Comparison of plasma aldosterone concentration among clinical status groups of dogs with chronic heart failure

The plasma aldosterone concentration (PAC) among clinical status groups of 23 dogs with chronic heart failure was compared at various times after diagnosis of the problem. Eighteen dogs admitted in New York Heart Association (NYHA) class IV clinical status had significant elevations in PAC (P<0.0001), when compared with clinically normal dogs. Five dogs admitted in NYHA class III status and 4 dogs that responded with a change to NYHA class III status had significant elevations in PAC (P<0.01), when compared with clinically normal dogs. In patients with NYHA class IV status, the PAC was significantly greater (P<0.01) than in patients in NYHA class III status. For patients with the poorest prognosis, ie, severe signs of NYHA class IV status, the PAC was not markedly different, when compared with that for patients with a favorable prognosis, ie, recent onset of signs of NYHA class IV status. Patients treated with captopril had significantly lower PAC after therapy (P<0.01), whereas patients treated with hydralazine had significantly higher PAC (P<0.05) after therapy. It was concluded that heart failure in the dog increases PAC, most likely because of renin-angiotensin-aldosterone-system activation, and that the increase is related directly to the clinical status of the patient. Further, it was concluded that treatment of dogs in heart failure with captopril causes a decrease in circulating PAC, whereas treatment with hydralazine causes an increase in circulating PAC.     

Echocardiographic and clinical effects of milrinone in dogs with myocardial failure

Milrinone is a recently synthesized bypyridine compound with positive inotropic and arteriolar dilating properties in persons and experimental animals. To examine the efficacy and safety of milrinone to treat myocardial failure in dogs, dogs with myocardial failure were selected from the patient populations of 3 veterinary hospitals. Progressively increased dosages of milrinone, from 0.05 to 1.0 mg/kg of body weight, were administered over 14 days, and cardiac responses, as determined by M-mode echocardiography, and clinical responses were recorded. An effective dosage of milrinone was identified for each dog and administered for 4 weeks to evaluate the stability of the cardiac response. A randomized blinded study of drug vs nondrug capsule or nondrug elixer (designated placebo) was performed at the end of 4 weeks to eliminate possible effects of investigator bias or spontaneous regression of the disease. The duration of drug effect was determined by evaluating echocardiographic measurements of left ventricular function for 12 hours after drug administration. Echocardiographic evaluation of left ventricular function improved in dogs given milrinone. The effective dosage was between 0.5 and 1.0 mg/kg. Tolerance to milrinone did not develop during the 4-week study. In dogs given placebo during the randomized blinded study, echocardiographic values decreased significantly. Dogs that were given milrinone remained echocardiographically stable. During the study, 6 dogs improved clinically, 5 remained the same, 1 had a decrease in exercise tolerance, 1 died of severe heart failure, and 1 died of hypoadrenocorticism. Ventricular tachydysrhythmia was exacerbated in 2 dogs, but was not treated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Milrinone

Milrinone, a positive inotropic drug with vasodilating properties, was administered at doses of 0.5 to 1 mg/kg orally twice daily to 29 dogs with moderate to severe congestive heart failure (CHF). Significant echocardiographic improvement in ventricular systolic function was observed after 3 days of administration of milrinone and at the patients' last echocardiographic observation (day 21 in 25 subjects, day 7 in 2 subjects, and day 3 in 2 subjects). Echocardiographic shortening fraction at the initial measurement had a median increase of 6.14% (P less than 0.001), and for the last observation a 2.83% increase (P less than 0.005). Most patients also showed improvement in their clinical signs as assessed by the veterinarian (72%) and by owner's evaluation (81%). No consistent problem or adverse reaction to milrinone was observed, except for a small number of clinically manageable ventricular dysrhythmias. Milrinone appears in this trial to be effective for the treatment of advanced CHF in dogs.     

Giant unruptured aneurysm of the left sinus of Valsalva in the left ventricular outflow tract of a young dog

A young adult, 28 kg, intact female Siberian husky-mixed breed dog was presented to the Veterinary Medical Teaching Hospital (VMTH) Emergency Service for evaluation of a dysrhythmia and an abnormal cardiac structure. The dog had been adopted from an animal shelter approximately 3 months before presentation. The dog occasionally showed exercise intolerance, and the owners suspected that she had impaired vision. Initial clinical signs appeared 2 days before presentation during strenuous activity—the dog uncharacteristically stopped and lay down while tachypneic. The dog produced dark liquid feces and was lethargic and anorexic overnight.     

