Cardiovascular Diseases In Dogs And Cats狗和猫心血管疾病狗和猫心血管疾病Clinical Cardiology ConceptsAnatomy of the Cardiovascular System心血管系统解剖心血管系统解剖Age Relation of Heart Diseases in Dogs心脏病与狗的年龄关系心脏病与狗的年龄关系Heart Failure Heart Disease心力衰心力衰竭竭n nHeart failure is the state when the heart fails to meet the Heart failure is the state when the heart fails to meet the metabolic demands of the bodymetabolic demands of the body心力衰竭是心输出量不能满心力衰竭是心输出量不能满足身体需要足身体需要 Heart failure can also be found in diseases not related directly Heart failure can also be found in diseases not related directly to the heart, such as Anaemia and Hyperthyroidismto the heart, such as Anaemia and Hyperthyroidism心力衰竭心力衰竭不是独立的疾病，常伴发于贫血和甲亢不是独立的疾病，常伴发于贫血和甲亢 n nHeart disease is the presence of heart murmurs, arrythmias and Heart disease is the presence of heart murmurs, arrythmias and other cardiac abnormalitiesother cardiac abnormalities心脏病表现于心动过慢，心律失心脏病表现于心动过慢，心律失常，或心脏畸形常，或心脏畸形 Until these heart conditions are severe, the Animals show no Until these heart conditions are severe, the Animals show no signs of heart failuresigns of heart failure一般动物不表现症状，表现出来已经很一般动物不表现症状，表现出来已经很严重了严重了Congestive Heart FailureCHF充血充血性心衰性心衰n nCHF occurs when the left ventricular pressure at end diastole is elevatedCHF发生于舒张期左心室压力增大n nThe results of CHF are elevated venous pressure and pulmonary oedemaCHF结果是静脉压升高，肺水肿Heart Diseases Congenital先天性心脏病先天性心脏病n nVentricular Septal Defect (VSD)Ventricular Septal Defect (VSD)心室间隔缺损心室间隔缺损n nAtrial Septal Defect (ASD)Atrial Septal Defect (ASD)心房间隔缺损心房间隔缺损n nPatent Ductus Arteriosus (PDA)Patent Ductus Arteriosus (PDA)动脉导管未闭动脉导管未闭n nPulmonic Stenosis (PS)Pulmonic Stenosis (PS)肺动脉瓣狭窄肺动脉瓣狭窄n nAortic Stenosis (AS)Aortic Stenosis (AS)主动脉瓣狭窄主动脉瓣狭窄n nSubaortic Stenosis (SAS)Subaortic Stenosis (SAS)n nPersistent Right Aortic Arch (PRAA)Persistent Right Aortic Arch (PRAA)永久性右位主永久性右位主动脉弓动脉弓n nTetralogy of Fallot Tetralogy of Fallot 法乐氏四联症法乐氏四联症Heart Diseases Acquired获得性心获得性心脏病脏病n nIdiopathic Heart DiseasesIdiopathic Heart Diseases先天性心脏病先天性心脏病n nMetabolic Heart DiseasesMetabolic Heart Diseases代谢性心脏病代谢性心脏病n nToxic Heart DiseasesToxic Heart Diseases中毒性心脏病中毒性心脏病n nNeoplastic Heart DiseasesNeoplastic Heart Diseases肿瘤性肿瘤性n nInfectious Heart DiseasesInfectious Heart Diseases感染性感染性n nGenetic Heart DiseasesGenetic Heart Diseases遗传性遗传性85% of heart diseases in dogs are cardiomyopathies85% of heart diseases in dogs are cardiomyopathies85%85%的心脏病属于心肌疾病的心脏病属于心肌疾病Heart Diseases - Acquiredn nChronic Valvular Disease (CVD)Chronic Valvular Disease (CVD)慢性瓣膜病慢性瓣膜病n nDilated Cardiomyopathy (DCM)Dilated Cardiomyopathy (DCM)扩张性心脏病扩张性心脏病n nHypertrophic Cardiomyopathy (HCM)Hypertrophic Cardiomyopathy (HCM)肥厚性心肌病肥厚性心肌病n nFeline Thromboembolic Disease (TED)Feline Thromboembolic Disease (TED)猫血栓猫血栓n nBacterial Endocarditis (BE)Bacterial Endocarditis (BE)细菌性心内膜炎细菌性心内膜炎n nPericardial Effusion (PE)Pericardial Effusion (PE)心包积液心包积液n nConstrictive Pericardial Disease (CPD)Constrictive Pericardial Disease (CPD)压迫性心包病压迫性心包病n nDirofilariosisDirofilariosis犬恶心丝虫犬恶心丝虫Chronic Valvular Disease慢性瓣膜病慢性瓣膜病n nDegenerative disorder of the AV-Valves, particularly the mitral valven nCommon in older, small breed dogs, acounting for 75-80% of canine cardiac diseases易发于老年，小型犬n nCaused by thickening and contraction of the valve leaflets and the chordae