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CONGENITAL DEFECTS CHIHUAHUAS, MALTESE, POODLE, POMERANIAN, SHELTIE PUPPIES COMMONLY AFFECTED Normally, the ductus arteriosus carries blood from the pulmonary artery to the aorta during fetal development. It bypasses the lungs of the fetus. The duct should close in the first 12-24 hours after birth. If it does not, the blood begins to shunt from the aorta into the pulmonary artery and hyperperfuse the lungs. The left side of the heart will have an increase in blood return and become volume overloaded. THIS IS CALLED A LEFT-TO-RIGHT SHUNT CLINICAL SIGNS: A loud murmur best heard over the left base Sometimes called a “machinery” murmur or a continuous murmur If the shunt is small some animals may be asymptomatic In large shunts the animal will develop left-sided heart failure Pulmonary edema Cough Exercise intolerance Tachypnea Weight loss ECG: wide range of arrhythmias including APCs and VPCs Echocardiography (ultrasound) Radiographs: left atrial and ventricular enlargement EXCELLENT PROGNOSIS WITH SURGICAL CORRECTION: LIGATION O THE DUCTUS ARTERIOSUS CLIENT INFO: 64% OF ANIMALS WILL DIE WITHIN 1 YEAR IF NOT TREATED SURGICALLY Dogs with this condition should not be used for breeding Atrial Septal Defect During fetal life, the foramen ovale is an openingi n the interatrial septum, allowing shunting of blood from the right atrium to the left atrium in order to bypass the nonfunctioning fetal lungs. It should close at birth. If it doesn’t, after birth, the blood will shunt from left to right resulting in overload of the right side of the heart. CLINICAL SIGNS: ATRIAL SEPTAL DEFECTS Result in overload of the right side of the heart → dilation and hypertrophy of the right-sided chambers Systolic murmur Right-sided heart failure Radiographs: right ventricular enlargement Echo: right ventricular dilatation Blood is shunted from the oxygen-rich left ventricle into the right ventricle. The blood goes through pulmonary circulation and right back into the left atrium and ventricle resulting in volume overload of the left side of the heart. The right ventricle may dilate as well. CLINICAL SIGNS: VENTRICULAR SEPTAL DEFECTS: Animals with small defects may have minimal or no signs Larger defects may result in acute left-sided heart failure, usually by 8 weeks of age A harsh holosystolic murmur CLIENT INFO: Repair of these defects requires open-heart surgery or cardiopulmonary bypass. These procedures are uncommon in the dog and cat Most of these animals will eventually experience development of congestive heart failure Chihuahuas, English Bulldogs, are commonly affected. CAUSE: polygenic inheritance In pulmonic stenosis, the right ventricular outflow tract is narrowed either at the valve itself, just below it, or just after it. The most common form of pulmonic stenosis involves a deformed pulmonary valve such that the valve leaflets are too thick, the opening is too narrow, or the valve cusps are fused. The heart must pump extra hard to get blood through This unusually narrow, stiff valve. The right ventricle becomes thickened from all this extra work. The right atrium May become dilated and hypertrophied. NORMAL CANINE CHEST RADS THIS DOG HAS PULMONIC STENOSIS – THE HEART LOOKS “PREGNANT” IN THE FRONT DUE TO RIGHT VENTRICULAR ENLARGEMENT CLINICAL SIGNS: Syncope Tiring on exercise Right-sided congested heart failure Left basilar (base) murmur 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 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. Beta-blockers may be used to relax the heart muscle and possibly dilate the stenosis. Newfoundland, Boxer, Golden Retriever, and Bull Terrier are most commonly affected LESION DEVELOPS IN THE FIRST 4-8 WEEKS OF LIFE There is a scar-like narrowing just below the aortic valve. The heart must pump extra hard to get blood through the narrowed area. The blood is pushed through in a turbulent fashion creating a heart murmur. THE HARD WORK RESULTS IN LEFT VENTRICULAR HYPERTROPHY, LEFT ATRIAL ENLARGEMENT, AORTIC DILATION CLINICAL SIGNS: Fatigue Exercise intolerance (low cardiac output) Syncope Systolic murmur at the left heart base ECG: evidence of left ventricular enlargement - ↑ QRS height Echo: left ventricular hypertrophy, subvalvular fibrous ring, aortic dilation 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; PROPRANOLOL (BETABLOCKER WILL DO THIS) CLIENT INFO: Should not be used for breeding Acute, left-sided congestive heart failure is possible Sudden death is not uncommon DCM HCM PDA Aortic 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 •Stenotic valve causes LV pulmonic valve hypertrophy •Pregnant heart •High pressure in aortic valve can lead to aortic dilatation •L sided heart failure (HF) •LV hypertrophy •Sudden death if aorta ruptures •Increased HR •Cough •Increased HR •Weakness in hindlimbs, acute pain, rear cold feet •Pulmonary edema •Digoxin: increased contractibility •Beta blocker: Slow HR •Diuretic •Blood thinner •Treat •No breeding surgically or die Pulmonic stenosis •RV hypertrophy •R sided HF •Balloon valvuloplasty