This video shows a massive clump of heartworms entangled around the tricuspid valve in the heart. The heartworms appear as two small, mobile, parallel lines in the top part of the video within the right ventricle and right atrium. The increased right-sided pressures are flattening the septum between the left and right ventricles, causing decreased left ventricular filling and decreased forward cardiac output to the systemic circulation. Treatment is emergency heartworm removal via cardiac catheterization and supportive care. Unfortunately, the mortality rate of this condition is high.
Another reason why I always say YES when asked if ultrasound might be helpful for a case. Some types of kidney stones don't show up on x-rays. This 3 year old Yorkie Terrier had a low platelet count and lab work changes suggestive of a congenital liver shunt. Ultrasound confirmed a small liver shunt. A stone obstructing the right ureter was also identified. I've never passed a kidney stone but I know this must have been super painful!
FDA RELEASES AN UPDATE from the INVESTIGATION into THE LINK BETWEEN GRAIN-FREE FOOD AND HEART DISEASE IN DOGS
Between January 1, 2014 and November 30, 2018, the FDA received 300 reports of DCM that were possibly related to diet. Here's the link to the update:
Some dogs improved simply by changing their diet. The FDA emphasizes that the potential link between diet and heart disease is a complex scientific issue that likely has multiple causes.
The FDA is urging veterinarians to report patients with a well-documented history that may have developed heart disease related to diet. If you are concerned about your pet's heart health, please contact us to schedule your pet's echocardiogram and cardiac evaluation. If a problem is found that could be related to diet we can submit your pet's case to the FDA.
Your older, adorable, Benji-like small dog with no history of heart murmur starts coughing. He's had a collapsing trachea before, so you're not terribly worried. Until it continues for several weeks and he develops a wheeze and trouble breathing. You take him to your vet for an exam and chest x-rays. Benji's heart is large but his murmur is quiet... not typical for heart failure from chronic valvular disease. So what's causing his cough? Is it broncho-pneumonia? Heart failure? Collapsing trachea? Or something else? An echocardiogram and cardiology consultation ordered through ETVETUS gives you answers and a plan to help your baby.
The technical detail: The thoracic radiographs show a severely enlarged cardiac silhouette with left atrial enlargement on all views. The pulmonary vasculature appears normal. There is a mild interstitial pattern to the perihilar area on the lateral view and this is seen on the right caudal lung fields on the V/D view. The trachea is compressed over the dorsal aspect of the heart and elevated in the cranial chest on the lateral views.
Let's look at some echo images.
A trace pericardial effusion was also noted, possibly secondary to congestive heart failure OR a left atrial tear.
what's causing my dog's cough?
The cough is thought to be from a combination of early left-sided congestive heart failure, pulmonary hypertension, and tracheal and mainstem bronchus collapse over the heart. Treatment consists of diuretics, pimobendan to increase heart contractility, enalapril, sildenafil to treat the pulmonary hypertension, and cough-suppressants if needed for the tracheal collapse. You're sweet baby can now get the exact help he needs. He'll need monitoring and ongoing treatment but should start feeling much better soon.
Unexpected findings during an echocardiogram on a Cavalier King Charles Spaniel with Chronic Valvular Disease
Lucky Star Cavalier Rescue and Admiral Veterinary Hospital take amazing care of the dogs in their care. This little male was found as a stray in rough shape with a broken jaw and a list of other health problems. The heart murmur was not a surprise, given his breed.
What was surprising was his echocardiogram findings! Besides the expected chronic mitral valve disease and mitral regurgitation, a significant aortic valve insufficiency was identified. His aortic valve was leaking a large amount of blood volume backwards. Check out the video above. The lovely yellow and blue color shows turbulence around the valve. The yellow red shows backflow of blood.
And the cause of the leak? A quadricuspid aortic valve. Normally the aortic valve has three leaflets. This guy has 4. Besides the extra valve, the aortic valve leaflets were thickened. See the picture on the left. There's normally a "mercedes sign" in the middle that looks like 3 thin lines joining in the middle of a circle. These valve cusps show thickening and if you look closely, there's a thin 4th line at the top right. There was also decreased motion of one of the valve cusps and systolic flutter of the cusps on M-mode. The systolic aortic flow velocity was normal with a normal flow profile, indicating that significant aortic stenosis (narrowing) was not present. That's best seen on the photo on the right.
