Cardiovascular Cardiovascular Disease

Diseases  Cardiac Output = Stroke volume x Heart rate

 Abnormalities of the Cardiovascular system
– Valvular Disease
– Myocardial Disease
– Cardiac Shunts
– Arrythmias
– Heartworm Disease
– Vascular Disease

Cardiovascular Disease Cardiovascular Disease

 Valvular Disease  Pulmonic and Aortic stenosis

– AV valve regurgitation (mitral and tricuspid) – All valvular diseases can lead to CHF
– Mitral Regurgitation: most common
• Most common in small breed dogs (bad teeth?)
and old horses

Canine Dilated Cardiomyopathy

Cardiovascular Disease
(DCM)
 Myocardial Disease
– Dilated Cardiomyopathy (Dogs)  One of the most common acquired
• Ventricular walls become very thin and flaccid
– Heart can “balloon” to very large size cardiovascular diseases of dogs

– Hypertrophic Cardiomyopathy (Cats)

• Ventricular walls become very thickened
– Myocardial diseases can result in CHF or sudden
death. Thrombosis is a common sequelae of
HCM
 A disease of older male large and giant breed
dogs
– Dobermans, Boxers, Irish Wolfhounds, St.
Bernards, Newfoundlands, also seen in English
and American Cocker Spaniels

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Canine Dilated Cardiomyopathy
(DCM)
 Pathology:
– Dilation of all chambers of the heart.
– This dilation (weak, thin, and flabby cardiac
muscle) results in a decreased cardiac
output and an increase in cardiac afterload
(blood left in the heart during diastole).
Canine Dilated Cardiomyopathy
(DCM)
 Dogs with DCM frequently develop atrial
fibrillation
– Further contributes to a decrease in
cardiac output.
– Signs of atrial fibrillation:
• Rapid irregular heart rhythms and sudden
death
Canine Dilated Cardiomyopathy
(DCM)
 Diagnosis
– Radiographs
• Enlarged heart
– Echocardiography
• Indicates dilated chambers
– ECG
• Widened QRS and p waves
• Rhythm disturbances, atrial fib
Canine Dilated Cardiomyopathy
(DCM)
 Etiology
– Unknown… although viral, nutritional, immune-
mediated, and genetic causes have been
proposed.
– DCM results in decreased stroke volume (volume
of blood ejected from the heart with each
contraction)
– Low output circulatory failure results in weakness,
exercise intolerance, syncope, or shock.
Canine Dilated Cardiomyopathy
(DCM)
 Clinical signs
– Right heart failure: ascites, hepatomegaly,
weight loss, abdominal distension
– Left heart failure: coughing, pulmonary
edema, syncope
– Exercise intolerance
Canine Dilated Cardiomyopathy
(DCM)
 Treatment
– There is no cure.
– Treatment is aimed at keeping the dog
comfortable.
• Diuretics (furosemide), Digoxin, Enalapril
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Canine Dilated Cardiomyopathy
(DCM)
 Information for clients
– This is almost always a fatal disease
– Most dogs will die within 6 months to 2
years
– Dogs may die suddenly from cardiac Feline Hypertrophic
arrhythmia
Cardiomyopathy (HCM)
– The disease appears to be more prevalent
in certain breeds of dogs

Feline Hypertrophic Feline Hypertrophic

Cardiomyopathy (HCM) Cardiomyopathy (HCM)
 Clinical signs:
 Left ventricular hypertrophy is the – Soft, systolic murmur
predominant pathology – Gallop rhythms or other arrhythmia
– Acute onset of heart failure or systemic
thromboembolism
 Neutered, male cats between the ages
of 1 and 16 yrs

Feline Hypertrophic Feline Hypertrophic

Cardiomyopathy (HCM) Cardiomyopathy (HCM)
 Thromboembolism:  Diagnosis:
– 10% to 20% of cats with HCM will develop – Radiographs
thrombi in the left heart. • Valentine heart shaped appearance
– Thrombi may dislodge and become
– ECG
trapped elsewhere in the arterial system.
• Increased P wave duration, increased QRS
– 90% of these emboli lodge as “saddle width, and sinus tachycardia
thrombi” in the distal aortic trifugation
resulting in hind limb pain and paresis. – Echocardiogram
– Prognosis is guarded to poor • Abnormal measurements

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 Feline Hypertrophic Feline Hypertrophic
Cardiomyopathy (HCM) Cardiomyopathy (HCM)
 Treatment:  Information for clients:
– Furosemide – Cats with HCM may experience heart
– Propranolol failure, arterial embolism, and sudden
– Monitor ECG, heart rate, and blood death
pressure – Cats with heart rates <200 beats/min have
a better prognosis

Uncommon Cardiomyopathy
Diseases
 Feline Dilated Cardiomyopathy
– Occurs in cats fed taurine-deficient diets
– Uncommon due to the addition of taurine in
commercial diets
 Canine Hypertrophic Cardiomyopathy
– Very uncommon
Cardiovascular Disease
 Cardiac Shunts
– Patent Ductus Arteriosis
• Between aorta and pulmonary trunk
– Ventricular Septal Defect
• Between left and right ventricles
– Atrial Septal Defect
• Between left and right atria
– Tetrology of Fallot
– Cardiac shunts will lead to CHF

