Background: Aortic stenosis refers to several types of anatomic and functional obstructions of the left ventricular outflow tract. In small animals, this anomaly is most commonly documented as either a congenital lesion or an obstruction that develops soon after birth. It is a hereditary disease, caused by a dominant autosomal gene and modifying genes that interfere with phenotype expression. Even though aortic thromboembolism may be a potential complication in cats with cardiac diseases, aortic stenosis is deemed rare in that species. In this paper, we report an unusual case of a Persian kitten with aortic stenosis that eventually developed arterial thromboembolism.Case: A 7-month-old Persian kitten (3.1 kg) was admitted to a Veterinary Teaching Hospital with a history of hindlimbs paralysis over the past 48 h, as well as excessive vocalization. Also, the cat presented with inappetence, adipsia, urine incontinence, and hematuria. On physical examination, we observed hypothermia and cold paws. The footpads were cyanotic and there were no palpable femoral pulses. Cardiac auscultation disclosed a regular fast pace (200 bpm) and a grade 2/6 murmur heard best over the left cardiac base, but irradiating to the contralateral hemithorax. Prothrombin time and activated partial thromboplastin time were within the normal reference range, but the complete blood count showed microcytosis, lymphopenia, and hyperproteinemia. Also, elevated alanine aminotransferase and BUN were identified. On the echocardiogram, we observed a subvalvular aortic stenosis, which resulted in concentric remodeling of the left ventricle and a mild left atrial dilation. The stenotic lesion was classified as mild. Also, the thoracic radiography unveiledcardiomegaly. The recommended therapy included atenolol (6.25 mg/cat PO, q24h), clopidogrel (18.7 mg/cat PO, q24h), enoxaparin (1 mg/kg SC, q24 h), methadone (0.2 mg/kg IM, q8h) and amoxicillin + potassium clavulanate (20 mg/kg SC, q12h). Additional recommendations included physical therapy on the hindlimbs as well as monitoring heart rate and blood pressure every two hours in the first day, and every six hours thereafter during hospitalization. Seven days later, the cat was depressed, extremely lethargic, and did not respond to therapy at all. Also, necrosis was documented on the hindlimb paws. Therefore, in face of the unfavorable prognosis, the owners opted for euthanasia.Discussion: Cats with cardiomyopathy have an increased risk for developing arterial thromboembolism. The dilated left atrium causes blood stasis and, because of the augmented sensitivity of platelets to serotonin, they aggregate and increase the likelihood of thrombi formation. While some thrombi remain within the heart, usually in the left atrial appendage, others may dislodge and follow blood flow to the aortic trifurcation down in the abdomen. That obstruction impairs blood flow to its tributaries such as the iliac and femoral arteries, which are involved with the hind limbs perfusion. Cats with severe stenotic lesions usually carry a bad prognosis, contrasting with our patient in which only a mild stenosis was documented.However, having developed aortic thromboembolism absolutely changed the prognosis for this cat. Although aortic stenosis is an uncommon condition in cats, its occurrence should be considered as differential diagnosis whenever young patients are admitted with a cardiac murmur. If the diagnosis is confirmed, the patient will need periodical re-evaluations due to the possibility of complications such as arterial thromboembolism. This condition carries a bad prognosis. In this case, it was responsible for the decline in clinical condition which eventually was crucial for the owner opting to euthanize the cat.Keywords: congenital heart disease, echocardiography, valve dysplasia, ischemia.
