DOCSLIB.ORG

Congenital Heart Disease Christian Weder DVM, MS, DACVIM (Cardiology) Great Lakes Veterinary Conference

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Congenital Heart Disease Christian Weder DVM, MS, DACVIM (Cardiology) Great Lakes Veterinary Conference Congenital Heart Disease Christian Weder DVM, MS, DACVIM (Cardiology) Great Lakes Veterinary Conference Introduction Congenital heart disease (CHD) refers to a set of cardiovascular defects that are present since birth. The overall prevalence of CHD in the general population of mixed breed dogs and cats is reported to be 0.13% and 0.14%, respectively.1 Pure-bred dogs and cats have a significantly greater predilection for CHD. Most animals have a single defect, however, multiple concurrent defects can also occur.2 Although exact percentages vary somewhat by study, the most common congenital defects in dogs are pulmonic stenosis (31%), patent ductus arteriosus (17%), subaortic stenosis (15%), ventricular septal defect (14%), mitral valve dysplasia (8%), tricuspid valve dysplasia (2%) and atrial septal defect (2%).1 The most common congenital defects in cats are ventricular septal defect (21%), aortic stenosis (valvular and subvalvular, 17%), pulmonic stenosis (valve and branch pulmonary arteries, 14%), atrioventricular septal defect (7%), hypertrophic obstructive cardiomyopathy (5%), patent ductus arteriosus (5%), mitral valve dysplasia (3%), and peritoneal-pericardial diaphragmatic hernia (3%).1 Innocent Murmurs Nonpathological heart murmurs are commonly detected in young animals. These are often referred to as puppy and kitten murmurs and are not due to a congenital defect. Common characteristics of these murmurs are that they are generally soft (grade I or II), of short duration, are predominately heard during early or mid-systole, and are typically located over the heart base.3 These murmurs can also be variable with heart rate and position of the patient. They often resolve after 6 months of age, however, they can persist for longer periods in some animals. Although the cause of these murmurs has not been definitively determined, they are thought to be due to increased blood flow velocity and turbulence through the outflow tracts or great vessels. It is also important to realize that young animals can also have physiologic hearts murmurs secondary to anemia, fever, and other systemic causes. Congenital Heart Disease in Dogs Pulmonic Stenosis Pulmonic stenosis (PS) is a congenital defect that results in an obstruction to outflow of blood from the right ventricle. PS can be anatomically classified as subvalvular, valvular and supravalvular based on the level of the obstruction. Valvular is the most common form of PS in dogs. Valvular PS can be further classified into type A and type B based on the valve and annulus morphologies.4 PS has been shown to be a heritable defect in beagles and keeshonds, but can occur in any breed.5 A somewhat distinct form of PS with coronary artery anomalies has been described in both English Bulldogs and Boxer dogs.6,7 Dogs with PS typically have a systolic ejection murmur of variable intensity heard best over the heart base. They often have a normal femoral pulse quality. PS is typically diagnosed on echocardiography. Dogs with PS have an increased velocity of flow across their pulmonary valve, variable right ventricular hypertrophy and right atrial enlargement, post-stenotic dilation of their main pulmonary artery, and some degree of pulmonary insufficiency. The severity of the PS can also be assessed based on the estimated pressure gradient across the pulmonary valve as well as the degree of secondary changes. A pressure gradient of greater than 80mmHg across the pulmonary valve is consistent with a severe lesion, whereas 50- 80mmHg is moderate and <50mmHg is mild. Mild PS is generally associated with a favorable long-term prognosis with most dogs have a normal life expectancy and intervention is generally not recommended.8 The prognosis and treatment recommendations for dogs with moderate PS is less certain. Many dogs with moderate PS still have a normal life expectancy without intervention. However, balloon valvuloplasty (BVP) is often considered in dogs with moderate PS of they have associated clinical signs, severe secondary changes, or significant concurrent tricuspid regurgitation. Dogs with severe PS are at risk for the development of clinical signs such as exercise intolerance, syncope, and those associated with right sided congestive heart failure. There is also some risk of sudden cardiac death. Given these risks, BVP is generally recommended for dogs with severe PS at the time of diagnosis. This procedure has been well described and is generally well tolerated in dogs.9 BVP has been shown to be successful both in alleviating clinical signs and in prolonging survival in dogs with severe pulmonic stenosis.10 While BVP is an effective treatment option, there is some risk of re-stenosis and the possibility of sudden death is never fully eliminated. Dogs with moderate-severe PS are also often treated with a beta blocker (atenolol). Atenolol (1-2mg/kg BID) is used in this disease process to