DISEASES OF THE CARDIOVASCULAR SYSTEM Cardiomyopathies Cogenital malformation

DISEASES OF THE CARDIOVASCULAR SYSTEM: Cardiomyopathies Cogenital malformation CHF Acquired 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 COMMON CAUSES IS CHRONIC PERIODONTAL DISEASE! BACTERIA THAT LIVE IN TARTAR, GET SHOWERED INTO THE BLOOD STREAM AND COLONIZE IN THE VALVE LEAFLETS.

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. Kidneys: Interstitial nephritis and glomerulonephritis.

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?

MITRAL VALVE INSUFFICIENCY CHORDAE TENDINEAE

MITRAL VALVE INSUFFICIENCY TOP LEAFLET IS NORMAL BOTTOM LEAFLET IS THICKENED AND NODULAR. THIS IS DUE TO INCREASED FIBROBLASTIC TISSUE WITHIN THE VALVE LEAFLETS L HR

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

MITRAL VALVE INSUFFICIENCY IF BLOOD CONTIUES THIS BACKWARD FLOW, THE ANIMAL MAY EXPERIENCE LEFT-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 RESULTS IN RIGHT-SIDED HEART FAILURE CHARACTERIZED BY PLEURAL EFFUSION

TRICUSPID VALVE INSUFFICIENCY Ascites. Blood backs up in vena cava and this back up causes back overload, liver overloaded with fluids. Vascular permeability, leaky vessels. RIGHT-SIDED HEART FAILURE ALSO LEADS TO pleural effusion and ASCITES NOTE: THE LOSS OF ABDOMINAL DETAIL

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: Cardiomyopathies Cogenital malformation CHF Acquired 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 Mosquito transmits L 3 stage. L 1 – L 3 develops in the mosquito. Dog mff goes to mosquito. Dog L 3 – L 5 ONLY FEMALE MOSQUITOES BITE

CANINE HEARTWORM DISEASE Intermediate host Definitive host

CANINE HEARTWORM DISEASE ADULT HEARTWORMS LIVE IN THE PULMONARY ARTERIES. THE HEART MUST WORK EXTRA HARD TO PUMP AGAINST THIS OBSTRUCTION. ADULT HEARTWORMS IN RIGHT 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.

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, 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 (L 5) 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: 1 mg/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: 1 mg/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: 1 mg/lb BID X 3 days PO before melarsomine injection; – Famotidine 0. 5 mg/kg SQ: before melarsomine injection – Melarsormine: 0. 1 mls/ kg IM

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References • Alleice Summers, Common Diseases of Companion Animals • http: //veterinarynews. dvm 360. com/dvm/article. Detail. jsp? id=156665 • VIN: Robert Prosek DVM, MS, DACVIMCardiology, DECVIM-CA • Echocardiography in the Dog, Cat and Horse: Dr. Francesco Porciello, 2009 • http: //www. vin. com/Web. Link. plx? URL=http: / /www. vmth. ucdavis. edu/cardio/cases/

References • http: //cardiology. vetmed. lsu. edu/Education/Ac quired. Cardiac. Diseases/Heartworm. Disease/tabi d/448/Default. aspx • http: //www. heartwormsociety. org/