DON

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DONT COMPARE YOURSELF TO OTHERS

• Everyone is a genius, but if you judge a fish by
  its ability to climb a tree, it will live its
  whole life believing its stupid.
• -Albert Einstein

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DISEASES OF THE CARDIOVASCULAR SYSTEM

• CARDIOMYOPATHIES

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PATIENT PRESENTATION
http//www.youtube.com/watch?vX-wLIoYTpOU
http//www.youtube.com/watch?vZp7CiC7SXjk
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FELINE HYPERTROPHIC CARDIOMYOPATHY
NEUTERED MALE CATS BETWEEN 1-16 YRS. OF AGE
THE MOST COMMON CARDIOMYOPATHY IN CATS!
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FELINE HYPERTROPHIC CARDIOMYOPATHY CLINICAL
SIGNS and DIAGNOSIS

• Soft, sytolic murmur
• Gallop rhythms or other arrhythmias
• ECG ? p wave duration, ? QRS width, sinus
  tachycardia
• Echo shows ? ventricular wall thickness, dilated
  left atrium
• Acute onset of heart failure
• Acute onset of systemic thromboembolism
• Hindlimb paresis
• Cold rear legs
• Painful rear legs

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FELINE HYPERTROPHIC CARDIOMYOPATHY

• THE PREDOMINANT PATHOLOGY OF THIS DISEASE IS LEFT
  VENTRICULAR HYPERTROPHY
• CAUSE
• Genetics
• Related to abnormal myocardial myosin or calcium
  transport within the muscles of the heart

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FELINE HYPERTROPHIC CARDIOMYOPATHY
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FELINE HYPERTROPHIC CARDIOMYOPATHY DIAGNOSIS
http//www.youtube.com/watch?vyNj-lQaUBao
http//www.youtube.com/watch?vKvUFb4qZwmwfeature
related
http//www.youtube.com/watch?vxlsq5tJpj04feature
related
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FELINE HYPERTROPHIC CARDIOMYOPATHY
Pathophysiology
PROBLEM 1 The walls lose compliance and resist
filling during diastole! (diastolic failure)
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FELINE HYPERTROPHIC CARDIOMYOPATHY
Pathophysiology

• PROBLEM 2 If the left ventricle cannot fill
  adequately with blood, the blood backs up into
  the left atrium (enlargement) ? pulmonary veins ?
  pulmonary edema!
• PROBLEM 3 The left atrium becomes dilated with
  blood ? the blood becomes static ? blood stasis
  leads to clot formation ? clot becomes dislodged
  and trapped elsewhere in the arterial system ?
  thromboembolism!

90 of thrombi become lodged in the aortic
trifurcation causing saddle thrombus
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FELINE HYPERTROPHIC CARDIOMYOPATHY SADDLE
THROMBUS
ACUTE, PAINFUL CONDITION CAUSING PARESIS, COLD
REAR LEGS/FEET!
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FELINE HYPERTROPHIC CARDIOMYOPATHY SADDLE
THROMBUS
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FELINE HYPERTROPHIC CARDIOMYOPATHY TREATMENT
FUROSEMIDE (DIURETIC)
ASPIRIN
ANTICOAGULANT
OR
DILTIAZEM (CALCIUM CHANNEL BLOCKER)
PROPRANOLOL (B-BLOCKER)
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FELINE HYPERTROPHIC CARDIOMYOPATHY TREATEMENT

• LASIX (furosemide) a diuretic used to treat
  pulmonary edema
• DILTIAZEM a calcium channel blocker used to
  inhibit cardiac and vascular smooth muscle
  contractility reduces blood pressure and cardiac
  afterload overall improvement in diastolic
  function
• Or Propranolol a beta-blocker to decrease heart
  rate and myocardial oxygen demand
• ASPIRIN an anticoagulant used to thin blood and
  help prevent clot formation in HCM
• TPA (Activase) serves as a fibrolysin resulting
  in the breakdown of clots that have already
  formed
• Or Heparin, Warfarin acts on the coagulation
  factors to inhibit the formation of a stable clot

