心血管疾病

nullCardiovascular Diseases In Dogs And Cats狗和猫心血管疾病Cardiovascular Diseases In Dogs And Cats狗和猫心血管疾病Clinical Cardiology ConceptsAnatomy of the Cardiovascular System心血管系统解剖Anatomy of the Cardiovascular System心血管系统解剖Age Relation of Heart Diseases in Dogs心脏病与狗的年龄关系Age Relation of Heart Diseases in Dogs心脏病与狗的年龄关系Heart Failure – Heart Disease心力衰竭Heart Failure – Heart Disease心力衰竭Heart failure is the state when the heart fails to meet the metabolic demands of the body心力衰竭是心输出量不能满足身体需要 Heart failure can also be found in diseases not related directly to the heart, such as Anaemia and Hyperthyroidism心力衰竭不是独立的疾病，常伴发于贫血和甲亢 Heart disease is the presence of heart murmurs, arrythmias and other cardiac abnormalities心脏病现于心动过慢，心律失常，或心脏畸形 Until these heart conditions are severe, the Animals show no signs of heart failure一般动物不表现症状，表现出来已经很严重了 Congestive Heart FailureCHF充血性心衰Congestive Heart FailureCHF充血性心衰CHF occurs when the left ventricular pressure at end diastole is elevatedCHF发生于舒张期左心室压力增大 The 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 Heart Diseases – Congenital 先天性心脏病 Ventricular Septal Defect (VSD)心室间隔缺损 Atrial Septal Defect (ASD)心房间隔缺损 Patent Ductus Arteriosus (PDA)动脉导管未闭 Pulmonic Stenosis (PS)肺动脉瓣狭窄 Aortic Stenosis (AS)主动脉瓣狭窄 Subaortic Stenosis (SAS) Persistent Right Aortic Arch (PRAA)永久性右位主动脉弓 Tetralogy of Fallot 法乐氏四联症Heart Diseases – Acquired获得性心脏病Heart Diseases – Acquired获得性心脏病Idiopathic Heart Diseases先天性心脏病 Metabolic Heart Diseases代谢性心脏病 Toxic Heart Diseases中毒性心脏病 Neoplastic Heart Diseases肿瘤性 Infectious Heart Diseases感染性 Genetic Heart Diseases遗传性 85% of heart diseases in dogs are cardiomyopathies 85%的心脏病属于心肌疾病Heart Diseases - AcquiredHeart Diseases - AcquiredChronic Valvular Disease (CVD)慢性瓣膜病 Dilated Cardiomyopathy (DCM)扩张性心脏病 Hypertrophic Cardiomyopathy (HCM)肥厚性心肌病 Feline Thromboembolic Disease (TED)猫血栓 Bacterial Endocarditis (BE)细菌性心内膜炎 Pericardial Effusion (PE)心包积液 Constrictive Pericardial Disease (CPD)压迫性心包病 Dirofilariosis犬恶心丝虫 Chronic Valvular Disease慢性瓣膜病Chronic Valvular Disease慢性瓣膜病Degenerative disorder of the AV-Valves, particularly the mitral valve Common in older, small breed dogs, acounting for 75-80% of canine cardiac diseases易发于老年，小型犬 Caused by thickening and contraction of the valve leaflets and the chordae tendinea Genetic 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Physical Examination身体检查Systolic heart murmur or mitral regurgitation (pansystolic)心脏听诊 Arrythmias in later CVD心律失常在后期慢性瓣膜病 Femoral pulses are often normal Chronic non-productive or productive cough咳嗽 If heart failure is present dyspnoe, weakness, exercise intolerance and syncope occur (signs of Congestive Heart Failure)如果有虚弱，不耐运动，昏厥（充血性心衰症状）Radiology x-检查Radiology x-检查Left atrial enlargement左心房扩大 Left ventricular enlargement左心室扩大 Dislocation of trachea to dorsal气管虚脱 Compression of left mainstream bronchus左支气管 Pulmonary oedema (accute chordal rupture shows severe oedema without atrial or ventricular enlargement)肺水肿（） Splitting of the main bronchi in latero-lateral view支气管侧面 Pulmonary artery dilation肺动脉扩张 Chronic Mitral Valve Disease慢性二尖瓣病变 Pulmonary OedemaChronic Mitral Valve Disease慢性二尖瓣病变 Pulmonary OedemaElectrocardiology心电图Electrocardiology心电图R-wave amplitude in lead II is increased R波的振幅增加 QRS duration in lead II is increased