1. What’s your purpose? “It may be that your sole purpose in life is simply to serve as a warning to others.” -Anonymous

2. DISEASES OF THE CARDIOVASCULAR SYSTEM: Cardiomyopathies CHF Valvular disease Cogenital malformation Infectious

3. CONGENITAL DEFECTS: PULMONIC STENOSIS Chihuahuas, English Bulldogs, are commonly affected. CAUSE: ___________________ > 1 year

4. PULMONIC STENOSIS In pulmonic stenosis, the _______________________ is narrowed, either at the valve itself, just below it, or just after it.

5. PULMONIC STENOSIS The most common form of pulmonic stenosis involves a deformed pulmonary valve such that the valve leaflets ____________, the ___________________, or the valve cusps are fused. The heart must pump extra hard to get blood through This unusually narrow, stiff valve. The __________________ becomes thickened from all this extra work. The right atrium May become dilated and hypertrophied.

6. CONGENITAL DEFECTS: PULMONIC STENOSIS NORMAL CANINE CHEST RADS THIS DOG HAS PULMONIC STENOSIS – THE HEART LOOKS “______________” IN THE FRONT DUE TO RIGHT VENTRICULAR ENLARGEMENT

7. CONGENITAL DEFECTS: PULMONIC STENOSIS CLINICAL SIGNS: – Syncope – Tiring on exercise – _______________ congested heart failure – ________________ basilar (base) murmur (PAM) – Right ventricular enlargement – Radiographs: right ventricular enlargement, dilation of the pulmonary artery, pulmonary underperfusion – Echo: right ventricular hypertrophy and enlargement, dilation of the main pulmonary artery ( __________________________________ )

8. PULMONIC STENOSIS: TREATMENT A special balloon is inserted into the valve where it is inflated and the obstruction is broken down: ____________ ___________________________ Unfortunately, medical management is not very beneficial in these cases. __________________________ may be used to relax the heart muscle and possibly dilate the stenosis.

9. CLIENT EDUCATION Do not breeding Mild - moderate pulmonic stenosis: better __________________ Moderate - severe pulmonic stenosis: poorer prognosis

10. CONGENITAL DEFECTS: SUBAORTIC STENOSIS LESION DEVELOPS IN THE FIRST ______________ WEEKS OF LIFE: thickening Endocardial tissue Newfoundland, Boxer, Golden Retriever, and Bull Terrier are most commonly affected

11. CONGENITAL DEFECTS: SUBAORTIC STENOSIS There is a scar-like narrowing just below the aortic valve. The heart must pump _________ to get blood through the narrowed area. The blood is pushed through in a turbulent fashion creating a heart murmur.

12. CONGENITAL DEFECTS: SUBAORTIC STENOSIS THE HARD WORK RESULTS IN LEFT VENTRICULAR HYPERTROPHY, LEFT ATRIAL ENLARGEMENT, AORTIC DILATION: ____________________

13. CONGENITAL DEFECTS: SUBAORTIC STENOSIS: CLINICAL SIGNS: – Fatigue – Exercise intolerance (low cardiac output) – ______________________ – Systolic murmur (soft – moderate) at the left heart base – ECG: evidence of left ventricular enlargement - ↑ QRS height – Echo: left ventricular hypertrophy, subvalvular fibrous ring, aortic dilation

14. CONGENITIAL DEFECTS: SUBAORTIC STENOSIS TREATMENT – Balloon catheter dilation – has been done with variable and temporary results – Medical management: THE GOAL IS TO SLOW THE HEART RATE AND DECREASE CONTRACTILITY; ________________ (BETA-BLOCKER WILL DO THIS)

15. CONGENITAL DEFECTS: SUBAORTIC STENOSIS CLIENT INFO: – Should not be used for breeding – Acute, left-sided congestive heart failure is possible – ___________________ is not uncommon

16. DCMHCMPDAAortic stenosisPulmonic stenosis 1 – dogs Enlarged Heart bronchile constriction Dilated Flappy muscle Nutritional: no taurin in cats 1 – Cats Saddle thrombus Rarely in dogs (hereditary) Noncompliant heart muscle Aorta – pulmonary a – lungs back L side Stenotic aortic valve causes LV hypertrophy High pressure in aortic valve can lead to aortic dilatation Stenotic pulmonic valve Pregnant heart L sided heart failure (HF) LV hypertrophy RV hypertrophy R sided HF Increased HR Cough Increased HR Weakness in hindlimbs, acute pain, rear cold feet Pulmonary edema Sudden death if aorta ruptures Digoxin: increased contractibility Beta blocker: Slow HR Diuretic Blood thinner No cure Treat surgically or die No breeding Balloon valvuloplasty

17. CONGENITAL DEFECTS: TETRALOGY OF FALLOT ______________ are the most commonly affected breed, but bulldogs and cats have increased incidence as well. Cause: polygenic inheritance

18. CONGENITAL DEFECTS: TETRALOGY OF FALLOT THERE ARE 4 MAIN ANATOMICAL ABNORMALITIES IN THIS DISEASE! – Pulmonic stenosis – Right ventricular hypertrophy – Ventricular septal defect – Overriding aorta

19. ________ to left shunt: pulmonary and systemic circulations

20. Overiding aorta: Blood from RV into aorta: mixed blood, not fully oxygenated blood. Body stimulates more RBC production to stimulate oxygen carrying capacity

21. CONGENITAL DEFECTS: TETRALOGY OF FALLOT CLINICAL SIGNS and DIAGNOSIS: – Affected puppies are _____________ than littermates – Exercise intolerance – Dyspnea, tachypnea – Syncope – Cyanosis – _________________________: occurs as a response to the large amount of deoxygenated blood going to the systemic circulation – Systolic murmur over the pulmonic area – ECHO: right ventricular hypertrophy, subaortic ventricular septal defect, right outflow tract obstruction

22. CONGENITAL DEFECTS: TETRALOGY OF FALLOT TREATMENT: – ___________________: to keep PCV below 65% (replace with crystalloids) – Surgery: Create a _______________________ shunt by doing systemic artery to pulmonary artery anastamosis Complete correction requires cardiopulmonary bypass which is uncommon in animals

23. CONGENITAL DEFECTS: TETRALOGY OF FALLOT CLIENT INFO: – These dogs should not be bred – Congestive heart failure _____________ develops – Affected animals need regular phlebotomy – Limit stress and exercise – Caution when using sedatives/ tranquilizers

24. CONGENITAL DEFECTS: PERSISTENT RIGHT 4 TH AORTIC ARCH Great Danes, German Shepherds, Irish Setters are most commonly affected

25. CONGENITAL DEFECTS: PERSISTENT RIGHT 4 TH AORTIC ARCH Constrict the esophagus, food cannot get pass and ________________ _______ will be formed.

26. CONGENITAL DEFECTS: PERSISTENT RIGHT 4 TH AORTIC ARCH Clinical signs include regurgitation due to megaesophagus, ______________________, dyspnea, weight loss Main cause of megaesophagus in puppies: dyspnea and weight loss.

27. PERSISTENT RIGHT 4 TH AORTIC ARCH Dx: ______________________ study Tx: Surgery (like PDA); megaesophagus maintenance; Ab’s for secondary infectionsSurgery Client informations – Do not breed – Sx is needed – After sx some megaesophagus hence no boluses of food