tendinean nGenetic in Cavalier King Charles Spaniel and Dachshund查理王犬和腊肠犬的遗传疾病Physical Examination身体检查身体检查n nSystolic heart murmur or mitral regurgitation Systolic heart murmur or mitral regurgitation (pansystolic)(pansystolic)心脏听诊心脏听诊 n nArrythmias in later CVDArrythmias in later CVD心律失常在后期慢性瓣膜心律失常在后期慢性瓣膜病病n nFemoral pulses are often normalFemoral pulses are often normaln nChronic non-productive or productive coughChronic non-productive or productive cough咳嗽咳嗽n nIf heart failure is present dyspnoe, weakness, exercise If heart failure is present dyspnoe, weakness, exercise intolerance and syncope occur (signs of Congestive intolerance and syncope occur (signs of Congestive Heart Failure)Heart Failure)如果有虚弱，不耐运动，昏厥（充血如果有虚弱，不耐运动，昏厥（充血性心衰症状）性心衰症状）Radiology x-检查检查n nLeft atrial enlargementLeft atrial enlargement左心房扩大左心房扩大n nLeft ventricular enlargementLeft ventricular enlargement左心室扩大左心室扩大n nDislocation of trachea to dorsalDislocation of trachea to dorsal气管虚脱气管虚脱n nCompression of left mainstream bronchusCompression of left mainstream bronchus左支气管左支气管n nPulmonary oedema Pulmonary oedema (accute chordal rupture shows severe (accute chordal rupture shows severe oedema without atrial or ventricular enlargement)oedema without atrial or ventricular enlargement)肺水肿（）肺水肿（）n nSplitting of the main bronchi in latero-lateral viewSplitting of the main bronchi in latero-lateral view支支气管侧面气管侧面n nPulmonary artery dilationPulmonary artery dilation肺动脉扩张肺动脉扩张Chronic Mitral Valve Disease慢性二慢性二尖瓣病变尖瓣病变Pulmonary OedemaElectrocardiology心电图心电图n nR-wave amplitude in lead II is increased R波的振幅增加n nQRS duration in lead II is increased QRS的宽度增加Summary概述概述n nProgressive diseaseProgressive disease病程病程n nIn early and mid stages no signs of heart failureIn early and mid stages no signs of heart failure在早期和中期，在早期和中期，心衰是没有明显症状的心衰是没有明显症状的n nIn later stages heart failure with pulmonary congestionIn later stages heart failure with pulmonary congestion心衰后心衰后期伴发肺水肿期伴发肺水肿n nLeft atrial enlargement with compression of left main bronchus Left atrial enlargement with compression of left main bronchus is responsible for coughis responsible for cough左心房的扩大压迫左支气管表现为左心房的扩大压迫左支气管表现为咳嗽咳嗽n nLeft atrial rupture with sudden death can occurLeft atrial rupture with sudden death can occur左心房衰竭可左心房衰竭可能会导致猝死能会导致猝死n nVentricula arrythmias can lead to sudden deathVentricula arrythmias can lead to sudden death心律失常也会心律失常也会猝死猝死Treatment治疗治疗n nPre-clinical Stages of CVD:Pre-clinical Stages of CVD:慢性瓣膜病早期治疗慢性瓣膜病早期治疗 ACE-Inhibitors ACE-Inhibitors ACE ACE抑制剂抑制剂 Bronchodilators Bronchodilators支气管扩张药支气管扩张药 Antitussiva Antitussivan nCDV with heart failureCDV with heart failure慢性瓣膜病办法心衰慢性瓣膜病办法心衰 Furosemide Furosemide呋噻米呋噻米 ACE-Inhibitors ACE-Inhibitors Pimobendan Pimobendan Low sodium diet and restricted exercise Low sodium diet and restricted exercise低盐饮食和限制运动低盐饮食和限制运动 Digoxin when sinus rhythm is present Digoxin when sinus rhythm is present地高辛地高辛Cardiomyopathy心肌疾病心肌疾病n nDilated Cardiomyopathy (DCM)扩张性心肌病 Systolic disfunction收缩不全 Thinning of ventricular walls心壁变薄 Ventricular cavity dilation心室扩张 Total ventricular mass is increased整个心室扩张经常发生在狗上 Occurs often in dogs In cats in connection with Taurine deficiency在猫上主要可能是牛黄酸缺乏症。