DON’T COMPARE YOURSELF TO OTHERS “ Everyone is a genius, but if you judge a fish by its ability...

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

DISEASES OF THE DISEASES OF THE CARDIOVASCULAR CARDIOVASCULAR SYSTEM:SYSTEM:

CARDIOMYOPATHIESCARDIOMYOPATHIES

PATIENT PRESENTATIONPATIENT PRESENTATION

http://www.youtube.com/watch?v=X-wLIoYTpOU

http://www.youtube.com/watch?v=Zp7CiC7SXjk

FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHYCARDIOMYOPATHY

NEUTERED MALE CATS BETWEEN 1-16 YRS. OF AGE

THE MOST COMMON CARDIOMYOPATHY IN CATS!

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


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

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

FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: CARDIOMYOPATHY: PathophysiologyPathophysiology

PROBLEM #1: The walls lose compliance and resist filling during diastole! (diastolic failure)

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”***

FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUSCARDIOMYOPATHY: SADDLE THROMBUS

ACUTE, PAINFUL CONDITION CAUSINGPARESIS, COLD REAR LEGS/FEET!

FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: SADDLE THROMBUSCARDIOMYOPATHY: SADDLE THROMBUS

FELINE HYPERTROPHIC FELINE HYPERTROPHIC CARDIOMYOPATHY: TREATMENTCARDIOMYOPATHY: TREATMENT

OR

PROPRANOLOL (B-BLOCKER) DILTIAZEM (CALCIUM CHANNEL BLOCKER)

FUROSEMIDE (DIURETIC)

ANTICOAGULANT

ASPIRIN

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

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

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

DISEASES OF THE DISEASES OF THE CARDIOVASCULAR CARDIOVASCULAR SYSTEM:SYSTEM:

CONGENITAL DEFECTSCONGENITAL DEFECTS

CONGENITAL DEFECTS: PATENT CONGENITAL DEFECTS: PATENT DUCTUS ARTERIOSUSDUCTUS ARTERIOSUS

CHIHUAHUAS, MALTESE, POODLE, POMERANIAN, SHELTIE PUPPIES COMMONLY AFFECTED

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.

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

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

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

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

PATENT DUCTUS ARTERIOSUS: PATENT DUCTUS ARTERIOSUS: TREATMENTTREATMENT

EXCELLENT PROGNOSIS WITH SURGICAL CORRECTION: LIGATION OF THE DUCTUS ARTERIOSUS

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

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


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


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.


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

CONGENITAL DEFECTS: CONGENITAL DEFECTS: PULMONIC STENOSISPULMONIC STENOSIS

Chihuahuas, English Bulldogs, are commonly affected. CAUSE: polygenic inheritance

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.

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.

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

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

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.

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

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.

CONGENITAL DEFECTS: SUBAORTIC CONGENITAL DEFECTS: SUBAORTIC STENOSISSTENOSIS

THE HARD WORK RESULTS IN LEFT VENTRICULAR HYPERTROPHY, LEFT ATRIAL ENLARGEMENT, AORTIC DILATION

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

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

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)

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

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

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


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


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


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


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

CONGENITAL DEFECTS: CONGENITAL DEFECTS: PERSISTENT RIGHT 4PERSISTENT RIGHT 4THTH AORTIC AORTIC ARCHARCH

Great Danes, German Shepherds, Irish Settersare most commonly affected


Clinical signs include regurgitation due to megaesophagus, aspiration pneumonia, dyspnea, weight loss


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

DISEASES OF THE CARDIOVASCULAR SYSTEM

ACQUIRED VALVULAR DISEASES

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.


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?


CHORDAE TENDINEAE


BOTTOM LEAFLET ISTHICKENED AND NODULAR. THISIS DUE TO INCREASED FIBROBLASTIC TISSUE WITHINTHE VALVE LEAFLETS

TOP LEAFLET IS NORMAL


DURING LEFT VENTRICULARCONTRACTION, BLOOD FLOWSBACK INTO THE LEFT ATRIUM

THE STIFF MALFORMED VALVE FAILS TO CLOSE SUFFICIENTLYDURING SYSTOLE.


IF BLOOD CONTIUES THIS BACKWARDFLOW, THE ANIMAL MAY EXPERIENCELEFT-SIDED HEART FAILURE CHARACTERIZED BY PULMONARY EDEMA


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

TRICUSPID VALVE INSUFFICIENCY


TRICUSPID INSUFFICIENCY RESULTSIN RIGHT-SIDED HEART FAILURECHARACTERIZED BY PLEURAL EFFUSION


RIGHT-SIDED HEART FAILURE ALSOLEADS TO ASCITES

NOTE: THE LOSS OF ABDOMINALDETAIL


Treatment and client info are the same as for mtiral insufficiency; repeated abdominocentesis may be needed in these cases.

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

HEARTWORM DISEASE

CANINE HEARTWORM DISEASE PARASITE CAUSING HEARTWORM

DISEASE: DIROFILARIA IMMITIS

MICROFILARIA OF D. IMMITIS ADULT HEARTWORMS

CANINE HEARTWORM DISEASE

ONLY FEMALE MOSQUITOES BITE

DISTRIBUTION OF 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


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

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


IDEXX SNAP TEST

ADULT FEMALE ANTIGEN

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

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

DON’T COMPARE YOURSELF TO OTHERS “ Everyone is a genius, but if you judge a fish by its ability...

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