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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice aHs HearTWorM HoTLine Peer reviewed 63 not long ago, heartworm disease (HWd) was considered a problem of the south—it was endemic in the southeast, Gulf coast, and Mississippi delta regions of the United states. Today, we fnd heartworms not only present in, but also transmitted in, every state in the continental U. s. as well as Hawaii (Figure 1). 1 according to the american Heartworm society, over one million dogs in the U.s. are currently infected with Diroflaria immitis (heartworms). although most infected pets are clinically normal, it has become increasingly important that veterinarians everywhere recognize the clinical signs of illness. a small percentage of dogs infected with heartworms develop caval syndrome (cs), an extremely serious form of HWd that must be promptly recognized as a surgical, rather than a medical, problem. When diagnosis of cs is delayed, the prognosis can quickly become grave. This article focuses on the recognition and diagnosis of this life- threatening consequence of HWd. Visit tvpjournal.com to read Part 1 of this article series—Understanding Development of Caval Syndrome (november/december 2015). DIAGNOSTIC OVERVIEW The following scenario is all the history a veterinarian needs to place cs high on a diagnostic rule-out list: 1. it is springtime. 2. a dog presents to your hospital with acute weakness, and is breathing hard. 3. The dog was normal yesterday morning. 4. The dog is not receiving heartworm prevention. These clues are often available to the clinician before entering the examination room. although this diagnosis might be quickly ruled out during the physical examination, the fact remains: when the history is similar to the above description, cs should at least be a consideration. canine caval syndrome series Part 2: a Practical aPProach to Diagnosing caval synDrome Stephen L. Jones, DVM Lakeside Animal Hospital, Moncks Corner, South Carolina The heartworm hotline column is presented in partnership between Today's Veterinary Practice and the american heartworm society (heartwormsociety.org). The goal of the column is to communicate practical and timely information on prevention, diagnosis, and treatment of heartworm disease, as well as highlight current topics related to heartworm research and fndings in veterinary medicine. FIGURE 1. Heartworm incidence survey map (2013). Courtesy American Heartworm Society