Cardiomyopathy心肌病心肌病n nHypertrophic Cardiomyopathy (HCM)Hypertrophic Cardiomyopathy (HCM)肥大性心肌病肥大性心肌病 Diastolic Dysfunction Diastolic Dysfunction舒张功能不全舒张功能不全 Ventricular cavity diminished dimension Ventricular cavity diminished dimension心室充盈不心室充盈不足足 Thickening of ventricular walls Thickening of ventricular walls心室变厚心室变厚 Ventricular mass increased Ventricular mass increased 心室流量增加心室流量增加 Occurs often in cats Occurs often in cats 易发于猫很少见于狗易发于猫很少见于狗 Rare in dogs Rare in dogsDilated Cardiomyopathy扩张性心肌扩张性心肌病病n nPrimary global disorder of the myocardial tissuePrimary global disorder of the myocardial tissuen nMainly in large and giant breed dogs主要发生于大狗和巨型狗n nAlso in Cocker Spaniels with Taurin deficiency可卡犬的牛磺酸缺乏症n nMiddle aged to older animals (except juvenile (except juvenile form as genetic DCM in Portuguese Water Dogs)form as genetic DCM in Portuguese Water Dogs)中中老年狗（除了先天性的老年狗（除了先天性的DCMDCM葡萄牙水猎犬）葡萄牙水猎犬）n nMost cases are idiopatic, viral infections are possible Most cases are idiopatic, viral infections are possible as a cause for DCMas a cause for DCM许多是由于病毒感染许多是由于病毒感染Physical Examinationn nSystolic heart murmurSystolic heart murmur心脏听诊心脏听诊n nArrhythmiasArrhythmias心率不齐心率不齐, primarily ventricular, primarily ventricular心室心室n nPulse dificitsPulse dificits脉搏脉搏n nWeight lossWeight loss体重下降体重下降n nCool extremitiesCool extremities四肢倔冷四肢倔冷n nDyspnoe or cough, restlessness at nightDyspnoe or cough, restlessness at night在夜间咳嗽在夜间咳嗽躁动躁动n nExercise intoleranceExercise intolerance运动不耐受运动不耐受n nSyncopeSyncope昏厥昏厥n nAscitesAscites腹水腹水Radiologyn nDefinitive diagnosis only with EchocardiographyDefinitive diagnosis only with Echocardiography主主要的诊断还是要心电图要的诊断还是要心电图n nLeft ventricular enlargemantLeft ventricular enlargemant左心室扩大左心室扩大n nLeft atrial enlargementLeft atrial enlargement左心房扩大左心房扩大n nPulmonary venous congestion (in cases of CHF)Pulmonary venous congestion (in cases of CHF)肺静肺静脉充血脉充血n nPulmonary oedema (in cases of CHF)Pulmonary oedema (in cases of CHF)肺水肿肺水肿n nPleural effusion (in cases of CHF)Pleural effusion (in cases of CHF)胸膜渗出胸膜渗出n nPeritoneal effusionPeritoneal effusion腹膜渗出腹膜渗出n nHepatomegalyHepatomegaly肝肿大肝肿大Canine DCMElectrocardiography心电图心电图n nST segment depressionST段压低n nWide QRS duration with microscopic intramural myocardial infarction心肌梗死的长QRS波Treatmentn nPre-clinical DCMPre-clinical DCM ACE-Inhibitors (can delay onset of CHF) ACE-Inhibitors (can delay onset of CHF)n nDCM with congestive heart failureDCM with congestive heart failure Furosemide Furosemide呋塞米呋塞米 Pimobendan Pimobendan ACE-Inhibitors ACE-InhibitorsACEACE抑制剂抑制剂 Arterial vasodilators (Amlodipine or Hydralazine) Arterial vasodilators (Amlodipine or Hydralazine)动动脉血管扩张药脉血管扩张药 Low sodium diet and severe exercise restriction Low sodium diet and severe exercise restriction低钠低钠饮食和限制运动饮食和限制运动 The use of Digoxin is questionable The use of Digoxin is questionable斟酌使用地高辛斟酌使用地高辛Differencies of Heart Diseases in Cats猫心脏病特别之处猫心脏病特别之处n n65-70% hypertrophe Cardiomyopathyn nDyspnoe without coughing呼吸困难没有咳嗽n nBreathing with open mouth张嘴呼吸n nHiding in dark corners躲在黑暗角落里n nInactivity不好动n nWeight loss体重下降n nEven cats with severe heart problems can appear asymptomatic即使猫有心脏的问题也不会表现明显的症状Hypertrophic Cardiomyopathy心脏心脏肥大肥大n nMost common type of cardiomyopathy in catsMost common type of cardiomyopathy in cats在猫上面常见在猫上面常见的心肌肥大症状的心肌肥大症状n nIdiopatic myocardial disorder with concentric hypertophy and Idiopatic myocardial disorder with