Congenital heart disease in dogs and cats

The presence of congenital heart disease in dogs and cats is usually indicated by a cardiac murmur. There may or may not be further signs of cardiac failure. The type and site of a murmur often suggests the nature of the underlying lesion, but electrocardiography and radiography can give further indications of the nature of the defect. Advanced diagnostic procedures include cardiac catheterisation for angiography, blood pressure recording and blood gas analysis, but this technique is now being superseded in many cases by cardiac ultrasound. Some lesions can be demonstrated directly by echocardiography, but the source of the murmur and the severity of the deformity can be defined precisely by Doppler. Congenital cardiovascular disorders can increasingly be relieved by sophisticated surgery.     

Paraneoplastic thrombocytosis-induced systemic thromboembolism in a cat

A six-year-old cat presented with clinical signs consistent with distal aortic thromboembolism while clinical signs of cardiovascular disease were absent. Diagnostics, including thoracic radiographs, electrocardiography, and echocardiography revealed no cardiovascular anomalies. Thoracic radiographs revealed multifocal pulmonary lesions consistent with neoplasia. Complete blood cell count demonstrated a marked thrombocytosis, leukopenia, and neutropenia. Histopathology of the pulmonary lesions confirmed multiple bronchoalveolar carcinomas. Myelodysplasia with megakaryocytic hyperplasia and ineffective myelopoiesis was noted on bone-marrow histopathology from multiple sites. The absence of other causes suggested a paraneoplastic thrombocytosis. The diagnosis of paraneoplastic thrombocytosis-induced thromboembolism was made due to the lack of underlying cardiac disease and the presence of a marked thrombocytosis. The presence of thrombocytosis and thromboembolism associated with neoplasia is discussed.     

Cardiovascular changes associated with intravenous administration of fumonisin B1 in horses

OBJECTIVE: To determine whether cardiovascular dysfunction is evident in horses with leukoencephalomalacia experimentally induced by administration of fumonisin B1. ANIMALS: 11 healthy horses of various breeds (body weight, 252 to 367 kg). PROCEDURE: Horses were randomly assigned to 3 groups and administered fumonisin B1 daily. Horses received IV injections of 0 (control horses; n = 4), 0.01 (3), or 0.20 mg (4) of fumonisin B1/kg for 7 to 28 days. Horses were examined daily for evidence of neurologic disease. When neurologic signs consistent with leukoencephalomalacia were evident, horses were anesthetized, and catheters were inserted for evaluation of the cardiovascular system. After recovery from anesthesia, hemodynamic measurements were obtained. RESULTS: Fumonisin-treated horses with clinical signs of neurologic disease had evidence of cardiovascular dysfunction manifested as decreases in heart rate, cardiac output, right ventricular contractility (assessed by measuring the maximal rate of change of right ventricular pressure), coccygeal artery pulse pressure, and pH and base excess in venous blood as well as increases in systemic vascular resistance, compared with values for control horses. Fumonisin-treated horses with and without clinical signs of neurologic disease also had higher serum and right ventricular sphinganine and sphingosine concentrations than control horses. CONCLUSIONS AND CLINICAL RELEVANCE: An association was detected among fumonisin-induced neurologic disease, increased serum and myocardial sphinganine and sphingosine concentrations, and decreased cardiovascular function in horses. Fumonisin-induced decreases in cardiovascular function may contribute to the pathophysiologic development of leukoencephalomalacia in horses.     

Medical evaluation of the cardiovascular system.

The approach to pre-purchase evaluation of the equine cardiovascular system is discussed with emphasis on cardiac auscultation and on the terminology that should be used when reporting clinical findings. Innocent cardiac murmurs and arrhythmias are contrasted with those that should be considered as reliable signs of cardiovascular disease. Ultrasonography and electrocardiography are recommended to establish baseline values for future reference, to support opinions rendered by the examining veterinarians, or to provide for diagnosis and treatment.     

Assessment of the ruminant digestive system.

Evaluation of the gastrointestinal system of ruminants is a logical progression of investigation and elimination. Important aspects of the animal's history pertinent to the gastrointestinal system are described. A systematic, comprehensive technique for physical examination is presented with emphasis on the digestive and lymphatic systems. Examples of potential signs of disease are provided for each body section.     