This little patient is recovering and already feels so much better. Thanks to the care of his devoted veterinarian and the caring folks with his rescue group, this is one Cavalier who is well cared for, inside AND out.
If you believe your dog is at risk for taurine deficient Dilated Cardiomyopathy, please review the following information. These guidelines are based on current information provided by cardiologists at Tufts and University of California College of Veterinary Medicine.
1. If you wish to have taurine levels tested, please request both a whole blood and plasma taurine level be submitted (lithium heparin tube) for analysis. Plasma is preferred by most if one must be chosen.
Testing for taurine requires special handling. Taurine is present in high concentrations in "buffy coat" cells and platelets and can be released into plasma with improper sample handling. Vacutainer collection systems should not be used. The needle should be removed from the syringe before blood is placed gently into the heparinized tube. Samples should be properly centrifuged and separated (for plasma) and immediately refrigerated.
Lab submission details are available HERE:
2. If you believe that your dog is showing signs of DCM already, please seek an appointment with your veterinarian immediately. Symptoms include coughing, decreased activity or decreased stamina, abnormal heart rate or rhythm, collapse, fainting, increased breathing rate, and weight loss. Symptoms that can be picked up during a physical exam include a heart murmur, arryhthmia, or abnormal lung sounds. DO NOT SUPPLEMENT OR CHANGE DOG FOODS BEFORE YOUR APPOINTMENT.
3. If taurine test levels return as low OR if your pet is showing symptoms of DCM, your veterinarian should perform chest x-rays, ecg, blood pressure and comprehensive labwork. A comprehensive echocardiogram should then be performed. It is very important that the echocardiogram findings be evaluated by a cardiologist. DO NOT SUPPLEMENT OR CHANGE FOODS UNTIL THE CARDIOLOGY EVALUATION IS COMPLETED.
4. If your dog receives a diagnosis of Dilated Cardiomyopathy (DCM), please take an image of the food bag, ingredient list, and lot number.
5. Report it to the FDA. This can be done either online or by telephone. The FDA may be able to help with testing costs for your dog.
6. Change your dog’s diet to one made by a well-known reputable company and containing standard ingredients such as chicken, beef, rice, corn or wheat. Please know that changing to a raw or homecooked diet will not protect your dog from this issue (and may increase the risk for other nutritional deficiencies). If your dog requires a homecooked diet or has other medical conditions that require special considerations, be sure to talk to a veterinary nutritionist (acvn.org) before making a dietary change. You can also consider BalanceIt to formulate a diet that is complete and balanced.
7. Start taurine supplementation. The dose and brand are important! Be sure to use a brand of taurine with good quality control. See your veterinarian for dosage recommendations.
8. Make sure your dog is getting the best combination of medications to treat his heart disease. This can make a difference in outcome.
If you have questions on how to proceed, please email us at firstname.lastname@example.org.
The FDA has announced that they are now investigating the potential link between grain-free diets and canine heart disease. The potentially fatal heart condition, Taurine-Deficient Dilated Cardiomyopathy, is known to develop in dogs who have defective taurine synthesis pathways. It has also been documented in certain breeds, such as Golden Retrievers, who are fed a lamb and rice diet.
Recently, cardiologists have noticed an uptick in Dilated Cardiomyopathy (DCM) in breeds not typically associated with the disease. Because DCM can occur secondary to other diseases, such as hypothyroidism or infectious Chagas disease, a primary cause for DCM must always be excluded. Cardiologists began to see a correlation between certain diets and the development of DCM in a number of different dog breeds over the last few years. Affected dogs were more likely to be eating a boutique or grain-free dietand diets with exotic ingredients. Lentils, kangaroo, duck, pea, tapioca, salmon, lamb, barley, bison, chickpeas, and fava beans, were common ingredients. Vegan and home-cooked diets have also been associated. While the mechanism is yet unknown, it is believed it may be caused by factors that include decreased amino acid absorption and decreased taurine synthesis. To complicate matters, whole blood taurine and plasma levels may test low in some dogs and normal in others.