decrease the myocardial oxygen demand, alleviate dynamic outflow tract obstructions, and prevent/treat ventricular arrhythmias. Patent Ductus Arteriosus The ductus arteriosus is a vessel present during fetal life and allows blood flow to bypass the lungs. When the ductus fails to close at birth, it is termed persistently patent and the defect is usually referred to as a patent ductus arteriosus (PDA). This typically results in shunting of blood from the aorta (left) to the pulmonary artery (right), although the opposite can also occur (right-to-left shunt). PDA is a hereditary defect in dogs and is likely related to varying degrees of hypoplasia and asymmetry of ductus-specific smooth muscle as well as the presence of abnormal elastic tissue in the ductus.11 PDA is more prevalent in female dogs.12 Dogs with PDA typically have a characteristic continuous heart murmur heard best over the heart base. It is important to note that the murmur may primarily sound systolic in its timing when auscultation is performed only over the left apex. The femoral pulse quality is usually hyperdynamic (often describes as “bounding”) due to the large difference between the systolic and diastolic pressures. While a presumptive diagnosis can often be made of physical exam, echocardiography is recommended to obtain a definitive diagnosis and also allows for the identification of any concurrent congenital defects. Chronic left-to-right shunting through a PDA leads to volume overload of the left side of the heart and pulmonary vasculature. If left untreated, approximately 65% of dogs experience congestive heart failure and death by one year of age.12 As such, PDA closure is recommended in all dogs with a left-to-right shunting defect at the time of diagnosis. PDA closure has been shown to be associated with an excellent long-term survival with most dogs having a normal life expectancy.13 PDA closure can be performed either via surgical ligation or interventional closure. Both methods have been shown to be highly successful with low complication rates.14, 15 The most commonly performed interventional closure is performed using an Amplatz Canine Ductal Occluder (ACDO). Medical therapy is generally not required or recommended unless congestive heart failure is present. Subaortic Stenosis Subaortic stenosis (SAS) is a congenital narrowing of the left ventricular outflow tract that results in a pressure overload on the left ventricle.17 SAS is a heritable defect to which large and giant breed dogs are predisposed. A specific gene associated with the development of SAS has been identified in the Newfoundland but the condition is also commonly diagnosed in Rottweilers, Boxers and Golden retrievers.18 SAS results in varying degrees of outflow tract obstruction and a grading system for the lesion does exist.19 Chronic pressure overload often leads to left ventricular hypertrophy and variable degrees of left atrial enlargement. Dogs with SAS typically have a systolic ejection murmur of variable intensity heard best over the heart base. In dogs with a moderate-severe obstruction, the femoral pulse quality is generally decreased. SAS is usually diagnosed on echocardiography. The severity of SAS is typically based on the estimated pressure gradient across the left ventricular outflow tract. Dogs with a pressure gradient of less than 50mmHg are categorized as having mild SAS, whereas, moderate SAS is defined as a pressure gradient between 50-80mmHg. A pressure gradient greater than 80mmHg is considered severe. The prognosis for dogs with mild-moderate SAS is generally good, with most dogs having a normal or near-normal life expectancy without treatment.20 Unfortunately, the long-term prognosis for dogs with severe SAS is often considered poor. A median survival time of 56 months has been reported for dogs with severe SAS that are treated with atenolol. However, a more recent study found no survival benefit for dogs treated with a beta blocker as compared to those that were untreated.21 The same study showed a marked survival difference in dogs with a pressure gradient greater than 133mmHg (2.8 years) as compared to those less than 133mmHg (8.3 years). Potential complications of SAS include left sided congestive heart failure, syncope, arrhythmias, sudden death, and infectious endocarditis. Treatment options for dogs with severe SAS are very limited. Both standard balloon valvuloplasty (BVP) and open surgical correction have been reported but have not been shown to prolong survival in dogs with severe SAS.20,22 Recently, a new procedure has emerged as a potential treatment option for dogs with severe SAS. This procedure is a modification on balloon valvuloplasty using combined cutting and high-pressure balloons and has been described in the veterinary literature.23 The procedure has been shown to significantly decrease the pressure gradient across the stenosis and improve clinical signs in symptomatic dogs, however, no long-term survival data is currently available. Given that the long-term outcome of this procedure is unknown, it is not routine recommended. However, it does provide an additional option for this often devastating disease.
