DISEASES OF THE CARDIOVASCULAR SYSTEM:

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DISEASES OF THE CARDIOVASCULAR SYSTEM

• Cardiomyopathies
• Cogenital malformation
• CHF
• Acquired Valvular disease
• Infectious

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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 L HR
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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)
• Enalapril (avoids retention of fluid) ACE
  inhibitor, vasodilator
• Pimobendan Helps pump blood efficiently
• 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
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
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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.
• Lasix Diuretics
• Enalapril Reduces retention of fluids

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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

• Cardiomyopathies
• Cogenital malformation
• CHF
• Acquired Valvular disease
• Infectious

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DISEASES OF THE CARDIOVASCULAR SYSTEM

• HEARTWORM DISEASE

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CATS HWD
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DISTRIBUTION OF CANINE 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
Mosquito transmits L3 stage. L1 L3 develops in
the mosquito. Dog mff goes to mosquito. Dog L3
L5
ONLY FEMALE MOSQUITOES BITE
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CANINE HEARTWORM DISEASE
Intermediate host
Definitive host
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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.
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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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. 

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• 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.

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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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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
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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
• REVOLUTION
• Selamectin
• ADVANTAGE MULTI/PROHEART 6
• Moxidectin
• Q 6 month injectable

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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 (WOLBACHIA)
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• 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

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THANK YOU ROYALS 2011
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References

• Alleice Summers, Common Diseases of Companion
  Animals
• http//veterinarynews.dvm360.com/dvm/article/artic
  leDetail.jsp?id156665
• 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?URLhttp//www.vmth
  .ucdavis.edu/cardio/cases/

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References

• http//cardiology.vetmed.lsu.edu/Education/Acquire
  dCardiacDiseases/HeartwormDisease/tabid/448/Defaul
  t.aspx
• http//www.heartwormsociety.org/