Assessment of the value of the vertebral heart scale in the radiographic diagnosis of cardiac disease in dogs

In order to assess the influence of the vertebral heart scale (VHS) on the accuracy of the radiographic diagnosis of cardiac disease, thoracic radiographs of 50 dogs with proven cardiac disease, 26 with other thoracic diseases, and 50 with no clinical signs of cardiovascular or respiratory disease were mixed and examined by three independent, blinded observers chosen to represent a range of radiographic abilities. They first examined all the radiographs without making measurements of VHS and made a diagnosis. They then re-examined the radiographs, and measured VHS on both lateral and dorsoventral or ventrodorsal radiographs before again recording a diagnosis without reference to their original diagnoses. For all the observers, the dogs with cardiac disease had a higher mean VHS than the normal dogs. A VHS over 10.7 on the lateral radiograph was a moderately accurate sign of cardiac disease. The observers' accuracy of diagnosis did not change significantly as a result of using VHS as an adjunct to a subjective assessment of the radiographs.     

Use of breed-specific ranges for the vertebral heart scale as an aid to the radiographic diagnosis of cardiac disease in dogs.

The vertebral heart scale was measured on right lateral recumbent thoracic radiographs of 320 dogs of six popular breeds, including for each breed at least 20 dogs with no clinical signs of cardiovascular or respiratory disease and at least 19 dogs with cardiac or respiratory disease. There were significant differences between the mean values of the scale for the different breeds; the normal boxer dogs had a significantly higher mean value than the normal dogs of all the other breeds, and the labrador retrievers had a significantly higher mean value than all the other breeds except the boxer and the cavalier King Charles spaniel. For all the breeds except the boxer, there was a trend for dogs with cardiac disease (but not respiratory disease) to have higher mean values on the scale than normal dogs of the same breed; however, at the optimal value of the scale for distinguishing between dogs of each breed with and without cardiac disease, the sensitivity and specificity were relatively low, in the range 58 to 83 per cent. The scale was most accurate for the diagnosis of cardiac disease in the Yorkshire terrier and the cavalier King Charles spaniel, breeds affected by predominantly dilative forms of cardiac disease. In contrast, it was very inaccurate in the boxer, a breed that has a higher incidence of cardiac diseases associated with concentric hypertrophy.     

Diagnosis of pulmonary hypertension

Pulmonary hypertension may complicate a variety of congenital or acquired cardiac and pulmonary conditions. This vascular disorder results from conditions that lead to a chronic increase in left atrial pressure, increased pulmonary blood flow, or increased pulmonary vascular resistance. Definitive diagnosis requires cardiac catheterization and detection of systolic and mean pulmonary artery pressures exceeding 30 and 20 mm Hg, respectively. Clinical signs and historical complaints reflect underlying cardiac or pulmonary conditions, although syncope may be a predominant finding. Radiographic changes are nonspecific; however, right ventricular enlargement and enlarged pulmonary arteries should increase suspicion for the disorder. Estimates of pulmonary arterial pressure may be obtained through Doppler echocardiography. This requires detection of a high-velocity regurgitant jet across the tricuspid or pulmonic valve. Further investigation is required to determine how pulmonary hypertension impacts therapy and prognosis for dogs and cats with cardiac and pulmonary diseases.     

Assessment of the cardiovascular and lymphatic systems.

Assessment of the cardiovascular and lymphatic systems first requires a complete signalment, history, and general physical examination. Further assessment of the cardiovascular system begins with evaluation of the cardiac borders through palpation and thoracic percussion. Complete cardiac auscultation requires careful evaluation of several parameters. The location, intensity, and character of normal heart sounds are first determined. This is followed by assessment of heart rate and rhythm. Finally, special attention should be placed on identifying abnormal heart sounds and describing them based on their location, intensity, duration, sound quality, and radiation. Assessment of the arterial, venous, and capillary systems provides additional information on the status of the cardiovascular system. Assessment of the lymphatic system primarily involves evaluation of external and palpable internal lymph nodes. Commonly palpable external lymph nodes include the intermandibular, parotid, retropharyngeal, superficial cervical, subiliac, mammary, and scrotal lymph nodes. Palpable internal abdominal lymph nodes include the iliofemoral lymph nodes and the iliosacral lymph center. Other lymph nodes that may be palpable include the renal, ruminal, and mesenteric lymph nodes. Lymph nodes should be evaluated for size, consistency, and tenderness.     

