Today's Veterinary Practice

MAY-JUN 2018

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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PEER REVIEWED 34 CE: CONGESTIVE HEART FAILURE IN CANINES required, pending left atrial adjustment, usually dilation, to the increased regurgitation. Eventually, in some dogs, systolic failure develops from the chronic volume overload. In the early and middle stages of DMVD, the fractional shortening is elevated. A finding of low or low- normal fractional shortening in a dog with advanced DMVD is a poor prognostic sign, as it suggests the patient is in the terminal stages of the disease. An uncommon cause of decompensation in a stable CHF patient with DMVD is the development of a hemopericardium secondary to left atrial rupture. These patients are difficult to manage, as draining the pericardium tends to encourage further hemorrhage. As this is an acute bleed, an echocardiogram may show clots developing in the pericardium. Given time, the defect can scar over and the patient recover, but recurrence is common. PROGNOSIS The development of heart failure represents a specific measurable point in the development of heart disease. For DMVD, the average survival of dogs with CHF is 9 months.5 However, within survival times in this group vary widely, with some patients living over 3 years.5 Survival in dogs with DCM is similar. 16 Parameters that can help stratify risk by suggesting poorer prognosis include large left atrial and left ventricular size and high mitral E wave velocity. When owners are questioned, it is evident that most would trade some longevity for improved quality of life. With a logical approach, heart failure can be controlled for many months with a good quality of life in most dogs. References 1. Kellet-Gregory LM, King LG. Management of acute respiratory distress. In: Fuentes VL, Johnson LR, Dennis S, eds. BSAVA Manual of Canine and Feline Cardiorespiratory Medicine. 2 nd ed. Gloucester: BSAVA; 2010:143. 2. Suzuki S, Fuk ushima R, Ishik awa T, et al. The effect of pimobendan on left atrial pressure in dogs with mitral valve regurgitation. J Vet Intern Med 2011;25(6):1328-1333. 3. Fuentes VL. Treatment of congestive heart failure. In: Fuentes VL, Johnson LR, Dennis S, eds. BSAVA Manual of Canine and Feline Cardiorespiratory Medicine. 2 nd ed. Gloucester: BSAVA; 2010:158. 4. O'Grady MR, Minors SL, O'Sullivan ML, Horne R. Effect of pimobendan on case fatality rate in Doberman Pinschers with congestive heart failure caused by dilated cardiomyopathy. J Vet Intern Med 2008;22(4):897-904. 5. Haggstrom J, Boswood A, O'Grady M, et al. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: The QUEST Study. J Vet Intern Med 2008;22(5):1124-1135. 6. Boswood A, Haggstrom J, Gordon SG, et al. Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: The EPIC study—a randomized clinical trial. J Vet Intern Med 2016;30(6):1765-1779. 7. Ettinger SJ, Benitz AM, Ericsson GF, et al. Effects of enalapril maleate on survival of dogs with naturally occurring acquired heart failure. The Long-Term Investigation of Veterinary Enalapril (LIVE) Study Group. J AVMA 1998;213(11):1573-1577. 8. BENCH Study Group. The effect of benazepril on survival times and clinical signs of dogs with congestive heart failure: Results of a multicenter, prospective, randomized, double-blinded, placebo- controlled, long-term clinical trial. J Vet Cardiol 1999;1(1):7-18. 9. Besche B, Chetboul V, Lachaud L efay MP, Grandemange E. Clinical evaluation of imidapril in congestive heart failure in dogs: results of the EFFIC study. J Small Anim Pract 2007;48(5):265-270. 10. Lantis AC, Ames MK, Atkins CE, et al. Aldosterone breakthrough with benazepril in furosemide-activated renin-angiotensin-aldosterone system in normal dogs. J Vet Pharmacol Ther 2015;38(1):65-73. 11. Bernay F, Bland JM, Haggstrom J, et al. Efficacy of spironolactone on survival in dogs with naturally occurring mitral regurgitation caused by myxomatous mitral valve disease. J Vet Intern Med 2010;24(2):331-341. 12. Gelzer AR, Kraus MS, Rishniw M, et al. Combination therapy with mexiletine and sotalol suppresses inherited ventricular arrhythmias in German shepherd dogs better than mexiletine or sotalol monotherapy: a randomized cross-over study. J Vet Cardiol 2010;12(2):93-106. 13. Gelzer AR, Kraus MS, Rishniw M, et al. Combination therapy with digoxin and diltiazem controls ventricular rate in chronic atrial fibrillation in dogs better than digoxin or diltiazem monotherapy: a randomized crossover study in 18 dogs. J Vet Intern Med 2009;23(3):499-508. 14. Freeman LM. Beneficial effects of omega-3 fatty acids in cardiovascular disease. J Small Anim Pract 2010;51(9):462-470. 15. Oyama MA, Peddle GD, Reynolds CA, Singletary GE. Use of the loop diuretic torsemide in three dogs with advanced heart failure. J Vet Cardiol 2011;13(4):287-292. 16. Martin MW, Stafford Johnson MJ, Strehlau G, King JN. Canine dilated cardiomyopathy: a retrospective study of prognostic findings in 367 clinical cases. J Small Anim Pract 2010;51(8):428-436. Simon Swift After qualifying from Cambridge University, Dr. Swift spent 2 years in mixed practice before moving to a specialist small animal practice in the Northwest of England. He developed an interest in cardiology taking the RCVS cardiology certificate in 1990. He became a partner in a large emergency and referral hospital building up the cardiology referral service until he left in 2005 to follow an alternative residency program at Liverpool University. Since becoming a European Diplomate in cardiology, he worked in a private referral hospital before moving to Florida to join the College of Veterinary Medicine as Clinical Associate Professor. He is service chief for cardiology and has recently been appointed medical director. He has been involved in breeding programs and the treatment of degenerative valvular disease especially in the cavalier King Charles spaniel having been adviser to the UK CKCS club for 20 years and more recently has helped develop advanced interventional techniques at the University of Florida.

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