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FELINE HYPERTROPHIC CARDIOMYOPATHY CLIENT INFO

• There is no cure!
• Cats with HCM may experience heart failure,
  arterial embolism, or SUDDEN DEATH!
• Cats whose heart rates stay below 200 beats/min
  have a better prognosis than those whose heart
  rate is gt200 beats/min

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CANINE HYPERTROPHIC CARDIOMYOPATHY

• An UNCOMMON canine disease, but the cause
  appears to be heritable
• CLINICAL SIGNS
• Fatigue
• Sudden death
• Tachypnea
• Syncope
• Cough
• BREEDS German Shepherds, Rottweilers, Cocker
  Spaniels, and others

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DISEASES OF THE CARDIOVASCULAR SYSTEM

• CONGENITAL DEFECTS

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CONGENITAL DEFECTS PATENT DUCTUS ARTERIOSUS
CHIHUAHUAS, MALTESE, POODLE, POMERANIAN, SHELTIE
PUPPIES COMMONLY AFFECTED
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CONGENITAL DEFECTS PATENT DUCTUS ARTERIOSUS
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 ARTERIOSUS
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!

• People who think they know everything are a
  great annoyance to those of us who do.
• -Isaac Asimov

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CONGENITAL DEFECTS PATENT DUCTUS ARTERIOSUS (PDA)
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CONGENITAL DEFECTS PATENT DUCTUS ARTERIOSUS

• CLINICAL SIGNS
• A loud murmur best heard over the left base
• Sometimes called a machinery murmur or a
  continuous murmur
• If the shunt is small some animals may be
  asymptomatic
• In large shunts the animal will develop
  left-sided heart failure
• Pulmonary edema
• Cough
• Exercise intolerance
• Tachypnea
• Weight loss
• ECG wide range of arrhythmias including APCs and
  VPCs
• Echocardiography (ultrasound)
• Radiographs left atrial and ventricular
  enlargement

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PATENT DUCTUS ARTERIOSUS TREATMENT
EXCELLENT PROGNOSIS WITH SURGICAL CORRECTION
LIGATION OF THE DUCTUS ARTERIOSUS
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PATENT DUCTUS ARTERIOSUS TREATMENT

• CLIENT INFO
• 64 OF ANIMALS WILL DIE WITHIN 1 YEAR IF NOT
  TREATED SURGICALLY
• Dogs with this condition should not be used for
  breeding

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CONGENITAL DEFECTS ATRIAL AND VENTRICULAR SEPTAL
DEFECTS
Atrial Septal Defect
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
doesnt, after birth, the blood will shunt from
left to right resulting in overload of the right
side of the heart.
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CONGENITAL DEFECTS ATRIAL AND VENTRICULAR SEPTAL
DEFECTS

• CLINICAL SIGNS ATRIAL SEPTAL DEFECTS
• Result in overload of the right side of the heart
  ? dilation and hypertrophy of the right-sided
  chambers
• Systolic murmur
• Right-sided heart failure
• Radiographs right ventricular enlargement
• Echo right ventricular dilatation

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CONGENITAL DEFECTS ATRIAL AND VENTRICULAR 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 ventricle resulting
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 VENTRICULAR SEPTAL
DEFECTS

• CLINICAL SIGNS VENTRICULAR SEPTAL DEFECTS
• Animals with small defects may have minimal or no
  signs
• Larger defects may result in acute left-sided
  heart failure, usually by 8 weeks of age
• A harsh holosystolic murmur
• CLIENT INFO
• Repair of these defects requires open-heart
  surgery or cardiopulmonary bypass. These
  procedures are uncommon in the dog and cat
• Most of these animals will eventually experience
  development of congestive heart failure