QRS的宽度增加Summary概述Summary概述Progressive disease病程 In early and mid stages no signs of heart failure在早期和中期，心衰是没有明显症状的 In later stages heart failure with pulmonary congestion心衰后期伴发肺水肿 Left atrial enlargement with compression of left main bronchus is responsible for cough左心房的扩大压迫左支气管表现为咳嗽 Left atrial rupture with sudden death can occur左心房衰竭可能会导致猝死 Ventricula arrythmias can lead to sudden death心律失常也会猝死Treatment治疗Treatment治疗Pre-clinical Stages of CVD:慢性瓣膜病早期治疗 ACE-Inhibitors ACE抑制剂 Bronchodilators支气管扩张药 Antitussiva CDV with heart failure慢性瓣膜病心衰 Furosemide呋噻米 ACE-Inhibitors Pimobendan Low sodium diet and restricted exercise低盐饮食和限制运动 Digoxin when sinus rhythm is present地高辛Cardiomyopathy心肌疾病Cardiomyopathy心肌疾病Dilated 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Cardiomyopathy心肌病Hypertrophic Cardiomyopathy (HCM)肥大性心肌病 Diastolic Dysfunction舒张功能不全 Ventricular cavity diminished dimension心室充盈不足 Thickening of ventricular walls心室变厚 Ventricular mass increased 心室流量增加 Occurs often in cats 易发于猫很少见于狗 Rare in dogsDilated Cardiomyopathy扩张性心肌病Dilated Cardiomyopathy扩张性心肌病Primary global disorder of the myocardial tissue Mainly in large and giant breed dogs主要发生于大狗和巨型狗 Also in Cocker Spaniels with Taurin deficiency可卡犬的牛磺酸缺乏症 Middle aged to older animals (except juvenile form as genetic DCM in Portuguese Water Dogs)中老年狗（除了先天性的DCM葡萄牙水猎犬） Most cases are idiopatic, viral infections are possible as a cause for DCM许多是由于病毒感染Physical ExaminationPhysical ExaminationSystolic heart murmur心脏听诊 Arrhythmias心率不齐, primarily ventricular心室 Pulse dificits脉搏 Weight loss体重下降 Cool extremities四肢倔冷 Dyspnoe or cough, restlessness at night在夜间咳嗽躁动 Exercise intolerance运动不耐受 Syncope昏厥 Ascites腹水 RadiologyRadiologyDefinitive diagnosis only with Echocardiography主要的诊断还是要心电图 Left ventricular enlargemant左心室扩大 Left atrial enlargement左心房扩大 Pulmonary venous congestion (in cases of CHF)肺静脉充血 Pulmonary oedema (in cases of CHF)肺水肿 Pleural effusion (in cases of CHF)胸膜渗出 Peritoneal effusion腹膜渗出 Hepatomegaly肝肿大Canine DCMCanine DCMElectrocardiography心电图Electrocardiography心电图ST segment depressionST段压低 Wide QRS duration with microscopic intramural myocardial infarction心肌梗死的长QRS波TreatmentTreatmentPre-clinical DCM ACE-Inhibitors (can delay onset of CHF) DCM with congestive heart failure Furosemide呋塞米 Pimobendan ACE-InhibitorsACE抑制剂 Arterial vasodilators (Amlodipine or Hydralazine)动脉血管扩张药 Low sodium diet and severe exercise restriction低钠饮食和限制运动 The use of Digoxin is questionable斟酌使用地高辛 Differencies of Heart Diseases in Cats猫心脏病特别之处Differencies of Heart Diseases in Cats猫心脏病特别之处65-70% hypertrophe Cardiomyopathy Dyspnoe without coughing呼吸困难没有咳嗽 Breathing with open mouth张嘴呼吸 Hiding in dark corners躲在黑暗角落里 Inactivity不好动 Weight loss体重下降 Even 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心脏肥大Hypertrophic Cardiomyopathy心脏肥大Most common type of cardiomyopathy in cats在猫上面常见的心肌肥大症状 Idiopatic myocardial disorder with concentric hypertophy and diastolic dysfunction of the left ventricle和左心室舒张障碍 HCM can be secondary to disorders like Hyperthyroidism伴发于甲亢 Systemic arterial hypertension高血压 Genetic predisposition in Main Coon, Persian, American and British Shorthair库恩猫，波斯猫，美短和英短的先天性易病症 Middle aged cats中年猫Physical ExaminationPhysical ExaminationGallop cardiac rhythms 奔马音 Systolic heart murmur心脏收缩音 Dysrhythmia节律不齐 Muffled heart sounds due to