Load more

Recommended publications
  • Heart Sound Analysis for Diagnosis of Heart Diseases in Newborns
    Available online at www.sciencedirect.com ScienceDirect APCBEE Procedia 7 ( 2013 ) 109 – 116 ICBET 2013: May 19-20, 2013, Copenhagen, Denmark Heart Sound Analysis for Diagnosis of Heart Diseases in Newborns Amir Mohammad Amiri*, Giuliano Armano University of Cagliari, Department of Electrical and Electronic Engineering(DIEE), 09123 Cagliari, Italy Abstract Many studies have been conducted in recent years to automatically differentiate normal heart sounds from heart sounds with pathological murmurs using audio signal processing in early stage. Serious cardiac pathology may exist without symptoms. The purpose of this study is developing an automatic heart sound signal analysis system, able to support the physician in the diagnosing of heart murmurs at early stage of life. Heart murmurs are the first signs of heart disease. We screened newborns for normal (innocent) and pathological murmurs. This paper presents an analysis and comparisons of spectrograms after smoothing phonocardiogram signals (PCG) with Cepstrum, Bispectrum, and Wigner Bispectrum techniques. A comparison between these methods has shown that higher order spectra, as Bispectrum and Wigner bispectrum, gave the best results. © 20132013 The Published Authors. Published by Elsevier by Elsevier B.V. B.V.Selection and/or peer review under responsibility of Asia-Pacific Chemical,Selection and Biological peer-review under& Environmental responsibility of EngineeringAsia-Pacific Chemical, Society Biological & Environmental Engineering Society. Keywords: Heart murmurs, Spectral, Cepstrum, Bispectrum, Wigner Bispectrum 1. Introduction Despite remarkable advances in imaging technologies for heart diagnosis, clinical evaluation of cardiac defects by auscultation is still a main diagnostic method for discovering heart disease. In experienced hands, this method is effective, reliable, and cheap.
    [Show full text]
  • Management of Incidentally Detected Heart Murmurs in Dogs and Cats*,**
    Journal of Veterinary Cardiology (2015) 17, 245e261 www.elsevier.com/locate/jvc REVIEW Management of incidentally detected heart murmurs in dogs and cats*,** Etienne Coˆte´, DVM a,*, N. Joel Edwards, DVM b, Stephen J. Ettinger, DVM c, Virginia Luis Fuentes, VETMB, PhD d, Kristin A. MacDonald, DVM, PhD e, Brian A. Scansen, DVM, MS f, D. David Sisson, DVM g, Jonathan A. Abbott, DVM h a Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Ave., Charlottetown, PE C1A 4P3, Canada b Upstate Veterinary Specialties, 222 Troy Schenectady Rd, Latham, NY 12110, USA c VetCorp Inc, 1736 S. Sepulveda Blvd., Los Angeles, CA 90025, USA d Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hawkshead Lane, Hatfield, Herts AL9 7TA, UK e VCA Animal Care Center of Sonoma County, 6470 Redwood Dr, Rohnert Park, CA 94928, USA f Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L Tharp St, Columbus, OH 43210, USA g Department of Small Animal Services, College of Veterinary Medicine, Oregon State University, 700 SW 30th Street, Corvallis, OR 97331, USA h Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, 215 Duck Pond Drive, Blacksburg, VA 24061, USA Received 31 March 2015; received in revised form 6 May 2015; accepted 11 May 2015 Prepared by the Working Group of the American College of Veterinary Internal Medicine Specialty of Cardiology on Incidentally Detected Heart Murmurs. * A unique aspect of the Journal of Veterinary Cardiology is the emphasis of additional web-based materials permitting the detailing of procedures and diagnostics.
