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DISEASES OF THE CARDIOVASCULAR SYSTEM ACQUIRED VALVULAR DISEASES 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 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. CHRONIC MITRAL VALVE INSUFFICIENCY CHRONIC PERIODONTAL DISEASE CAN AFFECT SEVERAL ORGAN SYSTEMS 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. 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? CHORDAE TENDINEAE MITRAL VALVE INSUFFICIENCY MITRAL VALVE INSUFFICIENCY TOP LEAFLET IS NORMAL BOTTOM LEAFLET IS THICKENED AND NODULAR. THIS IS DUE TO INCREASED FIBROBLASTIC TISSUE WITHIN THE VALVE LEAFLETS CHRONIC MITRAL VALVE INSUFFICIENCY THE STIFF MALFORMED VALVE FAILS TO CLOSE SUFFICIENTLY DURING SYSTOLE. DURING LEFT VENTRICULAR CONTRACTION, BLOOD FLOWS BACK INTO THE LEFT ATRIUM MITRAL VALVE INSUFFICIENCY IF BLOOD CONTIUES THIS BACKWARD FLOW, THE ANIMAL MAY EXPERIENCE LEFT-SIDED HEART FAILURE CHARACTERIZED BY PULMONARY EDEMA CHRONIC MITRAL VALVE INSUFFICIENCY • DIAGNOSIS: – Radiographs – Echo – Systolic murmur at left apex; “whooping” quality • There is no treatment to delay the onset of clinical signs. Treatment is aimed at improving symptoms of heart failure – Diuretics (lasix) – ACE inhibitor, vasodilator (Enalapril) – Diet change: low sodium TRICUSPID VALVE INSUFFICIENCY TRICUSPID VALVE INSUFFICIENCY TRICUSPID INSUFFICIENCY RESULTS IN RIGHT-SIDED HEART FAILURE CHARACTERIZED BY PLEURAL EFFUSION TRICUSPID VALVE INSUFFICIENCY RIGHT-SIDED HEART FAILURE ALSO LEADS TO ASCITES NOTE: THE LOSS OF ABDOMINAL DETAIL TRICUSPID VALVE INSUFFICIENCY • Treatment and client info are the same as for mtiral insufficiency; repeated abdominocentesis may be needed in these cases. LIVE LIFE TO THE FULLEST! “You only live once, but if you work it right, once is enough.” -Joe E. Lewis, comedian DISEASES OF THE CARDIOVASCULAR SYSTEM HEARTWORM DISEASE CANINE HEARTWORM DISEASE • PARASITE CAUSING HEARTWORM DISEASE: DIROFILARIA IMMITIS MICROFILARIA OF D. IMMITIS ADULT HEARTWORMS CANINE HEARTWORM DISEASE ONLY FEMALE MOSQUITOES BITE DISTRIBUTION OF CANINE HEARTWORM DISEASE CANINE HEARTWORM DISEASE ADULT HEARTWORMS LIVE IN THE PULMONARY ARTERIES. THE HEART MUST WORK EXTRA HARD TO PUMP AGAINST THIS OBSTRUCTION. CANINE HEARTWORM DISEASE ADULT HEARTWORMS IN RIGHT VENTRICLE AND PULMONARY ARTERY 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 RIGHTSIDED HEART FAILURE – The right ventricle compensates by dilating and increasing muscle thickness – Ultimately, there is decompensation and heart failure 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 venotomy CANINE HEARTWORM DISEASE CANINE HEARTWORM DISEASE IDEXX SNAP TEST ADULT FEMALE ANTIGEN CANINE HEARTWORM DISEASE CANINE HEARTWORM DISEASE CANINE HEARTWORM DISEASE: PREVENTION • HEARTGARD/IVERHEART – Ivermectin/pyrantel pamoate • INTERCEPTOR/SENTINEL – Milbemycin oxime/ milbemycin oxime+lufeneron • REVOLUTION – Selamectin • ADVANTAGE MULTI/PROHEART 6 – Moxidectin – Q 6 month injectable • TRIFEXIS – Moxidectin + spinosad 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