concentric hypertophy and diastolic dysfunction of the left ventriclediastolic dysfunction of the left ventricle和左心室舒张障碍和左心室舒张障碍n nHCM can be secondary to disorders likeHCM can be secondary to disorders like Hyperthyroidism Hyperthyroidism伴发于甲亢伴发于甲亢 Systemic arterial hypertension Systemic arterial hypertension高血压高血压n nGenetic predisposition in Main Coon, Persian, American and Genetic predisposition in Main Coon, Persian, American and British ShorthairBritish Shorthair库恩猫，波斯猫，美短和英短的先天性易库恩猫，波斯猫，美短和英短的先天性易病症病症n nMiddle aged catsMiddle aged cats中年猫中年猫Physical Examinationn nGallop cardiac rhythmsGallop cardiac rhythms 奔马音奔马音n nSystolic heart murmurSystolic heart murmur心脏收缩音心脏收缩音n nDysrhythmiaDysrhythmia节律不齐节律不齐n nMuffled heart sounds due to pleural effusionMuffled heart sounds due to pleural effusion胸腔积胸腔积液的排水音液的排水音n nPulse deficitsPulse deficits脉搏短促脉搏短促n nOften in connection with Thromboembolic Disease Often in connection with Thromboembolic Disease (TED)(TED)也常会和血栓病联系也常会和血栓病联系n nSudden DyspnoeSudden Dyspnoe突然的呼吸困难突然的呼吸困难n nAnorexiaAnorexia厌食厌食n nLethargy / SyncopeLethargy / Syncope昏睡或昏厥昏睡或昏厥Radiologyn nValentine-shaped heartValentine-shaped heartn nCardiomegalyCardiomegaly心脏扩大心脏扩大n nPleural effusion with obscure cardiac silhouttePleural effusion with obscure cardiac silhoutte渗出物渗出物的隐影的隐影n nPulmonary venous distensionPulmonary venous distension肺静脉扩张肺静脉扩张n nAir bronchogramsAir bronchograms支气管扩张支气管扩张n nPeribronchal patternsPeribronchal patterns 不明阴影不明阴影n nFissure linesFissure lines狭长缝隙狭长缝隙n nCotton-like densitiesCotton-like densities 云絮状阴影云絮状阴影Feline HCMTreatmentn nIncrease contractility, reduce preload, reduce Increase contractility, reduce preload, reduce afterloadafterload Beta blockers (Atenolol, Metoprolol)Beta blockers (Atenolol, Metoprolol) Calcium channel blockers (Diltiazem) Calcium channel blockers (Diltiazem) ACE-Inhibitors ACE-Inhibitors血管血管紧张紧张素抑制素抑制剂剂n nReduce pulmonary oedemaReduce pulmonary oedema减轻肺水肿减轻肺水肿 Diuretics (Furosemide)Diuretics (Furosemide)利尿剂（呋塞米）利尿剂（呋塞米）n nPrevent thrombolic diseasePrevent thrombolic disease 预防血栓病预防血栓病n nIf present treat underlying disorders If present treat underlying disorders (Hyperthyroidism, (Hyperthyroidism, Systemic Hypertension) Systemic Hypertension) 有必要先治疗原发病（甲亢，高血有必要先治疗原发病（甲亢，高血压）压） Thromboembolic Disease血栓病血栓病n nFrequent complication of feline myocardial disease常伴发猫的心肌病n nClot formation in cardiac chamber or vessel (atrial thrombi)血凝块形成于心房或静脉n nClot fragment lodges in distant vessel 游离血栓到达末端血管 (distal aortic trifurcation, sometimes renal or cerebral arteries)（末梢动脉，有时是肾或脑动脉）n nOften the first sign of underlying cardiomyopathy潜在的心肌病Physical Examination身体检查身体检查n nAcute onset of paresis with extreme pain and hard muscles in the affected legsn nCyanotic nail beds黏膜发绀n nWeak or absent arterial pulse虚弱或动脉微弱n nCool to palpation低温n nRiding aortic thrombus with changing lameness in hindlegs后肢无力n nSigns of HCM with gallop rhythms and murmurs (50% of the cats with TED)奔马音（50%的猫是血栓）Diagnosis诊断诊断n nClinical syptoms临床症状n nRadilogical, echocardiological and electrocardiological signs as in HCM X-检查和 心电图n nBlood work indicating muscle necrosis (CK)血液指标心肌坏死n nMetabolic acidosis代谢性酸中毒n nAcute renal failure急性肾衰n nHyperthyroidism甲亢Therapy治疗治疗n nInhibition of clot formationInhibition of clot formation抑制血栓形成抑制血栓形成 Low dose ASA (5mg/cat every 3 days) Low dose ASA (5mg/cat every 3 days) Clopidogrel Clopidogrel氯氯吡格雷吡格雷( (抗凝抗凝药药) ) Heparin Heparin 肝素肝素(Low molecular weight heparin(Low molecular weight heparin低浓度低浓度) ) Close monitoring for hemorrhage is necessary Close monitoring for hemorrhage is necessary监测出血监测出血n nPain managment (Fentanyl, Morphine)Pain managment (Fentanyl, Morphine)止痛药（芬太尼，吗止痛药（芬太尼，吗啡）啡）n nSupportive care (nutrition, warming)Supportive care (nutrition, warming)支持疗法（监护，温暖）支持疗法（监护，温暖）n nTreatment of CHFTreatment of CHF治疗充血性心衰治疗充血性心衰n nMonitoring of respiratory rate, renal function, temperature, Monitoring of respiratory rate, renal function, temperature, heart rhythm etc.heart rhythm etc.监测呼吸，肾功能，体温，心率监测呼吸，肾功能，体温，心率Prognosis预后预后Study of 127 cases (Smith et al. 2003)Study of 127 cases (Smith et al. 2003)n n63% died or were euthanized during initial episode63% died or were euthanized during initial episode 63%63%死亡或安乐死在开始治疗阶段死亡或安乐死在开始治疗阶段n n35% survived an average of 4 month35% survived an average of 4 month35%35%存活平均四存活平均四个月个月n n25% of the survivors had re-embolization25% of the survivors had re-embolization 25%25%存活者重新患有血栓存活者重新患有血栓 Persistence of low rectal temperature is a sign of poor Persistence of low rectal temperature is a sign of poor short-term prognosisshort-term prognosis持续体温也是预后不良持续体温也是预后不良Bacterial Endocarditis细菌性心内膜细菌性心内膜炎炎n nMultisystemic disorder with bacteremia and infection of kidneys, joints and cardiac valves多系统障碍 肾脏，关节，心瓣膜的n nDysrhythmias (premature beats, tachycardia)节律不齐（，心动过速）n nMitral valve insufficiency二尖瓣闭锁不全n nAortic valve insufficiency主动脉瓣闭锁不全n nRupture of chordae tendinae with mitral valve insufficiency, pumonary oedema and deathPhysical Examinationn nLarge breed dogs, middle age or olderLarge breed dogs, middle age or older大型狗或，中老年狗大型狗或，中老年狗n nPrimarily in malesPrimarily in males大部分公狗大部分公狗n nAnorexiaAnorexia厌食厌食n nVomitingVomiting呕吐呕吐n nLamenessLameness跛行跛行n nFeverFever高烧高烧n nJoint pains, swelling, heatJoint pains, swelling, heat关节疼，有肿块，高温关节疼，有肿块，高温n nPale mucous membranesPale mucous membranes可视粘膜惨白可视粘膜惨白n nDyspnoeDyspnoe呼吸困难呼吸困难n nCongestive heart failureCongestive heart failure充血性心衰充血性心衰Diagnosisn nRadiology, ECG and Echocardiography can all be inconclusive Radiology, ECG and Echocardiography can all be inconclusive in BEin BE X X片，心电图，心超都可以用来诊断细菌性心内膜片，心电图，心超都可以用来诊断细菌性心内膜炎炎n nDiagnosis can be made byDiagnosis can be made by 诊断建立于诊断建立于 Clinical symptoms of congestive heart failure Clinical symptoms of congestive heart failure充血性心衰的临充血性心衰的临床症状床症状 Evidence of septic or immune joint disease Evidence of septic or immune joint disease炎性或免疫性关节炎性或免疫性关节病病 Positive blood cultures Positive blood cultures血液培养血液培养 Positive urine culture Positive urine culture尿液培养尿液培养 Joint synovial culture Joint synovial culture关节液培养关节液培养 Treatmentn nAntimicrobial Therapy消炎 Most common bacteria are Streptococci, 大部分是链球菌Staphylococci and E. coli葡萄球菌和革兰氏阴性菌引起的 Treat with Gyrase-Inhibitors, Penicillins盘尼西林, Trimethoprim-Sulfadizine 甲氧汴氨嘧啶or Gentamycin庆大霉素 for 5-6 weeks治疗5-6周n nFluid and nutritional support输液和 营养支持n nTreatment of heart failure治疗心衰Pericardial Diseases心包疾病心包疾病n nCongential pericardial disorders先天性心包病 Peritoneal-pericardial diaphragmatic hernia Pericardial defects Pericardial cysts心包囊肿n nAcquired pericardial disorders获得性心包病 Pericardial effusion心包积液 