MATTERS OF THE HEART The heart has reasons that reason does not understand. -Jacques Benigne...
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Transcript of MATTERS OF THE HEART The heart has reasons that reason does not understand. -Jacques Benigne...
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MATTERS OF THE HEART
“The heart has reasons that reason does not understand.”
-Jacques Benigne Bossuel
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DISEASES OF THE CARDIOVASCULAR SYSTEM
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CANINE DILATED CARDIOMYOPATHY
OTHER BREEDS INCLUDE WOLFHOUNDS, GREAT DANES, AND COCKER SPANIELS
90% of cases occur in Doberman Pinschers and Boxers
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY
DECREASED CONTRACTILITY FROM AN UNKNOWN CAUSE (viral?, carnitine deficiency?)Decreased contractility = decreased cardiac
outputCO (CARDIAC OUTPUT) = SV (STROKE VOLUME) X HR (HEART RATE)
The amt. of blood that leavesThe heart
Amt. of blood ejected withEach cardiac contraction(affected by afterload, preload,and inherent contractility)
How often the heartcontracts
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY
THE BODY COMPENSATES BY: 1. INCREASING THE HEART RATE
*this is done by sympathetic nervous system stimulation
2. TRYING TO INCREASE STROKE VOLUME BY INCREASING PRELOAD (this means that the body increases filling of the heart) *This is done by activation of the Renin-angiotensin-aldosterone system which leads to sodium and water retention
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THE WALLS OF THE HEART ARE WEAK, FLABBY, AND DILATED – THIS DILATION MAY CAUSE SEPARATION OF THE MITRAL VALVE LEAFLETSLEADING TO MITRAL REGURGITATION
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CANINE DILATED CARDIOMYOPATHY: CLINICAL SIGNS
LETHARGY, EXERCISE INTOLERANCE, COUGHING, WEIGHT LOSS, TACHYPNEA,SYNCOPE, SOFT MURMUR (WHERE?)
PLEURAL EFFUSION, ASCITES, HEPATOMEGALY, WT. LOSS
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CANINE DILATED CARDIOMYOPATHY
Enlarged, round heartDOBERMANS ARE DEEP CHESTED AND MAY NOT APPEAR TO HAVE SUCH ANENLARGED HEART ON RADIOGRAPHS
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CANINE DILATED CARDIOMYOPATHY
PULMONARY EDEMA PLEURAL EFFUSION
PATIENT MAY SHOW SIGNS OF LEFT-SIDED, RIGHT-SIDED, OR HEART FAILURE FROM BOTH SIDES
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CANINE DILATED CARDIOMYOPATHY: PATHOPHYSIOLOGY
Constant stimulation of the heart by the sympathetic nervous system causes ventricular arrhythmias and myocyte death Most common arrhythmias: VPC’s and ventricular tachycardia,
esp. in boxers & Dobies; other dogs may have APC’s and atrial fibrillation
ONE VPC
MULTIPLE VPCsCAUSING TACHY-CARDIA
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CANINE DILATED CARDIOMYOPATHY: ECHOCARDIOGRAM
http://www.youtube.com/watch?v=NSnh3qN2kR4&NR=1
PERFORMING AN ECHOCARDIOGRAM IS THE DEFINITIVE WAY TO DIAGNOSEDILATED CARDIOMYOPATHY
http://www.youtube.com/watch?v=7TWu0_Gklzo&feature=related
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CANINE DILATED CARDIOMYOPATHY: DIAGNOSTICS
Laboratory testsAtrial Natriuretic peptide increase
Released from atria in response to excess stretchBrain natriuretic peptide increase
released from ventricles in response to excess stretch
Pro-BNP releaseTroponin 1 (cTn1) increased
Released when heart muscle is damaged
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CANINE DILATED CARDIOMYOPATHY: TREATMENT
INCREASES CONTRACTILITY
DIURETIC-ELIMINATES EXCESS FLUID
REDUCES FLUIDRETENTION
DIGOXIN
FUROSEMIDE
ENALAPRIL
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CANINE DILATED CARDIOMYOPATHY: TREATMENT
DIETARY SUPPLEMENTS THAT MAY HELP IMPROVE HEART FUNCTION, ESPIF THERE IS A DEFICIENCY
COENZYME Q10 TAURINE – USED IN COCKERSPANIELS AND CATS, MAINLY
L-CARNITINE
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CANINE DILATED CARDIOMYOPATHY: CLIENT INFO
DCM is a progressive diseases that is almost always fatalMost dogs die within 6 months -2 yearsDeath may occur suddenly due to arrhythmias
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FELINE DILATED CARDIOMYOPATHY
A globular-shaped heart withsevere dilation of all fourchambers. Depressedventricular contractileperformance occurs.Ventricular dilation distorts theatrioventricular valves leading tomitral regurgitation and atrialenlargement
ABNORMALLY THIN VENTRICULAR WALLS
ATROPHIED PAPILLARY MUSCLES
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FELINE DILATED CARDIOMYOPATHY
In the 1980’s DCM in cats was one of the most commonly diagnosed heart diseases. It was discovered that this was caused by a deficiency of TAURINE, an amino acid.
Since that time commercial foods have added taurine to feline diets, which has significantly decreased the number of cases of feline DCM