Cardiovascular Disease Heartworm Disease

 Arrhythmias: A heart beating too fast (remember
the term?), a heart beating too slow (remember
the term?), or too irregularly to maintain an
adequate cardiac output
 Most common
– Atrial Fibrillation (Horses and Large breed dogs)
– Ventricular Premature Depolarization
 Disease of worldwide significance
 Concentrated in area within 150 miles of
coastal regions, but it can be seen anywhere
 Spread by many different species of
mosquitoes
 Male dogs are more frequently infected
 Outside dogs are more frequently infected

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Heartworm Disease
 Large breed dogs appear to be more
susceptible
 Mosquito bites are less common in cats but
there is a continuous growth of Feline
Heartworm Disease
 Technicians must memorize the lifecycle of
Heartworm Disease for client education.
Heartworm Disease
 Lifecycle continued:
– The infective larvae migrate within the skin
of the new host for about 100 days.
– Young adults (L5 stage) enter the
vasculature and migrate to the pulmonary
artery where they mature into adults.
– Approximately 6 months after the initial
bite, microfilaria can be detected in the
blood of the host dog.
Heartworm Disease
 Clinical Signs:
– Cough, dyspnea
– Exercise intolerance
– Hemoptysis (coughing up blood)
– Signs of right heart failure
– Poor haircoat
Heartworm Disease
 Lifecycle:
– Female mosquito serves as the intermediate host
by obtaining a blood meal from a dog containing
the microfilaria of Dirofilaria immitis.
– Microfilaria develop in the mosquito within 2 to 2.5
weeks and then injected into the skin of another
dog through a mosquito bite.
Heartworm Disease
 Disease severity depends on number of
adult heartworms
 Physical presence of parasites results in
right-sided heart enlargement and
pulmonary hypertension.
 Severe heartworm disease causes CHF
Heartworm Disease
 Diagnosis:
– Positive antigen test
– Positive microfilaria test
• Filter technique, Knott’s test, direct method
– Radiographs
• Right ventricular enlargement
• Increased prominence of pulmonary artery
• Pulmonary edema
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Heartworm Disease Heartworm Disease

 Treatment:  Treatment continued:

– Pretreatment laboratory workup to – Adulticide treatment
determine severity • Tiacetarsamide (Caparsolate): 4 IV injections
over a period of 2 days, can cause
extravascular sloughing
• CBC, serum chemistry profile, and chest
radiographs
• Melarsamine dihydrochloride (Immiticide): IM
injection made deep into the lumbar muscle
given at 24-hour intervals

Heartworm Disease Heartworm Disease

 Treatment continued:  Prevention:
Microfilaricide treatment:
– Ivermectin (Heartguard)monthly
– Give 3 to 6 weeks after the adulticide treatment – Milbemycin oxime (Interrceptor) monthly
– Oral dose of Ivermectin mixed with propylene – Diethylcarbamazine (DEC)(Filaribits) daily
glycol or water • Do not use in heartworm positive dogs
• Use care in treating Collies due to genetic susceptibility
to ivermectin toxicity – Selamectin (Revolution)
– Other options: – Proheart 6 month injection
• Milbemycin oxime given as a single dose
• Injectable Ivermectin

Feline Heartworm Disease Cardiovascular Disease

 Cats are also at risk but much less common
than dogs
 Few adult worms and lack of microfilaria
 Symptoms differ:
– Sudden death of an asymptomatic cat
– Respiratory (cough and dyspnea) or
gastrointestinal tract (vomiting, anorexia,
lethargy)
 Treatment and prevention is controversial
 Most cardiovascular disease of
domestic animals is cardiac disease.
This is in contrast to humans that have
much more vascular disease
 Primary vascular disease in veterinary
medicine is rare.

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Cardiovascular Disease Cardiovascular Disease
 Diagnosis of Cardiovascular Disease  Clinical Signs of Cardiovascular
– History, Signalment
• Many breeds have predilection for specific
Disease might include:
cardiovascular diseases – Lethargy
– Old Cocker spaniels: mitral regurgitation
– Middle age Doberman pinschers, Boxers: DCM – Weight loss
– Young Golden Retrievers: Aortic Stenosis
– Cough
– Physical exam (especially auscultation)
– Radiography – Syncope
– Electrocardiogram (ECG)
– Echocardiography

Heart Failure Congested Heart Failure

 Heart Failure: cardiac output is inappropriate
to perfuse organs with enough oxygenated  Heart Failure is termed congestive heart
blood for the organs to function properly failure when the failing heart allows fluid
either at rest or during exercise
congestion to accumulate in the body,
 Congestive Heart Failure: Blood dams up in
organs-usually the lungs but occasionally in
resulting in edema.
the systemic organs- and causes the
congested organs to function abnormally or to  Most heart failure will become
become edematous “congestive” as the pump progressively
 Many lay people hear the term heart failure fails.
and think “cardiac arrest.” These are two
different conditions.