    [Show full text]
  • Subclinical Subaortic Stenosis in a Golden Retriever
    CASE ROUTES h CARDIOLOGY h PEER REVIEWED Subclinical Subaortic Stenosis in a Golden Retriever Kursten Pierce, DVM, DACVIM (Cardiology) Colorado State University THE CASE THE CASE A 12-month-old intact female golden retriever is pre- Diagnostic investigation of the heart murmur via echo- sented for a wellness examination and to discuss the cardiography is discussed with the owner but declined pros and cons of breeding the patient versus pursuing due to the patient’s lack of clinical signs and the costs ovariohysterectomy. The owner would like her to pro- associated with additional testing. duce one litter of puppies prior to being spayed. What are the next steps? On physical examination, the patient is bright, alert, and responsive. She is extremely energetic with a good THE CHOICE IS YOURS … BCS (4/9) and appropriate musculature. Cardiovascu- CASE ROUTE 1 lar examination reveals pink mucous membranes, no To provide information on breeding and caring for a obvious jugular venous distension, and a normal heart pregnant bitch and neonatal puppies and plan to spay rate and rhythm with normal synchronous femoral the patient after the puppies have been weaned, go to pulses. Auscultation is difficult and brief because the page 28. patient is rambunctious and panting. Despite the pant- ing, she is eupneic with clear bronchovesicular sounds. CASE ROUTE 2 A grade II/VI left basilar systolic heart murmur is aus- To avoid providing additional recommendations cultated. A murmur had not previously been docu- regarding breeding and ovariohysterectomy to the mented at her puppy wellness visits. The owner has not owner until a diagnostic investigation with a cardiolo- observed any coughing, trouble breathing, exercise gist has been pursued, go to page 32.
    [Show full text]
  • A Robust Heart Sounds Segmentation Module Based on S-Transform Ali Moukadem, Alain Dieterlen, Nicolas Hueber, Christian Brandt
    A Robust Heart Sounds Segmentation Module Based on S-Transform Ali Moukadem, Alain Dieterlen, Nicolas Hueber, Christian Brandt To cite this version: Ali Moukadem, Alain Dieterlen, Nicolas Hueber, Christian Brandt. A Robust Heart Sounds Segmen- tation Module Based on S-Transform. Biomedical Signal Processing and Control, Elsevier, 2013, 8 (Issue 3), pp.273-281. 10.1016/j.bspc.2012.11.008. hal-00984327 HAL Id: hal-00984327 https://hal.archives-ouvertes.fr/hal-00984327 Submitted on 28 Apr 2014 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. A Robust Heart Sounds Segmentation Module Based on S-Transform Ali Moukadem1, 3, Alain Dieterlen1, Nicolas Hueber2, Christian Brandt3 1MIPS Laboratory, University of Haute Alsace, 68093 - MULHOUSE CEDEX FRANCE 2 ISL: French-German Research Institute of SAINT-LOUIS, 68300 - SAINT-LOUIS FRANCE 3University Hospital of Strasbourg, CIC, Inserm, BP 426, 67091 STRASBOURG CEDEX FRANCE Abstract This paper presents a new module for heart sounds segmentation based on S-Transform. The heart sounds segmentation process segments the PhonoCardioGram (PCG) signal into four parts: S1 (first heart sound), systole, S2 (second heart sound) and diastole. It can be considered one of the most important phases in the auto-analysis of PCG signals.
    [Show full text]
  • Systolic Heart Murmur As First Manifestation of High Output Heart
    Arch Cardiol Mex. 2012;82(3):214---217 www.elsevier.com.mx BRIEF REPORT Systolic heart murmur as first manifestation of high output heart failure due to the vein of galen malformation Juan S. Barajas-Gamboa a,b,∗, Julio A. Diaz-Perez b, Yoana Leon-Camargo a, Carlos A. Gonzalez-Gomez a, Cecilia Sandoval-Gomez a a School of Medicine, Autonomous University of Bucaramanga (UNAB), Bucaramanga, Colombia b Department of Medicine, University of California, San Diego, La Jolla CA, USA Received 27 January 2012; accepted 17 April 2012 KEYWORDS Abstract The vein of Galen aneurysmal malformation (VGAM) is an extremely rare arterio- Newborn; venous malformation. The VGAM clinical manifestations vary depending on the magnitude of Vein of Galen vascular compromise and the age at initial presentation. Neonates typically present with severe malformations; congestive heart failure. Here we present a case in which a systolic heart murmur was the first Aneurysm; manifestation of high output heart failure due to a VGAM. Heart Failure; © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México United States S.A. All rights reserved. of America PALABRAS CLAVE Soplo sistólico como primera manifestación de insuficiencia cardiaca de gasto alto Neonato; secundaria a malformación de la vena de Galeno Malformaciones de la vena de Galeno; Resumen Las malformaciones de la vena cerebral de Galeno (MVG) son extremadamente Aneurisma; raras. Sus manifestaciones clínicas varían dependiendo de la magnitud del compromiso vascular Insuficiencia y la edad inicial de presentación. En neonatos, típicamente se presenta con una insuficiencia Cardiaca; cardiaca congestiva grave. Se presenta un caso en el cual un soplo sistólico cardiaco fue la Estados Unidos primera manifestación de una insuficiencia cardíaca de gasto alto secundaria a una malforma- de América ción aneurismática de la vena de Galeno.