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CONGENITAL DEFECTS PULMONIC STENOSIS
Chihuahuas, English Bulldogs, are commonly
affected. CAUSE polygenic inheritance
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PULMONIC 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 STENOSIS
The most common form of pulmonic stenosis
involves a deformed pulmonary valve such that the
valve leaflets are too thick, the opening is too
narrow, or the valve cusps are fused.
The heart must pump extra hard to get blood
through This unusually narrow, stiff valve.
The right ventricle becomes thickened from all
this extra work. The right atrium May become
dilated and hypertrophied.
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CONGENITAL DEFECTS PULMONIC STENOSIS
NORMAL CANINE CHEST RADS
THIS DOG HAS PULMONIC STENOSIS THE HEART LOOKS
PREGNANT IN THE FRONT DUE TO RIGHT
VENTRICULAR ENLARGEMENT
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CONGENITAL DEFECTS PULMONIC STENOSIS

• CLINICAL SIGNS
• Syncope
• Tiring on exercise
• Right-sided congested heart failure
• Left basilar (base) murmur
• Right ventricular enlargement
• Radiographs right ventricular enlargement,
  dilation of the pulmonary artery, pulmonary
  underperfusion
• Echo right ventricular hypertrophy and
  enlargement, dilation of the main pulmonary artery

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PULMONIC STENOSIS TREATMENT
A special balloon is inserted into the valve
where it is inflated and the obstruction is
broken down.
Unfortunately, medical management is not very
beneficial in these cases. Beta-blockers may be
used to relax the heart muscle and possibly
dilate the stenosis.
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CONGENITAL DEFECTS SUBAORTIC STENOSIS
Newfoundland, Boxer, Golden Retriever, and Bull
Terrier are most commonly affected
LESION DEVELOPS IN THE FIRST 4-8 WEEKS OF LIFE
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CONGENITAL DEFECTS SUBAORTIC STENOSIS

• There is a scar-like narrowing just below the
  aortic valve. The heart must pump extra hard to
  get blood through the narrowed area. The blood is
  pushed through in a turbulent fashion creating a
  heart murmur.

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CONGENITAL DEFECTS SUBAORTIC STENOSIS
THE HARD WORK RESULTS IN LEFT VENTRICULAR
HYPERTROPHY, LEFT ATRIAL ENLARGEMENT, AORTIC
DILATION
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CONGENITAL DEFECTS SUBAORTIC STENOSIS

• CLINICAL SIGNS
• Fatigue
• Exercise intolerance (low cardiac output)
• Syncope
• Systolic murmur at the left heart base
• ECG evidence of left ventricular enlargement - ?
  QRS height
• Echo left ventricular hypertrophy, subvalvular
  fibrous ring, aortic dilation

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ALWAYS FORGIVE

• The person with no forgiveness in his heart,
  lives in even worse punishment than death.
• - Mr. Miyagi, The Karate Kid 2

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CONGENITIAL DEFECTS SUBAORTIC STENOSIS

• TREATMENT
• Balloon catheter dilation has been done with
  variable and temporary results
• Medical management THE GOAL IS TO SLOW THE HEART
  RATE AND DECREASE CONTRACTILITY PROPRANOLOL
  (BETA-BLOCKER WILL DO THIS)

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CONGENITAL DEFECTS SUBAORTIC STENOSIS

• CLIENT INFO
• Should not be used for breeding
• Acute, left-sided congestive heart failure is
  possible
• Sudden 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 TETRALOGY 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 TETRALOGY OF FALLOT

• THERE ARE 4 MAIN ANATOMICAL ABNORMALITIES IN THIS
  DISEASE!
• Pulmonic stenosis
• Right ventricular hypertrophy
• Ventricular septal defect
• Overriding aorta

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CONGENITAL DEFECTS TETRALOGY OF FALLOT

• CLINICAL SIGNS and DIAGNOSIS
• Affected puppies are smaller than littermates
• Exercise intolerance
• Dyspnea, tachypnea
• Syncope
• Cyanosis
• Polycythemia occurs as a response to the large
  amount of deoxygenated blood going to the
  systemic circulation
• Systolic murmur over the pulmonic area
• ECHO right ventricular hypertrophy, subaortic
  ventricular septal defect, right outflow tract
  obstruction

