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Echocardiography and Heart Disease in Dogs and Cats
Our sarasota animal hospital veterinarian, Dr. Edward Cole, has over 25 years of experience treating dog and cat heart disease. Although X-rays and Ekgs are important in diagnosing and managing some heart diseases, echocardiography (or an Echo for short) is the mainstay of diagnosis for the vast majority of heart diseases in our cat and dog patients. Echocardiography is safe and painless and is a highly informative modality in treating our veterinary pet patients with cardiac issues. Echocardiography uses high frequency sound to image the structure and function of the heart in real-time. A small hand held probe is gently placed on the chest and delivers the sound waves through the body to the heart muscle and valves. Some of that sound is reflected back to the probe that stimulate crystals that are translated into an electric current that is processed using complex computer algorithms to form a high definition moving picture of the heart. This image gives the veterinarian a view of the heart chambers, how much they contract, and the valves that separate the chambers and vessels coming from the heart.
There are many indications for a cardiac evaluation by a veterinarian. These most commonly include the presence of a heart murmur, cough, trouble breathing, or increase respiratory rate, and fluid in the lungs. Other symptoms of heart disease can include abnormal heart rhythms, collapsing episodes, a reduced ability to exercise, fluid in the abdomen, decrease appetite, and general tiredness.
Heart Diseases of Dogs
MITRAL VALVE DISEASE - Mitral valve disease is by far the most common heart disease of dogs (around 75% of all heart disease in dogs). Over the years, the disease has been called chronic valvular disease, degenerative mitral valve disease, mitral valve disease, endocardiosis, and more recently and more approptriately myxomatous mitral valve disease. The “ myxomatous" describe the cellular changes that occur within the mitral valve that cause thickening and nodular changes in the valve structure and can lead to incomplete valve sealing and backward blood flow during contraction of the heart. These changes can affect the other valves of the heart as well but the mitral valve, which is located between the left atrium, that receives blood from the lungs and the left ventricle, which pumps blood to the rest of the body, is the most common site that is affected. Specific breeds predisposed to mitral valve disease include Cavalier King Charles Spaniels, miniature and toy Poodles, miniature Schnauzers, Lhasa Apso, dachshunds, Shi Tzu, Cocker Spaniels, and various terrier breeds. Even though small breeds are affected more commonly, many medium and larger breeds like Weimeraners, German Shepherds and Dobermans and other mixed breed dogs can also get mitral valve disease. Most dogs tend to be more than 5 years old. As with other heart diseases, the most common symptoms are trouble breathing, coughing and decrease activity and all symptomatic dogs have heart murmurs. It is important to note that not all dogs with mitral valve disease need treatment and there are some that will never go on to heart failure. Based on the results of the echocardiogram and chest radiographs, we can determine if treatment is needed and the best treatment regime for your pet to maximize their quality of life for as long as possible. Even in dogs that go into congestive heart failure, with periodic adjustment and tailoring of treatments, we can give our dog patients and extended period of good quality life.
DILATED CARDIOMYOPATHY - Dilated cardiomyopathy is an acquired heart disease affecting the heart muscle. Although there is a large genetic component to dilated cardiomyopathy, nutritional deficiencies, infectious agents, and toxicities also play a role in some cases. Breeds predisposed to dilated cardiomyopathy include Doberman Pinchers, Great Danes, Boxers, Newfoundlands, Irish Wolfhounds and Cocker Spaniels. Begining in 2018, 100’s of dogs developed a dilated cardiomyopathy like disease that represented many different dog breeds and mixes that don’t normally developed dilated cardiomyopathy. The only commonality that was found was the feeding of various “boutique" or “exotic” grain-free diets. In DCM the heart muscle dilates and looses the ability to pump normally. Signs of dilated cardiomyopathy can include lethargy, weakness, collapse, increased trouble breathing, and cough and rarely abdominal distention. Arrhythmias are very common in dogs with dilated cardiomyopathy. Echocardiography is integral to identifying dogs with cardiomyopathy. In some breeds, in-office ekgs and worn-at-home 24-hour ekg holter monitoring can detect disease even before dogs develop symptoms of dilated cardiomyopathy. Treatments for dilated cardiomyopathy are available to increase heart contraction, reduce vascular resistance and reduce fluid buildup in lungs.
Heart Diseases of Cats
HYPERTROPHIC CARDIOMYOPATHY - Hypertrophic cardiomyopathy ( HCM ) is by far the most common heart disease of cats. It involves the thickening of the heart muscle which hinders filling and relaxation of the muscle and therefore hinders the efficiency of the heart to contract. There are several breeds that have an increased prevalence to develop HCM including Maine Coon, Ragdoll, Persian, Sphynx, British Shorthair, Chartreux and Sphynx cats. In some breeds, there are genetic tests for markers that can show and increase chance of developing the disease and therefore could indicate closer monitoring for disease. Symptoms of hypertrophic cardiomyopathy include difficult or rapid breathing, lethargy, collapse, decrease activity, decreased appetite, weight loss, and even hind end paralysis or sudden death from blood clots. Less than 50% of cats with hypertrophic cardiomyopathy have a heart murmur. Also of all cats that have heart murmurs on 30% have any type of cardiomyopathy. Blood tests that assess liver, kidney and thyroid function and blood pressure assessment are essential to correctly diagnosing and managing the treatment of hypertrophic cardiomyopathy. Echocardiography is the mainstay of diagnosis, since it is the only modality that can measure heart muscle thickness in real time throughout the different phases of contraction. It is also important in assessing the risk of blood clots forming in the heart which can pass to other areas of the body. Depending on the severity of disease, treatments can be used to control heart rate, treat lung congestion and decrease the likelihood of clot formation.
DILATED CARDIOMYOPATHY - Dilated Cardiomyopathy is much less common disease that is similar to the disease in dogs in that the heart dilates, there are thin walls and contractility is poor.
RESTRICTIVE/ INTERMEDIATE CARDIOMYOPATHY - Restrictive/ intermediate cardiomyopathy as the name implies has features of both hypertrophic and dilated cardiomyopathy in that there is no to mild thickening of the heart muscle wall and mild decrease contractility. It typically involves ventriclar chambers that are stiff and result in poof filling. The left atrium and sometimes both atria are affected. This form of cariomyopathy is less common as well.