    [Show full text]
  • Rx004 ED03-04
    Mitral Valve Prolapse (MVP) Mitral valve prolapse (MVP) is also known as the “click-murmur” syndrome, “Barlow’s Syndrome,” and “floppy” valve syndrome. In this syndrome, one or both leaflets (cusps ) of the mitral valve are thin or floppy (redundant) and sometimes the valve fails to close properly. It usually is an idiopathic condition meaning that the cause is unknown but can be part of an underlying connective tissue disorder. Mitral valve prolapse is possibly the most common heart valve lesion in existence. Present in both men and women, it has been estimated to occur in 5-15% of young women. Many individuals with MVP are asymptomatic. Others experience symptoms such as chest pain, palpitations, shortness of breath or dizziness. The best diagnostic test available is the echocardiogram. Most applicants with mitral valve prolapse have a favorable prognosis. Complications that may develop include progressive mitral insufficiency, endocarditis, thromboembolism, and arrhythmias, especially premature ventricular and atrial contractions. Mitral valve prolapse is sometimes “silent,” in that no abnormal heart sound is detected. Other applicants with MVP may have a soft systolic heart murmur or click. For the majority of applicants with mitral valve prolapse, the prognosis is essentially normal and this condition is not rated. Occasional applicants with MVP have mitral insufficiency. They will be rated based on age and severity. When underlying causes are found (such as Marfan or Ehlers Danlos syndromes) or when serious complications/symptoms develop, ratings up to rejection for these impairments will apply. Mitral Valve Prolapse - Ask "Rx" pert underwriter To get an idea of how a client with a history of MVP would be viewed in the underwriting process, please (ask our experts) feel free to use the Ask “Rx” pert underwriter on the reverse side for an informal quote.
    [Show full text]
  • In This Issue Recommendations on the Management of Incidentally
    In this Issue Recommendations on the Management of Incidentally Detected Heart Murmurs COVER By: Michael Hickey, DVM, Diplomate, ACVIM (Cardiology) Recommenda- tions on the The Journal of the American Veterinary Medical Association recently pub- Management of lished a set of guidelines addressing the management of pets with heart mur- Incidentally murs detected in the course of a wellness exam, or in the work-up of a non- 1 Detected Heart cardiac illness. A working group of ACVIM board-certified cardiologists com- posed the recommendations. Murmurs Page 2 Successful initial management of a diagnosis of a new heart murmur in- volves: New Cardiologist Accurate description of the murmur Deciding whether a murmur is more likely functional (non- 4 Days a Week pathologic) or pathologic (insofar as it is possible from physical ex- amination) Accurate communication of the potential significance of the murmur Page 5 with the pet’s family Selection of appropriate diagnostic tests to determine a cause and For Veterinarian stage severity of the condition underlying the murmur. Section—New Handouts cont’d on page 3 For Tech Section NOW RACE Certified — Locations Earn CE Credits for Lunch and Learns Serving DE, PA, CVCA comes to you and WV Coffee and Learns February - Lunch and Learns American Heart Limited Dinner Opportunities Month Doctor and Technician Topics Available Payment Scheduling Available Online Options Earn CE Credits Email: [email protected] Web: www.cvcavets.com To learn more, visit www.cvcavets.com, go to “For Veterinarians” and click on Facebook: @cvcavets “Lunch n Learns / CE. **Please contact AAVSB RACE program at [email protected] or 877-698-8482 should Instagram: @cvcavets you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession, of if you have questions.