While DCM generally carries a poor-to-grave long-term outcome, changing diet and supplementation with taurine can often improve cardiac function, with some dogs being able to taper off heart medication after 6 months.
Symptoms of DCM can include decreased energy, increased breathing rate, labored breathing, irregular heart rate, coughing, and weight loss. Dogs are often asymptomatic until later stages of the disease. A heart murmur or arrhythmia and changes in lung sounds may be detected during an examination.
If your dog has been eating grain-free food and shows any of these symptoms, please contact your veterinarian immediately. You can also see our blog post about steps you can take.
Dogs with suspected DCM should receieve chest x-rays, ECG, blood pressure and a comprehensive echocardiogram. It is essential that the echocardiogram be performed by an experience ultrasonographer who is profecient in 2D, m-mode, color Doppler and spectral Dopper imaging. Ideally, a cardiologist would evaluate the x-rays, ecg and echo findings. Congenital defects need to be ruled out by x-ray/echo imaging in young and middle-aged dogs. Affected dogs should also have complete labwork (CBC, chem, lytes, T4 and urinalysis) performed and a travel history should be obtained.
Please contact us if you would like to schedule your dog's echocardiogram or if you have questions about the link between taurine and DCM in dogs.
Tufts Article: Risk of heart disease in boutique and grain-free diets and exotic ingredients
Taurine-Deficient Dilated Cardiomyopathy in Golden Retrievers
FDA Reporting Portal
Ultrasound is extremely helpful for evaluating the urinary and reproductive tracts of our small animal patients. Sometimes the cause of blood in the urine is due to a fairly benign cause, such as a urinary tract infection or sterile cystitis (bladder wall inflammation). Other times it is can be secondary to prostate disease or kidneys / bladder stones.
For this patient with blood in the urine, the cause was more concerning. Ultrasound revealed a large suspected clot within the urinary bladder. Color Doppler did no show blood flow within the structure, although sampling would be needed to definitively determine if the structure was a mass or a clot.
The patient also had bilateral renal masses, most consistent with a cancerous process. Bilateraly kidneys are affected in about 10% of patients with kidney cancer. Renal cell adenocarcinoma and lymphoma are the most common kidney cancers in companion animals.
Ultrasound should be utilized sooner rather than later for patients with blood in the urine. Diagnosing conditions earlier will lead to better treatment outcomes and help improve patient comfort and quality of life.
They say bad things come in 3s...
The last two weeks have been full of all things gallbladder, including a suspected rupture. But 3 gallbladder mucoceles was an interesting find. Ultrasound is such a useful modality for working up elevated liver enzymes, anorexia and vomiting, and patients who have (or who are suspected to have) hyperadrenocorticism (Cushings). Imaging should include a thorough evaluation of the the liver, biliary tree including the common bile duct and duodenal papilla, pancreas, and adrenal glands.
All 3 of these cases had adrenal changes that could be seen with hyperadrenocorticism. And all three were smaller, absolutely adorable dogs. Fingers crossed they are all on their way to feeling better now that they have a diagnosis and are receiving specific care.
Surgery is the treatment of choice for mucoceles, preferably before the patient becomes sick with clinical signs. Unfortunately, there is a high mortality rate once the gallbladder ruptures.
If you own a Boxer, either as a companion or with the intent of breeding, please consider having him or her tested for ARVC by the NC State College of Veterinary Medicine. The test can be performed on whole blood or by using special swabs (available by request from NC State) to collect samples of cheek cells inside the mouth.
ARVC is an adult-onset cardiac disease that can lead to sudden death and heart failure. It most commonly affects the Boxer breed but can affect other breeds as well, including the English Bulldog and American Staffordshire. It is recommended that Boxers undergo Holter monitoring beginning at age 3. Dogs which may be used for breeding should have genetic testing performed prior to breeding. Any patient with a heart murmur, substantial arrhythmia (>100 VPCs/24 hr or more complex VPCs), fainting, weakness, or heart enlargement should be further evaluated with an echocardiogram.
Please contact us if you would like our assistance with any aspect of your Boxer's heart health. We can provide Holter testing and rhythm evaluation, genetic testing submission, and echocardiography.
More information about genetic testing in boxer dogs can be found HERE.
A great summary from the University Federations for Animal Welfare can be found HERE.