Today's Veterinary Practice

JUL-AUG 2015

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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com HearT Failure in dogs: 6 PracTical TiPs From cardiologisTs Peer reviewed 26 arrhythmias are atrial fbrillation, ventricular premature complexes, and ventricular tachycardia. A CASE TO CONSIDER Consider the following scenario: An 8-year-old castrated male bichon frise has a 6-month history of exercise- induced cough and a grade 3/6 systolic left-sided heart murmur. The owner is concerned that the dog is coughing during the night and has labored breathing. During auscultation, the murmur is classifed as grade 4/6 systolic, heard loudest at the left apex. Consider These Questions Is this dog experiencing heart failure? Can you answer this question based on the available information, or do you need further details? What additional information is needed? Consider These Answers The signalment, combined with a heart murmur and cough, suggests that heart failure is possible; however, additional information from the history, physical examination, and diagnostic tests is needed to confrm whether the diagnosis is CHF. PRACTICAL TIPS FOR DIAGNOSIS & MANAGEMENT Following are 6 practical tips for optimizing heart failure diagnosis and management in dogs. These tips also provide the additional information needed for diagnosis of CHF as discussed in Consider These Answers. 1. Consider Patient Signalment Age and breed are useful when considering reasonable differential diagnoses for the type of disease responsible for heart failure. Dogs younger than 2 years of age are more likely to have congenital heart disease, while middle-aged to older dogs are more likely to have an acquired, adult-onset disease. Certain breeds are predisposed to specifc disease processes. Classic examples include DMVD incidence in small breeds, such as miniature poodles and Cavalier King Charles spaniels, and DCM incidence in large breeds, such as Doberman pinschers and Great Danes. Specifc examples include: • Incidence of DMVD in Cavalier King Charles spaniels increases with age but, in general, DMVD occurs at a younger age in this breed compared with other breeds. A mitral murmur can become evident at or after 4 years of age, but despite early age of onset, rate of progression is reportedly no different than progression rate in other breeds. • Lifetime risk for DCM in Doberman pinschers is approximately 60%; thus, about half of all Doberman pinschers develop this disease. The risk for asymptomatic DCM in Doberman pinschers increases with age and likely peaks around 7 years; however, the condition is sometimes seen in dogs as young as 3 years of age. Identifying an individual dog's type of heart disease helps guide assessment and treatment recommendations. 2. Be a Detective: Ask Detailed Questions Take time to gather information from the patient's history and physical examination, including details that may help determine whether the dog has heart failure and why it may have occurred. Does the history support heart disease and heart failure? • Is there a history of heart disease in a relative or littermate? • Is congenital or acquired heart disease more likely? For instance, in a middle-aged to older dog, is the murmur a relatively new finding, suggesting an acquired disease, or has it been present since the dog was a puppy, suggesting undiagnosed congenital heart disease? See Consider These Cases (#1). • Does the history of clinical sign progression support heart failure? Findings from the history that support heart failure are listed in Table 1. These findings, while not specific for heart failure, suggest that pulmonary edema may be present, especially when combined with signalment and abnormal findings on physical examination. Does the physical examination support heart disease and heart failure? • A left apical systolic murmur is a characteristic finding in dogs with mitral regurgitation from TablE 1. Clinical Signs Supportive of Heart Failure • Diffculty breathing • Worsening chronic cough that is associated with increased respiratory rate • Decreased appetite • Recent onset of coughing • Reduced activity or exercise ability

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