Congestive Heart Failure Congestive Heart Failure

 Pathophysiology:
 Congestive heart failure is a clinical – In left sided Congestive heart failure, blood
syndrome that has many causes dams up where?
 A diagnosis of CHF, does not presume an • Therefore what symptoms would you see?
etiology. The client will want to know “why”
 All of the above mentioned diseases can – In right sided Congestive heart failure, blood
result in congestive heart failure and the dams up where?
animals will present with symptoms • Therefore what symptoms would you see?
consistent with CHF

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Congestive Heart Failure
 Whether the disease starts out as left or
right sided failure, both sides will
eventually be affected and eventually
left-sided symptoms will predominate
due to the severe consequences of
pulmonary edema
Therapy of Congestive Heart
Failure
 The goal in treating Heart Failure is to
maintain adequete C.O. without making
the heart work “too hard”
 1. Diet: low salt
 2. Diuretics:
 3. Vasodilators:
 4. Positive Inotropic Agents:
 (specific medications to be covered in
pharmacology)

Respiratory Respiratory Diseases

Diseases  Clinical Signs of Respiratory Disease
– Nasal Discharge
• Epistaxis
– Coughing
• hemoptysis
– Dyspnea
• Crackles, Wheezes
– Hyperpnea/Tachypnea

Lower Airway disease

Upper Airway Disease
– URI
– Tracheal Collapse
– Brachycephalic syndrome
• Stenotic nares
• Elongated soft-palate
– Equine Laryngeal Hemiplegia (“Roaring”)
– Equine Guttural Pouch Disease
• Usually a streptococcal bacteria
– Bronchitis
• Infectious, Allergic, Idiopathic
– Feline Asthma
– Equine C.O.P.D. (“heaves”)
• Non infectious disease characterized by dyspnea,
increased abdominal expiratory effort, chronic coughing,
nasal discharge, lack of stamina
• Usually caused by exposure to dust and/or molds
– Pneumonia:
• Any animal can suffer from pneumonia, there are many
infectious agents of cattle that cause severe pneumonia
• Aspiration pneumonia
– Respiratory Parasites

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 Principals of Treatment
 Eliminate underlying cause
– Antibiotics
– Removal of allergen
– Surgery
 Anti-inflammatories
– Corticosteroids
– Antihistamines
Feline Chronic Bronchial
 Bronchodialators
 Anti-tussive agents
Disease (Feline Asthma)
 Specific drugs to be covered in pharmacology

Feline Chronic Bronchial Disease Feline Chronic Bronchial Disease

(Feline Asthma)
 Feline asthma, as in human asthma, is a
disease characterized by spontaneous
bronchoconstriction, airway inflammation, and
airway hyperreactivity.
(Feline Asthma)
 Results in decreased airflow
 A 50% decrease in the lumen of the airway
results in a 16-fold decrease in amount of air.

 Clinical Signs:  Primary goals of treatment:

– Coughing, wheezing, lethargy and acute onset of
– Decreasing inflammation in the airways
labored breathing
– Improving airflow

Feline Chronic Bronchial Disease Feline Chronic Bronchial Disease

(Feline Asthma) (Feline Asthma)
 Diagnosis:  Treatment:
– Clinical signs – Manage airway inflammation with
corticosteroid therapy
– History
• Prednisone
– Radiographs • DepoMedrol
• May show diffuse bronchial markings indicating – Bronchodilators
airway inflammation (“doughnuts”) • Terbutaline
• Cyproheptadine
– Oxygen therapy

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Feline Chronic Bronchial Disease
(Feline Asthma)
 Information for clients: Heaves in Horses
– Prognosis is variable
– If allergens can be determined and
exposure decreased before permanent
damage occurs, most cats do well.
– Aggressive treatment at the veterinary Chronic Obstructive
hospital is needed for acute bouts of Pulmonary Disease
respiratory distress.
– A cure is usually not possible. (COPD)

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary

Disease (COPD) Disease (COPD)
 Etiology:
 A noninfectious respiratory disease of – Exposure to dust, molds, or other air
horses characterized by dyspnea, pollutants
increased abdominal expiratory effort, – Triggering factors:
chronic coughing, nasal discharge, and • Prior respiratory tract infections, diet, or a
hereditary predisposition
lack of stamina
– Uncommon in horses <6 yrs. old

Chronic Obstructive Pulmonary Chronic Obstructive Pulmonary

Disease (COPD) Disease (COPD)
 Clinical Findings:  Diagnosis:
– History of spending time being stabled in a – History
dusty (sawdust bedding) poorly ventilated – Clinical signs
area. – Endoscopy
– Horse eating dusty or moldy hay – Evaluation of tracheobronchial exudate
– Expiration is labored (heave line may be – Chest radiograph (limited visibility)
present)
– Persistent Cough

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Chronic Obstructive Pulmonary
Disease (COPD)
 Treatment: Any Questions?
– Improve the environment!
• Turn horse out of doors permanently
• Remove inciting cause
– Ex. Moldy hay
• Dust free stable management such as using paper or
wood chips for bedding and feeding complete cubes,
vacuum-packed grass, silage, or thoroughly soaked hay.
– Bronchodilators, corticosteroids, and sometimes
antibiotics.

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