    [Show full text]
  • Degenerative Mitral Valve Disease
    Degenerative mitral valve disease Degenerative mitral valve disease (DMVD) (previously named myxomatous mitral valve degeneration or mitral valve endocardiosis) is the most commonly encountered cardiopathy in dogs. This disease is characterized by the appearance of nodules on the free edges of the valve and a thickening of the chordae tendinae. As they get bigger, these nodules can fuse and lead to a generalized thickening of the valve. Furthermore, an elongation of the valvular leaflets and a stretching of the chordae tendinae can be observed. The chordae tendinae can rupture, depriving the valve from its support (Figure 1). Figure 1 : Degenerative mitral valve disease in a dog : note the nodules deforming the free edges of the mitral valve (Web Archive) This leads to an inadequate coaptation of the leaflets, resulting in a leakage of blood from the left ventricle into the left atrium, called mitral regurgitation (MR). The degree of MR depends on the deformation, the degree of retraction of the leaflets and the status of the chordae tendinae. Even though this disease affects mostly the mitral valve, the tricuspid valve and more rarely the aortic and pulmonic valves can also be affected. DMVD mostly affects middle-aged small dogs (less than 20 kgs). The Cavalier King Charles Spaniels (CKCS) are particularly predisposed. The prevalence of this disease varies from 14% (non CKCS breeds) to 40% (CKCS). This prevalence increases with age, and can almost reach 100% in CKCS older than 11 years. Large breed dogs, such as the German Shepherd, can also be affected by this disease, albeit less frequently, CONSEQUENCES The long term consequences of this MR, depending on its severity, will be dilation of the left-sided cardiac chambers and an increase of pressure in the chamber receiving the regurgitation (the left atrium) (Figure 2).
    [Show full text]
  • Feature Extraction for Systolic Heart Murmur Classification
    Annals of Biomedical Engineering, Vol. 34, No. 11, November 2006 (Ó 2006) pp. 1666–1677 DOI: 10.1007/s10439-006-9187-4 Feature Extraction for Systolic Heart Murmur Classification 1,2 1,2 3 4 5 CHRISTER AHLSTROM , PETER HULT, PETER RASK, JAN-ERIK KARLSSON, EVA NYLANDER, 5 1,2 ULF DAHLSTRO¨ M, and PER ASK 1Department of Biomedical Engineering, University Hospital, Linko¨ ping University, IMT, SE-581 85, Linko¨ ping, Sweden; 2Biomedical Engineering, O¨ rebro University Hospital, O¨ rebro, Sweden; 3Department of Clinical Physiology, University Hospital, O¨ rebro, Sweden; 4Department of Internal Medicine, County Hospital Ryhov, Jo¨ nko¨ ping, Sweden; and 5Department of Medicine and Care, Linko¨ ping University Hospital, Linko¨ ping, Sweden (Received 8 March 2006; accepted 22 August 2006; published online: 4 October 2006) Abstract—Heart murmurs are often the first signs of path- care, auscultation still plays a very important role. For ological changes of the heart valves, and they are usually these situations, an ‘‘intelligent stethoscope’’ with found during auscultation in the primary health care. decision support abilities would be of great value. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an ‘‘intelligent stetho- Heart murmurs are caused by turbulent blood flow scope’’ with decision support abilities would be of great or jet flow impinging on and causing vibration of sur- value. Phonocardiographic signals were acquired from 36 rounding tissue. Pathological murmurs are caused by patients with aortic valve stenosis, mitral insufficiency or flow through stenosed valves, regurgitant flow through physiological murmurs, and the data were analyzed with the incompetent valves or flow through septal defects.
    [Show full text]
  • Cardiac Disorder in a Cat
    University of Pennsylvania ScholarlyCommons Departmental Papers (Vet) School of Veterinary Medicine 11-1-2008 Cardiac Disorder in a Cat Caryn A. Reynolds University of Pennsylvania Mark A. Oyama University of Pennsylvania, [email protected] Sonya G. Gordon Follow this and additional works at: https://repository.upenn.edu/vet_papers Part of the Small or Companion Animal Medicine Commons Recommended Citation Reynolds, C. A., Oyama, M. A., & Gordon, S. G. (2008). Cardiac Disorder in a Cat. NAVC Clinician's Brief, 6 57-58. Retrieved from https://repository.upenn.edu/vet_papers/4 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/vet_papers/4 For more information, please contact [email protected]. Cardiac Disorder in a Cat Keywords make your diagnosis, cardiology Disciplines Small or Companion Animal Medicine | Veterinary Medicine This journal article is available at ScholarlyCommons: https://repository.upenn.edu/vet_papers/4 make your diagnosis CARDIOLOGY make your diagnosis CONTINUED Visit cliniciansbrief.com/subscribe to get your OWN FREE digital subscription to Clinician’s Brief. Caryn A.Reynolds,DVM,and Mark A.Oyama,DVM,Diplomate ACVIM (Cardiology),University of Pennsylvania Diagnosis: Sonya G.Gordon,DVM,DVSc,Diplomate ACVIM (Cardiology),Texas A&M University Hypertrophic obstructive cardiomyopathy Further Diagnostics. The cat was referred to Cardiac Disorder in a Cat a specialty hospital for cardiac evaluation. Echo- cardiography revealed a thickened interventricu- lar septum and left ventricular free wall of 7.7 mm and 5.9 mm, respectively. The ratio of atrial diameter to aortic root diameter was mildly increased at 1.5. Systolic anterior motion of the An 8-year-old castrated male domestic shorthair was presented for an annual wellness mitral valve was documented (Figure 1) and the left ventricular outflow tract velocity was examination and vaccines.
