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

2. CHRONIC MITRAL VALVE INSUFFECIENCY SMALL BREED/TOY BREED DOGS, USUASLLY OLDER THAN 10 YEARS THE PREVALENCE OF THIS DISEASE INCREASES WITH AGE, AND IS PROGRESSIVE. IT ACCOUNTS FOR ~95% OF ALL HEART FAILURE CASES

3. CHRONIC MITRAL VALVE INSUFFICIENCY ONE OF THE MOST COMMON CAUSES IS CHRONIC PERIODONTAL DISEASE! BACTERIA THAT LIVE IN TARTAR, GET SHOWERED INTO THE BLOOD STREAM AND COLONIZE IN THE VALVE LEAFLETS.

4. CHRONIC MITRAL VALVE INSUFFICIENCY 1.Lungs: Pulmonary fibrosis, bronchitis, and chronic obstructive pulmonary disease. 2.Heart: Endocarditis, mitral valve regurgitation, and myocardial degeneration. 3.Liver: Hepatic parenchymal inflammation and hepatopathy. 4.Kidneys: Interstitial nephritis and glomerulonephritis. CHRONIC PERIODONTAL DISEASE CAN AFFECT SEVERAL ORGAN SYSTEMS

5. MITRAL VALVE INSUFFICIENCY THIS IS THE OPEN LEFT VENTRICLE SHOWING THE MITRAL VALVE LEAFLETS. WHAT ARE THE STRING-LIKE STRUCTURES THAT ATTACH THE VALVES TO THE PAPILLARY MUSCLES?

6. MITRAL VALVE INSUFFICIENCY CHORDAE TENDINEAE

7. MITRAL VALVE INSUFFICIENCY BOTTOM LEAFLET IS THICKENED AND NODULAR. THIS IS DUE TO INCREASED FIBROBLASTIC TISSUE WITHIN THE VALVE LEAFLETS L HR TOP LEAFLET IS NORMAL

8. CHRONIC MITRAL VALVE INSUFFICIENCY DURING LEFT VENTRICULAR CONTRACTION, BLOOD FLOWS BACK INTO THE LEFT ATRIUM THE STIFF MALFORMED VALVE FAILS TO CLOSE SUFFICIENTLY DURING SYSTOLE.

9. MITRAL VALVE INSUFFICIENCY IF BLOOD CONTIUES THIS BACKWARD FLOW, THE ANIMAL MAY EXPERIENCE LEFT-SIDED HEART FAILURE CHARACTERIZED BY PULMONARY EDEMA

10. CHRONIC MITRAL VALVE INSUFFICIENCY DIAGNOSIS: – Radiographs – Echo – Systolic murmur at left apex; “whooping” quality Systolic murmur There is no treatment to delay the onset of clinical signs. Treatment is aimed at improving symptoms of heart failure – Diuretics (lasix) – Enalapril (avoids retention of fluid): ACE inhibitor, vasodilator – Pimobendan: Helps pump blood efficiently – Diet change: low sodium

11. TRICUSPID VALVE INSUFFICIENCY

12. TRICUSPID INSUFFICIENCY RESULTS IN RIGHT-SIDED HEART FAILURE CHARACTERIZED BY PLEURAL EFFUSION

13. TRICUSPID VALVE INSUFFICIENCY RIGHT-SIDED HEART FAILURE ALSO LEADS TO pleural effusion and ASCITES NOTE: THE LOSS OF ABDOMINAL DETAIL Ascites. Blood backs up in vena cava and this back up causes back overload, liver overloaded with fluids. Vascular permeability, leaky vessels.

14. TRICUSPID VALVE INSUFFICIENCY Treatment and client info are the same as for mtiral insufficiency; repeated abdominocentesis may be needed in these cases. Lasix: Diuretics Enalapril: Reduces retention of fluids

15. LIVE LIFE TO THE FULLEST! “You only live once, but if you work it right, once is enough.” -Joe E. Lewis, comedian

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

17. DISEASES OF THE CARDIOVASCULAR SYSTEM HEARTWORM DISEASE

18. CATS HWD

19. DISTRIBUTION OF CANINE HEARTWORM DISEASE

20. CANINE HEARTWORM DISEASE PARASITE CAUSING HEARTWORM DISEASE: DIROFILARIA IMMITIS MICROFILARIA OF D. IMMITIS ADULT HEARTWORMS

21. CANINE HEARTWORM DISEASE ONLY FEMALE MOSQUITOES BITE Mosquito transmits L3 stage. L1 – L3 develops in the mosquito. Dog mff goes to mosquito. Dog L3 – L5

22. CANINE HEARTWORM DISEASE Intermediate host Definitive host

24. CANINE HEARTWORM DISEASE ADULT HEARTWORMS LIVE IN THE PULMONARY ARTERIES. THE HEART MUST WORK EXTRA HARD TO PUMP AGAINST THIS OBSTRUCTION. ADULT HEARTWORMS IN RIGHT VENTRICLE AND PULMONARY ARTERY