Constrictive pericarditis压迫性心包炎 Pericardial mass lesion创伤心包炎Pericardial Effusion心包积液心包积液n nAccumulation of fluids (blood, serous, pus) in the pericardial Accumulation of fluids (blood, serous, pus) in the pericardial sacsac血，脓液在心包囊内血，脓液在心包囊内n nCan be caused Can be caused byby transudates (hydropericardium transudates (hydropericardium心包积液心包积液) ) exudate (pericarditis), hemorrhagic (hemopericardiumexudate (pericarditis), hemorrhagic (hemopericardium心包积心包积血血), septic (fungus, bacteria), septic (fungus, bacteria真菌细菌真菌细菌), sterile (uremic), sterile (uremic尿毒素尿毒素), CHF ), CHF 充血性心衰充血性心衰(increased hydrostatic press(increased hydrostatic press，ure) ure) neoplasticneoplastic肿瘤肿瘤 and trauma and trauma外伤外伤n nImpedes the filling ability of the heartImpedes the filling ability of the heart压迫心脏压迫心脏 (diastolic (diastolic dysfunctiondysfunction心舒张障碍心舒张障碍) )n nNeoplastic etiologies are most common in dogs (heart base Neoplastic etiologies are most common in dogs (heart base tumour, hemangiosarcoma), very rare in catstumour, hemangiosarcoma), very rare in cats肿瘤原因在狗上肿瘤原因在狗上很常见，猫很少见很常见，猫很少见Physical Examinationn nLarge breed dogs are more commonly affectedLarge breed dogs are more commonly affected大狗易大狗易感感n nMiddle aged and olderMiddle aged and older中老年狗中老年狗n nIncreased resproatory effortIncreased resproatory effort呼吸影响呼吸影响n nSudden weaknessSudden weakness突然虚弱突然虚弱n nExercise intoleranceExercise intolerance运动不耐受运动不耐受n nMuffled heart soundsMuffled heart sounds心音低心音低n nWeak arterial pulseWeak arterial pulse脉搏弱脉搏弱n nJugular venous distensionJugular venous distension颈静脉充盈颈静脉充盈n nSigns of right heart failureSigns of right heart failure右心衰竭右心衰竭Diagnosis诊断诊断n nEchocardiography心超n nRadiologyX片n nElectrocardiography心电图n nHaematology (nucleated RBC in HAS)血常规（）n nCytology of pericardial fluids 心包液细胞n nPneumopericardiography (Injection of CO into the pericardial sac after (Injection of CO into the pericardial sac after pericardiocentisis and following radiology to identify HBT)pericardiocentisis and following radiology to identify HBT)Echocardiography心超心超n nTest of choicen nDetection of pericardial effusion心超可测出有无渗出液 n nPresence of tumours 肿瘤 (right atrium, right ventricle = HAS)右心房室肿瘤 (Base of Aorta = HBT)血管肉瘤n nCardiac tumours are easier to see while the fluids are still present (before pericardiocentesis)心脏肿瘤很容易诊断当穿刺后液体还存在心包Radiologyn nRadiology allows a presumptive diagnosis Very large, globose heart X片检查可见圆形扩张的心脏影印 Pulmonary oedman is unusual肺水肿很少见 Pleural effusions are unusual胸腔积液少见 Pulmonary metastatic lesion肺转移性损伤n nIn cats both pleural and pericardial effusion occur in HCM胸膜积液和心包积液发生于肥大性心肌病在猫上Pericardial Effusion心包积液心包积液Pericardial EffusionPleural And Pericardial Effusion胸膜炎和心包积液胸膜炎和心包积液Treatment治疗治疗n nPericardiocentesis心包穿刺 Fast control esp. if cardiac tamponade is present If effusion recurs repeated pericardiocentesisn nCorticosteriods (Prednisolone 5mg/kg 2xd)n nSurgical removal of pericarial sac (Also for determination of underlying neoplastic processes)Cardiac Tamponade心脏栓塞心脏栓塞n nMost severe form of pericardial effusionn nHeart failure due to severe pericardial effusion resulting in reduction or loss of right ventricular functionn nWeak arterial pulses muffled heart sounds, jugular venous distension, syncope, weaknessn nRepresents cardiac emergency and requires immediate