pleural effusion胸腔积液的排水音 Pulse deficits脉搏短促 Often in connection with Thromboembolic Disease (TED)也常会和血栓病联系 Sudden Dyspnoe突然的呼吸困难 Anorexia厌食 Lethargy / Syncope昏睡或昏厥RadiologyRadiologyValentine-shaped heart Cardiomegaly心脏扩大 Pleural effusion with obscure cardiac silhoutte渗出物的隐影 Pulmonary venous distension肺静脉扩张 Air bronchograms支气管扩张 Peribronchal patterns 不明阴影 Fissure lines狭长缝隙 Cotton-like densities 云絮状阴影Feline HCMFeline HCMTreatmentTreatmentIncrease contractility, reduce preload, reduce afterload Beta blockers (Atenolol, Metoprolol) Calcium channel blockers (Diltiazem) ACE-Inhibitors血管紧张素抑制剂 Reduce pulmonary oedema减轻肺水肿 Diuretics (Furosemide)利尿剂（呋塞米） Prevent thrombolic disease 预防血栓病 If present treat underlying disorders (Hyperthyroidism, Systemic Hypertension) 有必要先治疗原发病（甲亢，高血压） Thromboembolic Disease血栓病Thromboembolic Disease血栓病Frequent complication of feline myocardial disease常伴发猫的心肌病 Clot formation in cardiac chamber or vessel (atrial thrombi)血凝块形成于心房或静脉 Clot 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） Often the first sign of underlying cardiomyopathy潜在的心肌病 Physical Examination身体检查Physical Examination身体检查Acute onset of paresis with extreme pain and hard muscles in the affected legs Cyanotic nail beds黏膜发绀 Weak or absent arterial pulse虚弱或动脉微弱 Cool to palpation低温 Riding aortic thrombus with changing lameness in hindlegs后肢无力 Signs 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Diagnosis诊断Clinical syptoms临床症状 Radilogical, echocardiological and electrocardiological signs as in HCM X-检查和 心电图 Blood work indicating muscle necrosis (CK)血液指标心肌坏死 Metabolic acidosis代谢性酸中毒 Acute renal failure急性肾衰 Hyperthyroidism甲亢Therapy治疗Therapy治疗Inhibition of clot formation抑制血栓形成 Low dose ASA (5mg/cat every 3 days) Clopidogrel氯吡格雷(抗凝药) Heparin 肝素(Low molecular weight heparin低浓度) Close monitoring for hemorrhage is necessary 监测出血 Pain managment (Fentanyl, Morphine)止痛药（芬太尼，吗啡） Supportive care (nutrition, warming)支持疗法（监护，温暖） Treatment of CHF治疗充血性心衰 Monitoring of respiratory rate, renal function, temperature, heart rhythm etc.监测呼吸，肾功能，体温，心率Prognosis预后Prognosis预后Study of 127 cases (Smith et al. 2003) 63% died or were euthanized during initial episode 63%死亡或安乐死在开始治疗阶段 35% survived an average of 4 month35%存活平均四个月 25% of the survivors had re-embolization 25%存活者重新患有血栓 Persistence of low rectal temperature is a sign of poor short-term prognosis持续体温也是预后不良 Bacterial Endocarditis细菌性心内膜炎Bacterial Endocarditis细菌性心内膜炎Multisystemic disorder with bacteremia and infection of kidneys, joints and cardiac valves多系统障碍 肾脏，关节，心瓣膜的 Dysrhythmias (premature beats, tachycardia)节律不齐（，心动过速） Mitral valve insufficiency二尖瓣闭锁不全 Aortic valve insufficiency主动脉瓣闭锁不全 Rupture of chordae tendinae with mitral valve insufficiency, pumonary oedema and death Physical ExaminationPhysical ExaminationLarge breed dogs, middle age or older大型狗或，中老年狗 Primarily in males大部分公狗 Anorexia厌食 Vomiting呕吐 Lameness跛行 Fever高烧 Joint pains, swelling, heat关节疼，有肿块，高温 Pale mucous membranes可视粘膜惨白 Dyspnoe呼吸困难 Congestive heart failure充血性心衰DiagnosisDiagnosisRadiology, ECG and Echocardiography can all be inconclusive in BE X片，心电图，心超都可以用来诊断细菌性心内膜炎 Diagnosis can be made by 诊断建立于 Clinical symptoms of congestive heart failure充血性心衰的临床症状 Evidence of septic or immune joint disease炎性或免疫性关节病 Positive blood cultures血液培养 Positive urine culture尿液培养 