Cardiovascular drugs. Their pharmacology and use in horses

Knowledge of the dosage, rate and route of administration, and potential side effects of drugs used to treat cardiac disease in horses has been refined. The judicious use of these drugs can increase exercise capacity, improve health, and potentially prolong life. Currently, antiarrhythmics (quinidine, lidocaine), positive inotropies (digoxin), and diuretics (furosemide) are the primary agents used to treat cardiovascular disease in horses. The development of newer drugs (verapamil, milrinone, bumetanide) and their usefulness in therapy for horses with cardiovascular disease require further investigation.     

Prevalence of heart disease in symptomatic cats: an overview from 1998 to 2005

A total of 408 cats with various cardiovascular problems has been presented to two investigational clinics during the last 8 years. The number of yearly examinations has steadily increased during this period. Definitive cardiovascular disease was diagnosed in 287 cats, whereby hypertrophic cardiomyopathy (HCM) was the most common diagnosis with 67.6%. Congenital cardiovascular malformations were found in 11.8% of the cases. Ventricular septal defect (VSD) was the most frequent anomaly, in contrast to previously published studies. The ECG was found to be relatively non-specific and insensitive for the diagnosis of heart disease: Its usefulness lies in the recognition and diagnosis of cardiac arrhythmias. The radiographically recognized changes were also non-specific for certain heart diseases. Radiographs of the thorax are especially useful in the evaluation of cardiomegaly, and secondary signs of congestion.     

The clinical pathology of heartwater. II. Studies on cardiac and pulmonary function in 4 calves with experimentally-induced heartwater

Studies to evaluate cardiac and pulmonary function were undertaken in 4 calves suffering from experimentally-induced heartwater. There was a marked variation in the course of the disease. Three of the calves recovered spontaneously after developing clinical signs. These included a rectal temperature in excess of 40 degrees C, anorexia and listlessness but no neurological signs. The remaining calf died 2 days after developing a fever and neurological signs. In the 3 calves that recovered, a mild hypoxemia developed during the acute stage of the disease. Arterial CO2 tension remained within normal limits, but there was a tendency towards an alkalosis. Increases in pulmonary dead space and fluctuations in venous admixture were observed. The calf that died showed similar mild changes in blood gas parameters, despite the presence of a marked reduction in minute volume, and a lung oedema was demonstrated on post-mortem examination. No marked changes in systolic and diastolic blood pressures and in right cardiac intraventricular pressures were observed. Terminally, however, there were marked decreases in stroke volume and cardiac output. These changes were associated with a sharp increase in heart rate. No primary cardiac pathology was observed on clinical and post-mortem examinations.     

Haemodynamic changes during sedation in ponies

The cardiovascular changes induced by several sedatives were investigated in five ponies with a subcutaneously transposed carotid artery by means of cardiac output determinations (thermodilution technique), systemic and pulmonary artery pressure measurements (direct intravascular method) and arterial blood analysis (blood gases and packed cell volume). The cardiovascular depression (decrease in systemic blood pressure and cardiac output) was long lasting (greater than 90 min) after administration of propionylpromazine (0.08 mg/kg intravenous (i.v.)) together with promethazine (0.08 mg/kg i.v.). The phenothiazine-induced sedation was not optimal. alpha 2-Agonists (xylazine (0.60 mg/kg i.v.) and detomidine (20 micrograms/kg i.v.)) induced initial but transient cardiovascular effects with an increase in systemic blood pressure and a decrease in cardiac output for about 15 min. Second degree atrioventricular blocks and bradycardia were seen during this period. The cardiovascular depression was more pronounced during detomidine sedation. Atropine (0.01 mg/kg i.v.) induced a tachycardia with a decrease in stroke volume but did not alter the cardiac output or other cardiovascular parameters. It prevented the occurrence of the bradycardia and heart blocks normally induced by xylazine or detomidine. Atropine potentiated the initial hypertension induced by the alpha 2-agonistic sedatives (especially detomidine). The decrease in cardiac output induced by xylazine, and to a lesser extent by detomidine, was partially counteracted when atropine was given in advance. The atropine-xylazine combination seemed the best premedication protocol before general anaesthesia as it only resulted in minor and transient cardiovascular changes.     