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CONGENITAL DEFECTS TETRALOGY OF FALLOT

• TREATMENT
• Phlebotomy to keep PCV below 65
• Surgery
• Create a lefttoright shunt by doing systemic
  artery to pulmonary artery anastamosis
• Complete correction requires cardiopulmonary
  bypass which is uncommon in animals

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CONGENITAL DEFECTS TETRALOGY OF FALLOT

• CLIENT INFO
• These dogs should not be bred
• Congestive heart failure rarely develops
• Affected animals need regular phlebotomy
• Limit stress and exercise

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CONGENITAL DEFECTS PERSISTENT RIGHT 4TH AORTIC
ARCH
Great Danes, German Shepherds, Irish Setters are
most commonly affected
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CONGENITAL DEFECTS PERSISTENT RIGHT 4TH AORTIC
ARCH
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CONGENITAL DEFECTS PERSISTENT RIGHT 4TH AORTIC
ARCH
Clinical signs include regurgitation due to
megaesophagus, aspiration pneumonia, dyspnea,
weight loss
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CONGENITAL DEFECTS PERSISTENT RIGHT 4TH AORTIC
ARCH

• TREATMENT Early surgical correction
• Prognosis is poor without surgery
• Even with surgery, some esophageal dilation may
  persist
• CLIENT INFO
• These 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 COMMON CAUSES IS CHRONIC
PERIODONTAL DISEASE!
BACTERIA THAT LIVE IN TARTAR, GET SHOWERED INTO
THE BLOOD STREAM AND COLONIZE IN THE VALVE
LEAFLETS.
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CHRONIC MITRAL VALVE INSUFFICIENCY
CHRONIC PERIODONTAL DISEASE CAN AFFECT SEVERAL
ORGAN SYSTEMS
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.Kidne
ys Interstitial nephritis and glomerulonephritis.

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MITRAL VALVE INSUFFICIENCY
THIS IS THE OPEN LEFT VENTRICLE SHOWING
THE MITRAL VALVE LEAFLETS. WHAT ARE THE
STRING-LIKE STRUCTURES THAT ATTACH THE VALVES TO
THE PAPILLARY MUSCLES?
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MITRAL VALVE INSUFFICIENCY
CHORDAE TENDINEAE
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MITRAL VALVE INSUFFICIENCY
TOP LEAFLET IS NORMAL
BOTTOM LEAFLET IS THICKENED AND NODULAR. THIS IS
DUE TO INCREASED FIBROBLASTIC TISSUE WITHIN THE
VALVE LEAFLETS
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CHRONIC MITRAL VALVE INSUFFICIENCY
THE STIFF MALFORMED VALVE FAILS TO CLOSE
SUFFICIENTLY DURING SYSTOLE.
DURING LEFT VENTRICULAR CONTRACTION, BLOOD
FLOWS BACK INTO THE LEFT ATRIUM
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MITRAL VALVE INSUFFICIENCY
IF BLOOD CONTIUES THIS BACKWARD FLOW, THE ANIMAL
MAY EXPERIENCE LEFT-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 RESULTS IN RIGHT-SIDED
HEART FAILURE CHARACTERIZED BY PLEURAL EFFUSION
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TRICUSPID VALVE INSUFFICIENCY
RIGHT-SIDED HEART FAILURE ALSO LEADS TO ASCITES
NOTE THE LOSS OF ABDOMINAL DETAIL
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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

ADULT HEARTWORMS
MICROFILARIA OF D. IMMITIS
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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 LIVE IN THE PULMONARY
ARTERIES. THE HEART MUST WORK EXTRA HARD TO PUMP
AGAINST THIS OBSTRUCTION.
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CANINE HEARTWORM DISEASE
ADULT HEARTWORMS IN RIGHT 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 (gt60)
• 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 oximelufeneron
• 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,
followed By 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