    [Show full text]
  • Vegetative Endocarditis in Cattle
    Vegetative Endocarditis in Cattle J.A. Hoffmann Fourth Year Student College of Veterinary Medicine University ofMissouri Columbia, MO 65211 Introduction organ systems involved. The most common reasons for presentation are reported to be recurrent or persistent A case of bovine vegetative endocarditis was described fever, anorexia, decreased milk production, weight loss as early as 1841 by Joseph Carlisle V.S. who called for and chronic lameness. 2,3,4 Tachycardia, a loud pounding "... a thorough investigation into cardiac diseases ...." 1 In heartbeat, and cardiac murmurs are also common early the last 148 years vast progress has been made in cardiac clinical signs. The murmurs are usually systolic and physiology and pathology; however, bovine endocarditis is louder over the right body wall. 2,8 As the disease pro­ still commonly misdiagnosed until necropsy if it is gresses, signs of congestive heart failure, such as ventral diagnosed at all. This misdiagnosis is probably due, in edema, dyspnea, and distension or pulsation of the mam­ large part, to the similarity of the clinical signs of endo­ mary and jugular veins, become more evident.3 In general, carditis with the clinical signs of other diseases, especially the clinical signs will increase in intensity if proper ther­ traumatic reticuloperitonitis and pneumonia. Another apy is not instituted. factor contributing to the misdiagnosis of endocarditis is A confirmed diagnosis of vegetative endocarditis is that primary cardiac disease is rarely among the initial difficult to achieve without necropsy. CBC results usually diagnostic rule-outs of bovine diseases. Good figures on show a non-regenerative anemia indicative of chronic in­ morbidity are not available, but one study found the flammatory disease and a mild leukocytosis.
    [Show full text]
  • Heart Murmurs in Young Dogs and Cats: Differentials, Tips and Additional Testing
    SMALL ANIMAL I CONTINUING EDUCATION Heart murmurs in young dogs and cats: differentials, tips and additional testing Ilaria Spalla DVM PhD MRCVS MVetMed DACVIM, veterinary cardiology specialist, Ospedale Veterinario San Francesco (Milan, Italy) provides a comprehensive overview of heart murmurs in young dogs and cats Heart murmurs can occasionally be auscultated in young dogs (S1-S2) from diastole (S2-S1). A quiet environment and a and cats; their discovery can be in conjunction with other relaxed patient provide the best clinical condition to detect signs of cardiac disease or it may be an incidental finding. abnormalities; however, this sometimes may not happen in The identification of heart murmurs can cause apprehension everyday practice. Strategies to reduce environmental noise for owners, and depending on the location, intensity and levels and calm the patient, as well as repeated auscultation characteristics, the veterinary professional can perform a list can be attempted to increase e icacy or confirm the initial of di erentials and suggest the best diagnostic approach. suspicion. The patient should be standing, and palpation of the chest walls should be performed prior to applying the CARDIAC AUSCULTATION stethoscope to identify the precordium and look for thrills, if The first stethoscope was invented in 1816 by René Laennec present (Smith et al, 2006). in Paris (Rishniw, 2018) and it has been, since then, a very Inching (moving the stethoscope between the cardiac apex powerful instrument to aid clinicians in their everyday cardiac and base) helps in identifying any abnormal heart sound and evaluation. Auscultation takes time and practice, but it can its point of maximal intensity (PMI).
    [Show full text]