Aortic foreign body (airgun pellet) embolism in a cat

A five-year-old female domestic shorthair cat presented with clinical signs typical of an aortic saddle thromboembolism. An echocardiogram and thoracic radiographs excluded cardiac disease as a source of the thrombus. Two heavy metal opacity, pellet-like objects were seen in the thoracic and abdominal radiographs. Abdominal ultrasound demonstrated occlusion of aortic blood flow by the abdominal pellet but could not indicate whether this was due to a penetrating aortic wound or pellet embolisation. A necropsy confirmed a penetrating left ventricular cardiac wound with subsequent embolisation of the pellet to the abdominal aorta.     

Canine hypertrophic cardiomyopathy.

Necropsy findings in 10 dogs with naturally occurring cardiac disease closely resembled hypertrophic cardiomyopathy in human beings and cats. Each dog had marked cardiac hypertrophy, and 8 dogs had disproportionate thickening of the ventricular septum with respect to the left ventricular free wall (compared with dogs with normal hearts or with cardiac hypertrophy due to acquired or congenital heart disease). Ratios of septum to free wall thickness in the 10 dogs ranged from 1.1 to 1.5, and 6 had ratios greater than or equal to 1.3. Marked cardiac muscle cell disorganization in the ventricular septum, characteristic of human patients with hypertrophic cardiomyopathy, was found in only 2 of the 10 dogs. Death occurred while the dogs were under anesthesia during the course of operative procedures (5 dogs) or unexpectedly in animals without previous manifestations of cardiac disease (3 dogs). Four dogs had clinical signs of congestive heart failure, including 2 with marked cardiac decompensation. Two of these 4 dogs with heart failure and 1 dog that died during unrelated surgery, but without prior signs of heart disease, had electrocardiographic evidence of complete heart block.     

Treatment of cardiovascular disease in cattle.

Cardiac diseases of cattle may involve valvular structures, myocardium, pericardium, or blood vessels and are manifested by the clinical signs of cardiac dysrhythmias, cardiac murmurs, generalized edema, muffled heart sounds, jugular venous distention, jugular venous pulsations, pulmonary edema, pleural effusion, or ascites. Digoxin, quinidine, and furosemide can be used effectively to control signs of CHF and cardiac arrhythmias. Combination antimicrobial therapy can be successful for cows with infective endocarditis and thrombophlebitis. Pericardial fluid drainage may temporarily improve cattle with traumatic pericarditis or lymphosarcoma so that short-term goals may be reached.     

Hypoplasia of the trachea in dogs: 103 cases (1974-1990).

A multi-institutional retrospective study of 103 dogs in which hypoplasia of the trachea was diagnosed was conducted. Bulldogs (55%) and Boston Terriers (15%) were most commonly affected. Age at diagnosis ranged from 2 days to 12 years, with a median of 5 months. Hypoplasia of the trachea was diagnosed more frequently in males (66%) than females (34%). Congenital anomalies in dogs with hypoplasia of the trachea included elongated soft palate (n = 44), stenotic nares (n = 23), cardiac defects (n = 12), and megaesophagus (n = 10). Ratios between tracheal lumen diameter and depth of the thoracic inlet or width of the third rib did not correlate with dyspnea. Of 42 dogs reexamined greater than 6 months after diagnosis, 25 (60%) were clinically normal. The remaining 17 were dyspneic and 15 (88%) had concurrent respiratory or cardiovascular disease that could account for their clinical signs. Hypoplasia of the trachea appears to be tolerated well in the absence of concurrent respiratory or cardiovascular disease.     