A prospective study of canine infective endocarditis in northern California (1999-2001): emergence of Bartonella as a prevalent etiologic agent

A prospective study was performed (June 1999 to May 2001) to determine the incidence of infective endocarditis (IE) due to Bartonella in dogs in northern California and to compare these patients with other dogs with IE. IE was diagnosed antemortem based on clinical signs and echocardiography in 18 dogs. The etiologic agent was Bartonella sp. in 5 dogs (28%) and was diagnosed by high seroreactivity to Bartonella (titer > 1:512; range, 1:1,024-1:4,096); and confirmed postmortem by positive polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) from the infected valve and partial DNA sequencing of the citrate synthase gene (glt A). Conventional bacteria were causative agents in 7 dogs (39%). An etiologic agent was not identified in 6 dogs (33%). Bartonella vinsonii berkhoffii (n = 3), B clarridgeiae (n = 1), and a B clarridgeiae-like organism (n = 1) were identified. Blood culture was positive only for the IE case due to B clarridgeiae. All dogs with IE due to Bartonella were also seroreactive to Anaplasma phagocytophilum. All dogs with IE due to Bartonella had lesions only on the aortic valve. Of the cases of IE not due to Bartonella, 31% involved the aortic valve, 61% the mitral valve, and 8% both valves. Dogs with mitral valve IE lived longer than all dogs with aortic valve IE (P = .004) and dogs with IE of the aortic valve due to Bartonella (P = .002). In conclusion, Bartonella is a common cause of IE in dogs of northern California. A high Bartonella serologic titer (> 1:512) is useful antemortem to diagnose aortic valve IE due to Bartonella.     

Clinicopathologic findings and outcome in dogs with infective endocarditis: 71 cases (1992-2005)

OBJECTIVES: To evaluate clinical, laboratory, and necropsy findings in dogs with infective endocarditis (IE). DESIGN: Retrospective case series. ANIMALS: 71 dogs with possible or definite IE. PROCEDURES: Medical records were reviewed for signalment, clinical features, and results of clinicopathologic testing and diagnostic imaging. Yearly incidence and the effect of variables on survival were determined by use of survival curve analysis. RESULTS: The overall incidence of IE was 0.05%. Most affected dogs were of large breeds, and > 75% were older than 5 years. The aortic valve was affected in 36 of the 71 (51%) dogs, and the mitral valve was affected in 59%. Lameness caused by immune-mediated polyarthritis, septic arthritis, or peripheral arterial thromboembolism was observed in 53% of the dogs. Neurologic complications were diagnosed in 17 of 71 (24%) dogs. Thromboembolic disease was suspected in 31 of 71 (44%) of dogs. The mortality rate associated with IE was 56%, and median survival time was 54 days. Factors negatively associated with survival included thrombocytopenia, high serum creatinine concentration, renal complications, and thromboembolic complications. CONCLUSIONS AND CLINICAL RELEVANCE: A diagnosis of IE should be suspected in dogs with fever, systolic or diastolic murmur, and locomotor problems. Dogs with thrombocytopenia, high serum creatinine concentration, thromboembolism, or renal complications may have a shorter survival time.     

The effect of hydration status on the echocardiographic measurements of normal cats

BACKGROUND: Diagnosis of cardiomyopathy of cats is based on 2-dimensional (2D) echocardiography. However, circulating fluid volume largely determines diastolic cardiac chamber dimensions, and reduced diastolic volume in other species results in what has been called "pseudohypertrophy of the ventricular myocardium." HYPOTHESIS: Altered hydration produces changes on 2D echocardiography that may confound the diagnosis or severity assessment of cardiomyopathy of cats. ANIMALS: Ten normal colony-sourced mixed breed cats were included. METHODS: Cats were examined by echocardiography at baseline and at completion of 3 protocols (volume depletion and maintenance-rate and anesthetic-rate IV fluid administration) applied in randomized crossover design with a 6-7 day washout period. RESULTS: Volume depletion increased diastolic left ventricular interventricular septal (IVSd) and free wall diameter (4.5 +/- 0.4 to 5.8 +/- 0.6 mm; P < .001) with wall thickness exceeding 6 mm in 4 cats. Diastolic left ventricular internal diameter (LVIDd) decreased, and reduction in systolic left ventricular internal diameter (LVIDs) produced end-systolic cavity obliteration in 7 cats. Left-atrial-to-aortic-root ratio (LA: Ao, 1.4 +/- 0.2 to 1.2 +/- 0.1, P < .05) and left atrial area in diastole (LAAd) decreased with volume depletion. Maintenance-rate IV fluid administration increased LAAd and fractional shortening (FS%). Anesthetic-rate IV fluid administration increased LVIDd, FS%, LAAd, and LA:Ao ratios (to 1.7 +/- 0.1, P < .01), producing an LA: Ao ratio above normal limits in 6 cats. A systolic heart murmur developed with administration of fluid at maintenance (n = 1) and anesthetic rates (n = 6). CONCLUSIONS: Altered hydration status produces changes in the echocardiographic examination of normal cats that may lead to an erroneous diagnosis of cardiomyopathy or mask its presence. Hydration status should be considered during echocardiographic examination in cats.