25. CANINE HEARTWORM DISEASE PREDOMINANT PATHOLOGY: DAMAGE TO THE PULMONARY ARTERY FROM ADULT HEARTWORMS – Endothelial damage and sloughing – Inflammation (leukocytes, platelets) Risk of thromboemboli – Pulmonary hypertension – Disruption of vascular integrity Thickened, fibrosed RIGHT VENTRICULAR HYPERTROPHY AND RIGHT-SIDED HEART FAILURE – The right ventricle compensates by dilating and increasing muscle thickness – Ultimately, there is decompensation and heart failure

26. GRADING Class 1: No symptoms or mild symptoms such as an occasional cough. Class 2: Mild to moderate symptoms such as an occasional cough and tiredness after moderate activity. Class 3: General loss of body condition, a persistent cough, and tiredness after mild activity. Trouble breathing and signs of heart failure are common. For class 2 and 3 heartworm disease, heart and lung changes are usually seen on chest x-rays. Class 4: Caval syndrome. There is such a heavy worm burden that blood flowing back to the heart is physically blocked by a large mass of worms. Caval syndrome is life-threatening and quick surgical removal of the heartworms is the only treatment option. The surgery is risky, and even with surgery, most dogs with caval syndrome die.

27. The yellow arrows point to the tortuous and severely enlarged pulmonary arteries. There is a mild increase in the size of the right atrium. The pulmonary parenchyma also has a slight interstitial pattern.

29. CANINE HEARTWORM DISEASE Severe infection can lead to CAVAL SYNDROME – Worms back up into the right atrium and venae cavae Found in heavy worm burdens (>60) Associated with a poor prognosis Surgical treatment: pull worms from the right heart and venae cavae via jugular venotomyjugular venotomy

30. Heartworm embolectomy procedure. Basket forceps placed throught he right jugular vein and into the right heart were used to retrieve the heartworms from this Rottweiler with caval syndrome. Seventy-one worms were removed from this patient's right heart

31. CANINE HEARTWORM DISEASE IDEXX SNAP TEST ADULT FEMALE ANTIGEN

32. CANINE HEARTWORM DISEASE

34. CANINE HEARTWORM DISEASE: PREVENTION HEARTGARD/IVERHEART – Ivermectin/pyrantel pamoate INTERCEPTOR/SENTINEL – Milbemycin oxime REVOLUTION – Selamectin ADVANTAGE MULTI/PROHEART 6 – Moxidectin – Q 6 month injectable

35. CANINE HEARTWORM DISEASE: TREATMENT STANDARD PROTOCOL: 1 epaxial injection, followed By a second injection on the opposite side 24 hours later ALTERNATIVE PROTOCOL: 1 Injection given followed in 4-6 weeks by 2 injections given 24 hours apart ONLY KILLS ADULT (L5) STAGE WORMS; DOXYCYCLINE IS REC. AS COMPLIMENTARY TX (WOLBACHIA)

36. Heartworm Treatment – Slow Kill Method – VTI Team: Dr. B, Dr. Dev, Miss Kennar, Miss Foitnik Doxycycline: 5 – 10 mg/ kg (SID or BID) Prednisone: 1 mg/kg : BID X 7 days; SID X 7 days, EOD X 7 days DAY 1 – Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection – Famotidine 0.5 mg/kg SQ: before melarsomine injection – Melarsormine: 0.1 mls/ kg IM DAY 30 – Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection; – Famotidine 0.5 mg/kg SQ: before melarsomine injection – Melarsormine: 0.1 mls/ kg IM DAY 31 – Buprenex: 0.015 mg/ kg OR Tramadol: 1mg/lb BID X 3 days PO before melarsomine injection; – Famotidine 0.5 mg/kg SQ: before melarsomine injection – Melarsormine: 0.1 mls/ kg IM

37. THANK YOU ROYALS 2011

38. References Alleice Summers, Common Diseases of Companion Animals http://veterinarynews.dvm360.com/dvm/article /articleDetail.jsp?id=156665 http://veterinarynews.dvm360.com/dvm/article /articleDetail.jsp?id=156665 VIN: Robert Prosek DVM, MS, DACVIM- Cardiology, DECVIM-CA Echocardiography in the Dog, Cat and Horse: Dr. Francesco Porciello, 2009 http://www.vin.com/WebLink.plx?URL=http:// www.vmth.ucdavis.edu/cardio/cases/

39. References http://cardiology.vetmed.lsu.edu/Education/Ac quiredCardiacDiseases/HeartwormDisease/tabi d/448/Default.aspx http://cardiology.vetmed.lsu.edu/Education/Ac quiredCardiacDiseases/HeartwormDisease/tabi d/448/Default.aspx http://www.heartwormsociety.org/