Norwich terriers possess a greater vertebral heart scale than the canine reference value

Previous studies have demonstrated evidence that normal reference ranges for radiographic vertebral heart scale values can vary among dog breeds. The purpose of this retrospective, observational study was to determine whether the normal vertebral heart scale values published by Buchanan and Bücheler for lateral radiographs are applicable to the Norwich terrier. Secondary objectives were to determine if clinical signs of respiratory disease, age, sex, weight, body condition score, recumbency, or thoracic depth‐to‐width ratio had any influence on vertebral heart scale measurements in this breed. The electronic medical record systems of two universities were reviewed and Norwich terriers were included in the study if they had orthogonal thoracic radiographs performed and no historical or radiographic evidence of cardiopulmonary disease. A vertebral heart scale was calculated for each patient. Sixty‐one client‐owned, Norwich terrier dogs with no clinical signs of cardiovascular disease were evaluated. The vertebral heart scale for Norwich terriers without evidence of cardiac disease (10.6 ± 0.6) was found to be significantly greater than the canine reference value of 9.7 ± 0.5 initially established by Buchanan and Bücheler. No significant correlation was found between clinical signs of respiratory disease, sex, age, thoracic depth‐to‐width ratio or lateral recumbency, and vertebral heart scale. Norwich terriers with a body condition score ≥6 had a significantly higher vertebral heart scale than those with a body condition score ≤5. Breed‐specific ranges and body condition scores need to be considered when interpreting vertebral heart scale values for Norwich terriers.     

Electrocardiography in the horse. (A report of findings in 138 horses)

Over a period of approx. 3 years, electrocardiograms (ECG) were recorded from 138 horses referred as patients to the Medical Clinic. Of these, 22 horses (approx. 16 per cent) has ECG alterations. The 22 ECG's revealed a total of 29 ECG abnormalities. The most frequent ECG alteration was incomplete AV block, that was seen in 9 horses (31 per cent of the ECG abnormalities). Abnormal (i.e. broad, tent-like and, sometimes, inverted) T waves and deviations of the ST segment were seen each in 5 ECG's from 7 horses, 3 of which had both abnormalities which were associated with severe underlying disease (colic, enteritis, pneumonia, strangles a.o.). Premature ventricular beats were seen in 3 horses, two of which had serious cardiovascular dysfunction whereas the third showed no signs of cardiac disease. Atrial fibrillation was observed in two horses. Both were treated with chinidine sulphate but a conversion to sinus rhythm was not achieved in either case. Other ECG abnormalities observed in the study were, parasystole (1 horse), sinus arrhythmia (2 horses), sinoatrial block (1 horse) and wandering pacemaker (1 horse). Each abnormality is discussed with regard to its clinical significance and diagnosis. Cardiac murmurs were detected on auscultation of 26 horses (approx. 19 per cent). The murmurs in 15 horses were short and faint sounds most of which were diastolic. They were considered of no importance. Eleven horses, on the other hand, had distinct, loud (grade 4 or 5), holosystolic or holodiastolic murmurs that were considered pathological. Eight of these horses had actual signs of cardiac disease. Cardiac vector distribution in patients with ECG abnormalities or murmurs showed no systematic differences from vectors in horses showing no cardiac abnormality.     

Third-degree atrioventricular block in 21 cats (1997-2004)

The effect of 3rd-degree atrioventricular block on long-term outcome in cats is unknown. Clinical findings and long-term outcome of 21 cats with 3rd-degree atrioventricular block were studied retrospectively. Median age of cats studied was 14 years (range 7-19 years). Presenting signs included respiratory distress or collapse, but 6 cats had no clinical signs of disease. Eight cats had congestive heart failure (CHF) at the time that 3rd-degree atrioventricular block was detected. Heart rates ranged from 80 to 140 beats per minute (bpm; median 120 bpm) with no difference in heart rate between cats with and those without CHF. Eleven of 18 cats that had echocardiograms had structural cardiac disease, and 6 cats had cardiac changes consistent with concurrent systemic disease. No atrioventricular nodal lesions were detected by echocardiography. One cat had atrioventricular nodal lesions detected on histologic examination. Median survival of 14 cats that died or were euthanized was 386 days (range 1-2,013 days). Survival did not differ between cats with or without CHF or between cats with or without structural cardiac disease. Thirteen cats with 3rd-degree atrioventricular block survived > 1 year after diagnosis, regardless of presenting signs or underlying cardiac disease. Third-degree heart block in cats is often not immediately life threatening. Survival was not affected by the presence of underlying heart disease or congestive heart failure at the time of presentation. Even cats with collapse might survive > 1 year without pacemaker implantation.