosis D

3. Cu deficiency

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Etiology…

Myocardial infarcts or fibrosis

Cardiac inflammation, degeneration or myocyte

electrolyte changes cause:

1) Altered conduction and arrhythmia

2) Reduced myocardial function, chamber

dilation, insufficient AV valves and failure

3) Can lead to arrhythmias and murmurs

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Etiology…

Neoplasia:

Aortic or carotid body tumor, may invade

atrium or ventricle.

Lymphosarcoma (cow, cat) and

Angiosarcoma (dog). Usually involves right

atrium.

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Etiology…

Toxic cardiomyopathy:

Bacterial toxins (e.g. clostridia).

Myocardial depressant factors of shock.

Chronic renal failure-induced myocardial depression

External toxins, (e.g. furazolidone, cobalt, alcohol).

Electrolyte abnormalities especially hypocalcemia, hypophosphatemia, and hyperkalemia.

Drugs, e.g. doxorubicin, sodium iodide (causes dilated cardiomyopathy in cat)

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Etiology…

Vascular disease and ischemia:

Atherosclerosis of coronary arteries

secondary to severe hypothyroidism in

dogs.

Ischemic myocardial necrosis and fibrosis in

the horse, possibly secondary to

arteriosclerosis.

Ischemia caused by hypotension.

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Etiology…

Trauma:

penetrating (e.g. bullet)

Non-penetrating ( blunt) very common.

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Clinical signs and physical findings

Variable, depending on severity and underlying

cause

Exercise intolerance, Syncope and collapse

Persistent tachycardia common, but

bradycardia may also occur

Murmurs, especially systolic over AV valves

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Clinical signs

Myalgia - if generalized muscle pain

Arrhythmias, especially ventricular tachycardia, and premature atrial or ventricular contractions, and atrial fibrillation

Congestive heart failure - edema and/or jugular venous distention

Sudden death

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Myocarditis, or inflammation of the muscular walls of

the heart, is a common sign of FMD.

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Focal Myocarditis

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Death is the usual result of Myocarditis among

newborn calves that contract FMD

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Diagnosis Can be difficult

Increased serum cardiac Troponin

Identify underlying cause

1) Always check serum electrolytes

2) Endotoxemia-neutropenia

3) Endocarditis-inflammatory leukogram

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Diagnosis….

• Blood concentrations of Vitamin E/selenium and CK

. Feed analysis for Monensin: Monensin concentration in cattle feed, Recommended

level 12 mg/kg BW

• BLV serology in cattle

ECG - arrhythmias

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Treatment

1. Treat underlying disease

2. Rest, avoid stress

3. Nonsteroidal anti-inflammatory drugs for

myocarditis

(Flunixin 1.1 mg/kg)

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Treatment…

4. Control cardiac arrhythmias:

in heart failure from myocarditis digoxine or dopamine are indicated:

Digoxin: Horse: 12-14 g/ kg/24 hours

Cattle: 11 g/ kg tid

5. In case of Oedema, diuretics mast be given, as:

Furosemide: 0.5 - 1 mg/kg/day