CVS - The Spectrum of Cardiac Disease in Animals
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Clinical case focusing on the topic of cardiology. The case aims to highlight commonly presenting cardiology concerns and how the similar presenting complaints can represent very different disease processes. The cases are presented in a fashion so that they can be worked through in the same approach a working vet would. The level is intended for pre-veterinary students and veterinary students. For more information please go to http://www.IWantToBecomeAVet.com
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CVS - The Spectrum of Cardiac Disease in Animals
- 1. a vaccination appointment The wide spectrum of cardiac disease
- 2. IWantToBecomeAVet.com dodger HISTORY: In today for routine yearly vaccination booster Doing well, no changes from last year except maybe slowing down a little NoV-D-C-S- Fed home cooked diet after pancreatitis 5 years ago 9yo MN Terrier Mix
- 3. IWantToBecomeAVet.com Physical exam Heart murmur Grade II/VI left systolic pmi apex, radiates dorsally within the thorax Signs of heart failure? Pink moist MM, CRT 1 sec Lungs sounds clear and RR 20 No organomegaly or ascites detected on palpation HR 64 sinus arrythmia, no pulse deficits NO!
- 4. IWantToBecomeAVet.com Murmurs I Audible after a long time listening in perfect conditions II Clearly audible as soon as the stethoscope is placed over the point of maximal intensity III Clearly audible and as loud as the normal heart sounds IV Audible louder than the heart sounds but no palpable thrill, likely to radiate widely over the thorax V Thrill palpable over the point of maximal intensity at the skin surface VI Audible with the stethescope lifted off teh chest
- 5. IWantToBecomeAVet.com What do we tell the owner?? (A)Your dog has a heart murmur and is going to die (B) Your dog has a heart murmur and we need to find out more straight away! (C) Your dog has a heart murmur, so lets pretend this consult never happened and you go get Dodger insured! (D) Your dog has a heart murmur, which means I can hear a heart sound in his chest which is not normal. Given his age, breed, that he has no clinical signs of heart disease or illness ,and this is the first time we are noticing it, it is most likely caused by a degenerative change in his heart structure. You have a couple of options, we can investigate further now or we can leave Dodger and see him back in 6 months for his twice yearly health check.
- 6. IWantToBecomeAVet.com I want to know exactlyI want to know exactly what is wrong with mywhat is wrong with my precious Dodger!precious Dodger!
- 7. IWantToBecomeAVet.com Ddx Left apical systolic murmurs Mitral valve endocardiosis Mitral valve endocarditis Mitral dysplasia DCM Breed Mitral valve endocardiosis Age Mitral valve endocardiosis DCM Pericardial effusion
- 8. IWantToBecomeAVet.com Acquired CVS Dz in dogs
- 9. IWantToBecomeAVet.com How to interpret cardiac rx
- 10. IWantToBecomeAVet.com Diagnostics Thoracic Radiographs Moderate LV RL: increased DV dimension and increased on craniocaudal dimension, DV:elongated cardiac silhoette Moderate LA enlargement RL: bulge on caudodorsal aspect, dorsal displacement of L caudal bronchus, increased dorsoventral demension DV: more curved right border
- 11. IWantToBecomeAVet.com In house Referral Echocardiography: Right parasternal long axis 4 chamber with color doppler Demonstrated: moderate mitral valve regurgitation tips of mitral valve leaflets thickened mild volume overload of LV and LA Endocardiosis Endocarditis
- 12. IWantToBecomeAVet.com The Canine heart Distortion of valve leaflets due to degenerative change. • Results in development of insufficiency • Necessitates an increase in the ventricular stroke volume • Leads to ventricular dilatation • Exacerbates leakage of valve • Worsened by vasoconstriction
- 13. IWantToBecomeAVet.com ending consult Vaccination Describe Rx and Echo findings Client Education Disease progression and prognosis Clinical signs of heart failure to watch for
- 14. IWantToBecomeAVet.com Prognosis Disease of slow progression Usually a protracted period of on average 3 years, where animals show no signs. In 50% of dogs Dx with MV never go on to develop HF (as usually succumb to some other Dz first) Once in HF dogs have average survival time of 200-200days I am an angel,I am an angel, but not goingbut not going to heavento heaven anytime soon!anytime soon!
- 15. IWantToBecomeAVet.com heart failure Treatment: Furosemide Pimobendan ACEi Spironolactone Diagnostics: PE Rx ECG PE Signs of left sided failure – Cough, Dyspnoea, Exercise intolerance Signs of collapse – Dysrhythmias Sudden death (rare) – Arrhythmia/left atrial tear/Ruptured chord Signs of right sided heart failure – Late in disease progression Clinical signs:
- 17. Ok. Thank you.Ok. Thank you. THE ENDTHE END