Joint synovial culture关节液培养 TreatmentTreatmentAntimicrobial 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 Fluid and nutritional support输液和 营养支持 Treatment of heart failure治疗心衰Pericardial Diseases心包疾病Pericardial Diseases心包疾病Congential pericardial disorders先天性心包病 Peritoneal-pericardial diaphragmatic hernia Pericardial defects Pericardial cysts心包囊肿 Acquired 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Pericardial Effusion心包积液Accumulation of fluids (blood, serous, pus) in the pericardial sac血，脓液在心包囊内 Can be caused by transudates (hydropericardium心包积液) exudate (pericarditis), hemorrhagic (hemopericardium心包积血), septic (fungus, bacteria真菌细菌), sterile (uremic尿毒素), CHF 充血性心衰(increased hydrostatic press，ure) neoplastic肿瘤 and trauma外伤 Impedes the filling ability of the heart压迫心脏 (diastolic dysfunction心舒张障碍) Neoplastic etiologies are most common in dogs (heart base tumour, hemangiosarcoma), very rare in cats肿瘤原因在狗上很常见，猫很少见Physical ExaminationPhysical ExaminationLarge breed dogs are more commonly affected大狗易感 Middle aged and older中老年狗 Increased resproatory effort呼吸影响 Sudden weakness突然虚弱 Exercise intolerance运动不耐受 Muffled heart sounds心音低 Weak arterial pulse脉搏弱 Jugular venous distension颈静脉充盈 Signs of right heart failure右心衰竭Diagnosis诊断Diagnosis诊断Echocardiography心超 RadiologyX片 Electrocardiography心电图 Haematology (nucleated RBC in HAS)血常规（） Cytology of pericardial fluids 心包液细胞 Pneumopericardiography (Injection of CO into the pericardial sac after pericardiocentisis and following radiology to identify HBT)Echocardiography心超Echocardiography心超Test of choice Detection of pericardial effusion心超可测出有无渗出液 Presence of tumours 肿瘤 (right atrium, right ventricle = HAS)右心房室肿瘤 (Base of Aorta = HBT)血管肉瘤 Cardiac 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RadiologyRadiologyRadiology 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 In 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Pericardial Effusion心包积液Pericardial EffusionPericardial EffusionPleural And Pericardial Effusion胸膜炎和心包积液Pleural And Pericardial Effusion胸膜炎和心包积液Treatment治疗Treatment治疗Pericardiocentesis心包穿刺 Fast control esp. if cardiac tamponade is present If effusion recurs repeated pericardiocentesis Corticosteriods (Prednisolone 5mg/kg 2xd) Surgical removal of pericarial sac (Also for determination of underlying neoplastic processes)Cardiac Tamponade心脏栓塞Cardiac Tamponade心脏栓塞Most severe form of pericardial effusion Heart failure due to severe pericardial effusion resulting in reduction or loss of right ventricular function Weak arterial pulses muffled heart sounds, jugular venous distension, syncope, weakness Represents cardiac emergency and requires immediate pericardiocentesisConstrictive Pericardial Disease压迫性心包疾病（心包炎）Constrictive Pericardial Disease压迫性心包疾病（心包炎）Fibrosis of the pericardium纤维化渗出 Usually without pericardial effusion一般没有心包积液 Middle aged dogs, mainly large breeds Same symptoms as cardiac tamponade and pericardial effusion和心脏栓塞，心包积液相同的症状 Radiography shows absence of globose heart and pulmonary oedema X片显示没有球型心影。 