Today's Veterinary Practice

JAN-FEB 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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Today's VeTerinary PracTice | January/February 2016 | tvpjournal.com aHs HearTWorM HoTLine Peer reviewed 66 2. For many practitioners, the thought of performing echocardiography can be intimidating; as a result, many of us fail to place an ultrasound probe on a heart. any practitioner with access to ultrasonography and minimal training can make this diagnosis (see The Role of Ultrasonography); it does not require the expertise of a cardiologist. as such, the practitioner can and should perform ultrasonography as soon as possible, keeping in mind that surgery would most appropriately be done that same day. IN SUMMARY Most veterinarians have great insight for diagnosing illness and, at times, can readily guess a diagnosis simply on the basis of history, such as in the following examples: • an owner calls to report that her 6-week-old puppy is weak, with pale gums and black stool. our usual thought is hookworm anemia. • an intact female was in heat a month ago and is now anorexic, with a fetid vaginal discharge. We are quick to think of pyometra. cs can be similarly suspected when history indicates an acute onset of respiratory distress and weakness in a pet that is not receiving heartworm prophylaxis. add to the history a tricuspid murmur, bounding jugular pulses, and hemoglobinuria, and a clinician might well be on the way to diagnosing cs . Because HWd is no longer limited to the southern and coastal regions of the U. s., it is important that we all become capable of recognizing its clinical signs. Being familiar with the history and presenting signs of cs allows clinicians the opportunity to save a life when a pet presents with this syndrome. read the next article in this series, Management & Treatment of caval s yndrome—which will cover the medical management and surgical extraction of heartworms in canine cs —in an upcoming issue of Today's Veterinary Practice. cs = caval syndrome; HWd = heartworm disease References 1. american Heartworm society. current canine guidelines for the prevention, diagnosis and management of heartworm infection in dogs. July 2014. heartwormsociety.org/images/pdf/canine- Guidelines-summary.pdf 2. atkins ce. caval syndrome in the dog. Semin Vet Med Surg (Small Anim) 1987; 2(1):64-71. 3. Jackson rF, seymore WG, Growney rJ. surgical treatment of the caval syndrome of canine heartworm disease. JAVMA 1977; the role of Ultrasonography Today, high-quality ultrasound equipment is found in many clinical practices, but just a decade ago this technology was far less available. Without ultrasonography, experienced veterinarians diagnosed CS on the basis of history, clinical fndings, and minimal diagnostic tests. Confrmation was possible only when the mass of worms was surgically removed. Thus, a great deal of confdence was required to tell a pet owner that, while it could not be proven, there was a mass of heartworms blocking the pet's heart and surgery was needed to blindly attempt to remove this mass. Today, ultrasonography makes our job much easier, but we should keep in mind that many pets were diagnosed and underwent successful surgeries long before this technology was readily available. The inability to perform an ultrasound on a heart should not deter a clinician from diagnosing CS and performing surgery when fndings strongly support the diagnosis. t h r FIGURE 3. The distinct, hyperechoic cuticular wall of the heartworm can be readily visualized on ultrasonography. The white, parallel lines ( white arrow) depict a short section of an adult heartworm extending from the right atrium into the ventricle. Courtesy Merial FIGURE 4. Cardiac ultrasonography shows many short pairs of hyperechoic lines. Each set of lines represents a short section of an adult heartworm. This pet with CS had a high number of worms within the right atrium, tricuspid orifce, and right ventricle. Courtesy Merial

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