pericardiocentesisConstrictive Pericardial Disease压迫压迫性心包疾病（心包炎）性心包疾病（心包炎）n nFibrosis of the Fibrosis of the pericardiumpericardium纤维化渗出纤维化渗出n nUsually without pericardial Usually without pericardial effusioneffusion一般没有心包积一般没有心包积液液n nMiddle aged dogs, mainly large breedsMiddle aged dogs, mainly large breedsn nSame symptoms as cardiac tamponade and pericardial Same symptoms as cardiac tamponade and pericardial effusioneffusion和心脏栓塞，心包积液相同的症状和心脏栓塞，心包积液相同的症状n nRadiography shows absence of globose heart and Radiography shows absence of globose heart and pulmonary pulmonary oedemaoedema X X片显示没有球型心影。片显示没有球型心影。n nEchcardiography shows absence of pericardial Echcardiography shows absence of pericardial effusioneffusionn nSurgical pericardectomy has excellent prognosisSurgical pericardectomy has excellent prognosisPeritoneal-Pericardial Diaphragmatic Hernia膈疝膈疝n nCongenital disorder with genetic predisposition in cats and Congenital disorder with genetic predisposition in cats and dogs dogs (Persian, Himalayan, Weimaraner(Persian, Himalayan, Weimaraner) )先天遗传（波斯猫，希玛拉亚猫，威马先天遗传（波斯猫，希玛拉亚猫，威马犬）犬）n nOften asymptomatic, depending on herniated organ and Often asymptomatic, depending on herniated organ and restriction of blood flow. In many cases are omentum and liver restriction of blood flow. In many cases are omentum and liver herniated, sometimes small intestine, spleen and stomachherniated, sometimes small intestine, spleen and stomachn nGastrointestinal problems such as anorexia, vomiting and Gastrointestinal problems such as anorexia, vomiting and diarrhoea are diarrhoea are commoncommon胃肠问题：厌食，呕吐，拉希很常见胃肠问题：厌食，呕吐，拉希很常见n nRespiratory symptoms also Respiratory symptoms also occuroccur呼吸症状呼吸症状n nSigns of CHF or cardiac tamponade are Signs of CHF or cardiac tamponade are rarerare充血性心衰和心充血性心衰和心脏栓塞发生很少脏栓塞发生很少n nDiagnosis with radiology, if necessary contrast radiology and Diagnosis with radiology, if necessary contrast radiology and echocardiographyechocardiography X X片检查，有必要也可以增加心超片检查，有必要也可以增加心超n nSurgical treatment has excellent Surgical treatment has excellent prognosisprognosis手术的预后手术的预后Peritoneal-Pericardial Diaphragmatic HerniaHeartworm Diseasen nHeartworm is a parasitic pulmonary artery disease due to infection with Dirofilaria immitis心丝虫是肺动脉寄生虫病n nMosquitos ingests the microfilaria, after 2 weeks inside the mosquito the microfilaria are mature enough to develop in a dog蚊子吞下微丝蚴，2周后，微丝蚴就发育感染狗n n4-5 month after infection larvae are present in the heart and pulmonary arteries4-5个月后可以在心脏和肺动脉里发现幼虫n n6-7 month after infection adult parasites are present and ready to produce microfilara6-7个月后发育为成虫，产生微丝蚴Physical Examinationn nDogs at least 6 month of age6月龄以上的狗n nWeight loss, anorexia体重减轻，没胃口n nChronic non-productive cough慢性咳嗽n nRespiratory distress, dyspnoe呼吸困难n nExercise intolerance, syncope运动不耐受，昏厥n nDistended abdomen腹部膨胀n nSigns of right heart failure elevated right heart preload右心衰竭症状Diagnosis诊断诊断n nMicrofilarial detectionMicrofilarial detection微丝蚴检查微丝蚴检查 Concentration techniques Concentration techniques (Knotts test, wet mound)(Knotts test, wet mound) Antigen tests Antigen tests 抗原检测抗原检测(ELISA(ELISA酶联免疫酶联免疫, Immunochromatographic , Immunochromatographic teststests免疫层析免疫层析) ) Tests are very sensitive, false results rare Tests are very sensitive, false results rare监测很灵敏监测很灵敏n