Background: Spectral Doppler assessment of hepatic veins may provide information on heart function. Hypothesis/Objectives: To assess the normal pattern of hepatic venous flow using spectral Doppler ultrasound examination; to correlate this information with structural and functional variables of the right ventricle (RV), and to analyze the impact of age, sex, body weight quartiles, heart rate, cardiac rhythm, and systolic arterial pressure on the results in healthy dogs.Animals: Sixty-five healthy dogs.Methods: Cross-sectional observational study. The direction and maximum velocity of each of the 4 possible components of venous flow were determined from pulsed-wave Doppler examination of the hepatic veins. In addition, structural and functional parameters (TAPSE, longitudinal strain, FAC%, S 0 , E t /A t, and E 0 t / A 0 t ) of the RV were evaluated. Results: The same phase patterns for different waves were seen in all animals: A and V were retrograde waves, and S and D were anterograde waves. The velocity of the spectral waves increased with body weight (P < .05) and could be correlated with functional indices of the RV. A significant difference was found when comparing morphometric indices with body weight quartiles (P < .05). In addition, intra-and inter-observer assessments showed low variability. The mean duration of the examinations was 5.2 minutes.Conclusions and Clinical Importance: Hepatic spectral Doppler findings can be correlated with systolic and diastolic indices of the RV and vary with body weight. K E Y W O R D S diagnosis, echocardiography, hemodynamics, ultrasonography 1 | INTRODUCTION Normal hepatic venous blood flow has low velocity and a pulsatile pattern that reflects the changes in right atrial pressure throughout the Abbreviations: A 0 , velocity of the tricuspid annulus systolic excursion in late diastole; BW, body weight; CV, coefficient of variation; E 0 , velocity of the tricuspid annulus systolic excursion in early diastole; FAC%, fractional area change; HR, heart rate; RV, right ventricle; S/D, ratio between the S and the D wave derived from hepatic venous Doppler; S 0 , velocity of the tricuspid annulus systolic excursion; SAP, systolic arterial pressure; TAPSE, tricuspid annular plane systolic excursion; TDI, tissue Doppler imaging.
ResumoO presente trabalho tem como objetivo realizar uma análise dos métodos indiretos da avaliação da pressão da artéria pulmonar com base na literatura científica. Por meio de levantamento bibliográfico, artigos científicos foram selecionados conforme a sua relevância para o tema. A avaliação da pressão da artéria pulmonar permite inferir se o paciente apresenta hipertensão arterial pulmonar (HAP), a qual está associada a um prognóstico ruim em cães. O exame padrão é a cateterização da artéria pulmonar, porém este método não tem Development, v. 9, n. 3, e44932309, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i3.2309 2 sido utilizado na rotina da medicina veterinária porque o quadro clínico do animal comumente não permite a sedação e por se tratar de um procedimento oneroso. O diagnóstico da HAP em pequenos animais por meio da ecodopplercardiografia pode ser obtido com a avaliação da regurgitação da valva tricúspide ou pulmonar, características subjetivas e mensuração do tempo de aceleração (TA) e relação entre o tempo de aceleração e o tempo de ejeção do fluxo pulmonar (TA:TE), relação entre a artéria pulmonar e a veia pulmonar, distensibilidade da artéria pulmonar direita (RPAD), e ainda por avaliação da função do ventrículo direito, principalmente o índice de TEI e o strain. O objetivo desta revisão foi demonstrar as principais técnicas ecocardiográficas para estimar HAP, com o intuito de contribuir com o cardiologista no diagnóstico da HAP. Todas as técnicas apresentam fatores positivos e negativos, porém é importante ressaltar que não existe uma técnica ideal, e a forma mais assertiva de se chegar ao diagnóstico é associando as diversas técnicas. Palavras-chave: Hipertensão Arterial Pulmonar; Índice de Distensibilidade da Artéria Pulmonar Direita; Regurgitação da Pulmonar; Regurgitação da Tricúspide. Abstract This paper aims to perform an analysis of the indirect methods of pulmonary artery pressure assessment based on the scientific literature. Through bibliographic survey, scientific articles were selected according to their relevance to the theme.The assessment of pulmonary artery pressure allows to infer whether the individual has pulmonary arterial hypertension (PAH), which is associated with a poor prognosis in dogs diagnosed with mitral valve degeneration. The standard examination is pulmonary artery catheterization, but this method has not been used in routine veterinary medicine because the clinical status of the animal usually does not allow sedation and it is a costly procedure. The diagnosis of PAH in small animals through Doppler echocardiography can be obtained by evaluating the regurgitation of the tricuspid or pulmonary valve, subjective characteristics and measurement of the acceleration time (AT) and the acceleration time-to-ejection time ratio of pulmonary artery (AT:ET), pulmonary artery-to-pulmonary vein ratio, distensibility of the right pulmonary artery (RAPD), and assessment of right ventricular function, especially TEI index and strain. The aim of this...
