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Therapies that support reverse remodeling have been investigated, and this may suggests a new approach to the prognosis of cardiomyopathies (see ventricular remodeling).
In patients with advanced disease who are refractory to medical therapy, heart transplantation may be considered. For these people 1-year survival approaches 90% and over 50% survive greater than 20 years.
Current treatment options for Boxer cardiomyopathy are largely restricted to the use of oral anti-arrhythmic medications. The aim of therapy is to minimize ventricular ectopy, eliminate syncopal episodes, and prevent sudden cardiac death. A number of medications have been used for this purpose, including atenolol, procainamide, sotalol, mexiletine, and amiodarone. Combinations can also be used. Sotalol is probably the most commonly used antiarrhythmic at this time. It has been demonstrated that sotalol alone, or a combination of mexiletine and atenolol, results in a reduction in the frequency and complexity of ventricular ectopy. It is likely that these medications also reduce syncopal episodes, and it is hoped this extends to a reduced risk of sudden death. Consequently, antiarrhythmic therapy is typically recommended by veterinary cardiologists for Boxer dogs with ARVC. Although relatively rare, oral antiarrhythmic medications may be proarrhythmic in some dogs; consequently, appropriate monitoring and follow-up is recommended.
The ideal therapy for Boxer cardiomyopathy would be implantation of an implantable cardioverter-defibrillator (ICD). This has been attempted in a limited number of dogs. Unfortunately, ICDs are programmed for humans and the algorithms used are not appropriate for dogs, increasing the risk of inappropriate shocks. In the future, reprogramming of ICDs may allow them to emerge as a viable option in the treatment for Boxer cardiomyopathy.
Boxer cardiomyopathy (also known as "Boxer arrhythmogenic right ventricular cardiomyopathy") is a disease of the myocardium primarily affecting Boxer dogs. It is characterized by the development of ventricular tachyarrhythmias, resulting in syncope and sudden cardiac death. Myocardial failure and congestive heart failure are uncommon manifestations of the disease.
Aortic stenosis in the Rottweiler appears to be true subvalvular aortic stenosis (SAS), similar to that in the Newfoundland dog, as opposed to the valvular form (seen more in boxer dogs) or the supravalvular form sometimes seen in people.
Canine subvalvular aortic stenosis (SAS) is an abnormal, congenital heart murmur caused by subaortic stenosis (SAS). There is a high incidence of this condition among Rottweiler dogs.
There is very good evidence that it is heritable, passed on from generation to generation genetically. This genetic trait is what is called polygenic, so that the inheritance is complex. An animal might have the genes for SAS, yet have no actual sign of SAS. Also, an animal might have signs of subaortic stenosis, and yet offspring with signs of SAS may not be seen for a couple of generations. Any animal that has subaortic stenosis should not be bred, because they can definitely pass the defect on to future offspring. There is some controversy as to whether the parents of an animal with SAS should be bred again.
Heart murmurs are graded on a scale of 1 to 6, with one being very mild and six being very serious, with some animals dying before they reach this high stage due to a sudden leap in the grade or through long-term slowing down. Murmurs can exist due to a large number of heart problems (infection, trauma, anemia, etc.; some are innocent, with no cardiac pathology. Tests such as chest X-rays, echocardiography, and electrocardiography can be performed to evaluate the severity of the situation
The condition is usually detected during puppy visits to the veterinarian by hearing a heart murmur during physical examination. A heart murmur is the abnormal sound of blood rushing through one of the heart valves. Instead of just the heartbeat, a whistle of blood flow through a narrowed opening is heard. The puppy will most likely appear normal in all other respects. There is a possibility that the murmur may come and go, or it may develop slowly; this can be determined by frequent checks of a puppy's heart during its first few months. The chance for long-term survival of SAS is low.
Puppies and dogs diagnosed with subaortic stenosis can suffer from heart failure and sudden death. If a dog with SAS develops heart failure, medications can be prescribed to alleviate the clinical signs (sudden/strong lethargicism, continuous heavy panting, rise in temperature etc.)
The OFA has established a Congenital Heart Registry whose guidelines were established by veterinary cardiologists. A dog which auscultates normally at 12 months of age is considered to be free of congenital heart disease; upon confirmation of this, the OFA will issue a certificate.
Heart valve dysplasia is a congenital heart defect which affects the aortic, pulmonary, mitral, and tricuspid heart valves. Dysplasia of the mitral and tricuspid valves can cause leakage of blood or stenosis.
Dysplasia of the mitral and tricuspid valves - also known as the atrioventricular (AV) valves - can appear as thickened, shortened, or notched valves. The chordae tendinae can be fused or thickened. The papillary muscles can be enlarged or atrophied. The cause is unknown, but genetics play a large role. Dogs and cats with tricuspid valve dysplasia often also have an open foramen ovale, an atrial septal defect, or inflammation of the right atrial epicardium. In dogs, tricuspid valve dysplasia can be similar to Ebstein's anomaly in humans.
Mitral valve stenosis is one of the most common congenital heart defects in cats. In dogs, it is most commonly found in Great Danes, German Shepherd Dogs, Bull Terriers, Golden Retrievers, Newfoundlands, and Mastiffs. Tricuspid valve dysplasia is most common in the Old English Sheepdog, German Shepherd Dog, Weimaraner, Labrador Retriever, Great Pyrenees, and sometimes the Papillon. It is inherited in the Labrador Retriever.