Echcardiography shows absence of pericardial effusion Surgical pericardectomy has excellent prognosisPeritoneal-Pericardial Diaphragmatic Hernia膈疝Peritoneal-Pericardial Diaphragmatic Hernia膈疝Congenital disorder with genetic predisposition in cats and dogs (Persian, Himalayan, Weimaraner)先天遗传（波斯猫，希玛拉亚猫，威马犬） Often asymptomatic, depending on herniated organ and restriction of blood flow. In many cases are omentum and liver herniated, sometimes small intestine, spleen and stomach Gastrointestinal problems such as anorexia, vomiting and diarrhoea are common胃肠问题：厌食，呕吐，拉希很常见 Respiratory symptoms also occur呼吸症状 Signs of CHF or cardiac tamponade are rare充血性心衰和心脏栓塞发生很少 Diagnosis with radiology, if necessary contrast radiology and echocardiography X片检查，有必要也可以增加心超 Surgical treatment has excellent prognosis手术的预后Peritoneal-Pericardial Diaphragmatic HerniaPeritoneal-Pericardial Diaphragmatic HerniaHeartworm DiseaseHeartworm DiseaseHeartworm is a parasitic pulmonary artery disease due to infection with Dirofilaria immitis心丝虫是肺动脉寄生虫病 Mosquitos 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 4-5 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 6-7 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 ExaminationPhysical ExaminationDogs at least 6 month of age6月龄以上的狗 Weight loss, anorexia体重减轻，没胃口 Chronic non-productive cough慢性咳嗽 Respiratory distress, dyspnoe呼吸困难 Exercise intolerance, syncope运动不耐受，昏厥 Distended abdomen腹部膨胀 Signs of right heart failure – elevated right heart preload右心衰竭症状Diagnosis诊断Diagnosis诊断Microfilarial detection微丝蚴检查 Concentration techniques (Knotts test, wet mound) Antigen tests 抗原检测(ELISA酶联免疫, Immunochromatographic tests免疫层析) Tests are very sensitive, false results rare监测很灵敏 Radiology x片检查 Electrocardiography (limited application)心电图（不多） Echocardiography (limited application)心超 Hematology (eosinophilia, basophilia, chemistry)血液学（嗜酸粒细胞增多，嗜碱粒细胞增多）RadiologyRadiologyRight ventricle enlargement 右心室扩大 Main pulmonary artery enlargement主动脉扩张 Dilation of pulmonary arteries肺血管扩张 Pruned or truncated pulmonary arteries Width of the caudal pulmonary artery > 9th rib肺动脉宽达到大于9个肋间距 Radiographic changes occur early in disease病变早期的X片 In severe cases signs of right heart failure右心衰竭的症状Severe Heartworm Disease心丝虫Severe Heartworm Disease心丝虫Severe Heartworm DiseaseSevere Heartworm DiseaseTreatmentTreatmentTreatment of heart failure Diuretics利尿剂, low Na-diet低钠饮食, exercise restriction控制运动, Pimobendan匹莫苯（强心药）, Digoxin地高辛, arterial vasodilators动脉扩张药, after 7-14 days start adulticide therapy Adulticide therapy杀虫药治疗 Melarsonine (2.5mg/kg im for 2 days, repeat in 4 month) Thiacetarsamide (2.2mg/kg 2xd for 2 days) Strict exercise restriction for 4-6 weeks post adulticide严格限制运动 Corticosteroid therapy皮质类固醇类药治疗, Heparin肝磷脂, Bronchodilators支气管扩张药, intravenous fluids静脉输液, oxygen supplementation输氧Prophylaxis预防Prophylaxis预防Heartworm is a preventable disease心丝虫是可被预防的 Puppies as young as 8 weeks can use prophylaxis小狗在8周时就可以开始预防 For dogs over 6 month heartworm test prior to chemoprophylaxis6个月以后的狗就可以做心丝虫的测试 Very safe, very effective安全，有效 Microfilaricide therapy 药物治疗(Ivermectin, Milbemycin, Selamectin) These drugs are effective against microfilariae, 3rd and 4th stage larvae and young adult heartworms 3到4 期的幼虫 和成虫有效。 Other Heart Diseases In Dogs And Cats其他的心脏病Other Heart Diseases In Dogs And Cats其他的心脏病Canine Hypertophic Cardiomyopathy犬肥厚性心肌病 Feline Dilated Cardiomyopathy猫心肌病 Feline Restrictive Cardiomyopathy猫限制性心肌病 Boxer Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) 右心室心率失常 Sick Sinus Syndrome窦房结综合症 Hyperkalemia高钾血症