RESUMO:Crescentes estudos e achados clínicos apontam para a relevância da vitamina D no desenvolvimento e como valor preditivo de alterações cardiovasculares. Assim, a presente revisão tem por objetivo abordar o papel da vitamina D nas cardiopatias de cães. A vitamina D classifica-se como um nutriente dietético essencial para cães e há evidências crescentes de que a sua deficiência é uma importante condição para a patogênese das cardiopatias, acredita-se que por ter ação inicial direta sobre a célula cardíaca, com ativação neuro-hormonal e remodelamento cardíaco e insuficiência congestiva, estando associada ao aumento da morbidade e mortalidade. Embora pioneiras, as pesquisas apontam que a vitamina D em concentrações adequadas pode influenciar na redução do risco de ocorrência das cardiopatias, aumentar a eficácia do tratamento e, consequentemente, promover um melhor prognóstico. Palavras-chave: Deficiência; nutrição; suplementação.ABSTRACT: Studies have been emerging and clinical findings point to the relevance of vitamin D in development and as a predictive value of cardiovascular changes. Thus, this review aims to address the role of vitamin D in cardiac diseases. Vitamin D is classified as an essential dietary nutrient for dogs and there is growing evidence that its deficiency is an important condition for the pathogenesis of heart disease, with neuro-hormonal activation and cardiac remodeling and congestive insufficiency, being associated with increased morbidity and mortality. Although pioneering, research indicates that vitamin D in adequate concentrations may influence the reduction of the risk of heart disease, increase the effectiveness of treatment and, consequently, promote a better prognosis.
Background: Volume replacement is considered an essential component in the treatment of critically ill patients, but excess fluid administration can be as harmful as the lack of fluid therapy. Therefore, the volume replacement is only beneficial in patients deemed to be fluid responsive, that is, when the individual has an increase in their stroke volume after administration of a volume challenge. This study aim to assess whether conventional and advanced echocardiographic parameters for assessing left ventricular systolic function are able to predict fluid responsiveness in healthy spontaneously breathing dogs. The hypothesis was that some of these parameters would differ between responsive and non-responsive animals and could be used as a complementary measure for assessment of fluid responsiveness.Materials, Methods & Results: A prospective study was carried out in which 22 client-owned healthy dogs over 1 year of age that presented to the Veterinary Medical Teaching Hospital for elective neutering procedure were included. All dogs underwent conventional and advanced echocardiographic examination to obtain the left ventricular internal diameter in diastole normalized (LVIDDn), left ventricular internal diameter in systole normalized (LVIDSn), ejection fraction (EF) and shortening fraction (SF) according to the Teischholz methodology, global longitudinal strain (GLS) and tissue motion annular displacement (TMAD). There parameters were evaluated before and after administration of a volume challenge with 10 mL/kg lactate ringer intravenously for 20 min. Based on the variation in aortic velocity integral time, 31.82% of dogs were considered responsive and 68.18% were non-responsive to the volume challenge. For advanced echocardiography, TMAD indexed by body weight (mm/kg) > 0.89 (P = 0.004) and body surface area (mm/m2) >18.9 (P = 0.004) after volume challenge had the best area under the curve values (both 0.895) and smaller gray zone intervals (0.52 - 0.81 and 14.89 - 17.88) for the identification of responsive dogs. Although, TMAD (mm/kg and mm/m2) before volume challenge was also higher in the responsive dogs (P = 0.041 and P = 0.029). As for conventional echocardiography, the LVIDDn < 1.39 (P = 0.003) before volume challenge had the best area under the curve value (0.866) and the smallest gray zone interval (1.4 - 1.57) for the identification of responsive dogs. The GLS and the TMAD in milimeters (mm), percentage (%) and indexed by cubic root of weight (mm/∛kg) did not differ between the responsive and non-responsive dogs before and after volume challenge.Discussion: TMAD indexed by body weight (mm/kg) and body surface area (mm/m2) before and after volume challenge and the LVIDDn before volume challenge may be useful measures to complement the assessment of fluid responsiveness in spontaneously breathing dogs. This is the first study to use TMAD as a predictive parameter for fluid responsiveness in healthy, spontaneously breathing, dogs. Even it is an advanced echocardiographic technique, TMAD has advantages interms of execution time and the fact that it is less dependence on image quality or operator experience. It is possible that in the future such variables may form a useful part of the evaluation of fluid responsiveness in dogs. However, more studies are needed to better understand the applicability of these techniques, especially in dogs with hemodynamic changes. Keywords: canine, global longitudinal strain, stroke volume, tissue motion annular displacement, TMAD, VTI.
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