nRadiologyRadiology x x片检查片检查n nElectrocardiography (limited application)Electrocardiography (limited application)心电图（不多）心电图（不多）n nEchocardiography (limited application)Echocardiography (limited application)心超心超n nHematology (eosinophilia, basophilia, chemistry)Hematology (eosinophilia, basophilia, chemistry)血液学（嗜血液学（嗜酸粒细胞增多，嗜碱粒细胞增多）酸粒细胞增多，嗜碱粒细胞增多）Radiologyn nRight ventricle enlargementRight ventricle enlargement 右心室扩大右心室扩大n nMain pulmonary artery enlargementMain pulmonary artery enlargement主动脉扩张主动脉扩张n nDilation of pulmonary arteriesDilation of pulmonary arteries肺血管扩张肺血管扩张n nPruned or truncated pulmonary arteriesPruned or truncated pulmonary arteriesn nWidth of the caudal pulmonary artery 9th ribWidth of the caudal pulmonary artery 9th rib肺动肺动脉宽达到大于脉宽达到大于9 9个肋间距个肋间距n nRadiographic changes occur early in diseaseRadiographic changes occur early in disease病变早病变早期的期的X X片片n nIn severe cases signs of right heart failureIn severe cases signs of right heart failure右心衰竭的右心衰竭的症状症状Severe Heartworm Disease心丝虫心丝虫Severe Heartworm DiseaseTreatmentn nTreatment of heart failureTreatment of heart failure Diuretics Diuretics利尿剂利尿剂, low Na-diet, low Na-diet低钠饮食低钠饮食, exercise restriction, exercise restriction控控制运动制运动, Pimobendan, Pimobendan匹莫苯（强心药）匹莫苯（强心药）, Digoxin, Digoxin地高辛地高辛, , arterial vasodilatorsarterial vasodilators动脉扩张药动脉扩张药, , after 7-14 days start adulticide therapy after 7-14 days start adulticide therapyn nAdulticide therapyAdulticide therapy杀虫药治疗杀虫药治疗 Melarsonine Melarsonine (2.5mg/kg im for 2 days, repeat in 4 month)(2.5mg/kg im for 2 days, repeat in 4 month) Thiacetarsamide Thiacetarsamide (2.2mg/kg 2xd for 2 days)(2.2mg/kg 2xd for 2 days) Strict exercise restriction for 4-6 weeks post adulticideStrict exercise restriction for 4-6 weeks post adulticide严格限严格限制运动制运动n nCorticosteroid therapyCorticosteroid therapy皮质类固醇类药治疗皮质类固醇类药治疗, Heparin, Heparin肝磷脂肝磷脂, , BronchodilatorsBronchodilators支气管扩张药支气管扩张药, intravenous fluids, intravenous fluids静脉输液静脉输液, , oxygen supplementationoxygen supplementation输氧输氧Prophylaxis预防预防n nHeartworm is a preventable diseaseHeartworm is a preventable disease心丝虫是可被预防的心丝虫是可被预防的n nPuppies as young as 8 weeks can use prophylaxisPuppies as young as 8 weeks can use prophylaxis小狗在小狗在8 8周时周时就可以开始预防就可以开始预防n nFor dogs over 6 month heartworm test prior to For dogs over 6 month heartworm test prior to chemoprophylaxischemoprophylaxis6 6个月以后的狗就可以做心丝虫的测试个月以后的狗就可以做心丝虫的测试n nVery safe, very effectiveVery safe, very effective安全，有效安全，有效n nMicrofilaricide therapy Microfilaricide therapy 药物治疗药物治疗(Ivermectin, Milbemycin, Selamectin) (Ivermectin, Milbemycin, Selamectin) These drugs are effective against microfilariae, 3rd and 4th These drugs are effective against microfilariae, 3rd and 4th stage larvaestage larvae and young adult heartworms and young adult heartworms 3 3到到4 4 期的幼虫期的幼虫 和和成虫有效。成虫有效。Other Heart Diseases In Dogs And Cats其他的心脏病其他的心脏病n nCanine Hypertophic CardiomyopathyCanine Hypertophic Cardiomyopathy犬肥厚性心肌犬肥厚性心肌病病n nFeline Dilated CardiomyopathyFeline Dilated Cardiomyopathy猫心肌病猫心肌病n nFeline Restrictive CardiomyopathyFeline Restrictive Cardiomyopathy猫限制性心肌病猫限制性心肌病n nBoxer CardiomyopathyBoxer Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)(ARVC) 右心室心率失常右心室心率失常n nSick Sinus SyndromeSick Sinus Syndrome窦房结综合症窦房结综合症n nHyperkalemiaHyperkalemia高钾血症高钾血症