The disease and symptoms are similar to progression of acquired valve disease in older dogs. Valve leakage leads to heart enlargement, arrhythmias, and congestive heart failure. Heart valve dysplasia can be tolerated for years or progress to heart failure in the first year of life. Diagnosis is with an echocardiogram. The prognosis is poor with significant heart enlargement.
The intrahepatic shunts found in large dog breeds are passed on in a simple autosomal recessive way, while the extrahepatic shunts of the small breeds are inherited on a polygenic basis.
Surgical treatment is best, when it can be performed. Pressure within the portal vein is measured as the shunt is closed, and it must be kept below 20 cm HO or else portal hypertension will ensue. Methods of shunt attenuation should aim to slowly occlude the vessel over several weeks to months in order to avoid complications associated with portal hypertension. These methods include ameroid ring constrictors, cellophane banding, intravascular or percutaneous silicone hydraulic occluders. The most common methods of attenuation used by veterinarians are ameroid ring constrictors and cellophane banding. Both methods have reportedly good outcomes in both cats and dogs, although the true composition of readily sourced cellophane has been found to be made from plastics (inert) and not cellulose (stimulates a fibrous reaction). Recently, a commercial supplier of regenerated cellulose based cellophane for veterinarians has been established for use of cellophane banding for portosystemic shunts in dogs and cats. Complete closure of extrahepatic shunts results in a very low recurrence rate, while incomplete closure results in a recurrence rate of about 50 percent. However, not all dogs with extrahepatic shunts tolerate complete closure (16 to 68 percent). Intrahepatic shunts are much more difficult to surgically correct than extrahepatic shunts due to their hidden nature, large vessel size, and greater tendency toward portal hypertension when completely closed. When surgery is not an option, PSS is treated as are other forms of liver failure. Dietary protein restriction is helpful to lessen signs of hepatic encephalopathy, and antibiotics such as neomycin or metronidazole and other medicines such as lactulose can reduce ammonia production and absorption in the intestines. The prognosis is guarded for any form of PSS.
The disease can be treated only to slow down the development, by use of cyclosporine A and ACE inhibitors, but not stopped or cured.
Hyperthyroidism is very rare in dogs, occurring in less than 1% of dogs. Hyperthyroidism may be caused by a thyroid tumor. This may be a thyroid carcinoma. About 90% of carcinomas are a very aggressive; they invade the surrounding tissues and metastasize (spread), to other tissues, particularly the lungs. This has a poor prognosis. Surgery to remove the tumor a carcinoma is often very difficult, due to the spread of the tumor to the surrounding tissue, for example, into arteries, the esophagus, or the windpipe. It may be possible to reduce the size of the tumor, thus relieving symptoms and allowing time for other treatments to work. About 10% of thyroid tumors are benign; these often cause few symptoms.
In dogs treated for hypothyroidism (lack of thyroid hormone), hyperthyroidism may occur as a result of an overdose of the thyroid hormone replacement medication, levothyroxine; in this case treatment involves reducing the dose of levothyroxine. Dogs which display coprophagy, that is, which often eat feces, and which live in a household with a dog receiving levothyroxine treatment, may develop hyperthryoidism if they frequently eat the feces from the dog receiving levothyroxine treatment.
Hyperthyroidism may occur if a dog eats an excessive amount of thyroid gland tissue. This has occurred in dogs fed commercial dog food.
With rest, the tail returns to normal within a few days. Pain relief, such as a nonsteroidal anti-inflammatory drug may be administered. The symptoms may reoccur.
Emesis (induction of vomiting) is the generally recommended treatment if a dog has eaten grapes or raisins within the past two hours. A veterinarian may use an emetic such as apomorphine to cause the dog to vomit. Further treatment may involve the use of activated charcoal to adsorb remaining toxins in the gastrointestinal tract and intravenous fluid therapy in the first 48 hours following ingestion to induce diuresis and help to prevent acute renal failure. Vomiting is treated with antiemetics and the stomach is protected from uremic gastritis (damage to the stomach from increased BUN) with H receptor antagonists. BUN, creatinine, calcium, phosphorus, sodium, and potassium levels are closely monitored. Dialysis of the blood (hemodialysis) and peritoneal dialysis can be used to support the kidneys if anuria develops. Oliguria (decreased urine production) can be treated with dopamine or furosemide to stimulate urine production.
The prognosis is guarded in any dog developing symptoms of toxicosis. A negative prognosis has been associated with oliguria or anuria, weakness, difficulty walking, and severe hypercalcemia (increased blood calcium levels).
People with autoimmune hyperthyroidism should not eat foods high in iodine, such as edible seaweed and kelps.
From a public health perspective, the general introduction of iodized salt in the United States in 1924 resulted in lower disease, goiters, as well as improving the lives of children whose mothers would not have eaten enough iodine during pregnancy which would have lowered the IQs of their children.
Hepatic microvascular dysplasia (HMD or MVD) or portal atresia is a disorder where mixing of venous blood and arterial blood in the liver occurs at the microscopic level. It occurs most commonly in certain dog breeds such as the Cairn and Yorkshire terriers although any dog breed may be at risk.
This disease may also be found in cats.
HMD is sometimes misdiagnosed as Portosystemic vascular anomaly (PSVA) or a "Liver Shunt" (portosystemic shunt). HMD can be diagnosed with an MRI, using a tracing dye in the subject's blood, and observing the flow of blood through the subject's liver and surrounding areas (stomach, intestine) for anomalies. It can also be diagnosed using a bile-acid level test; or more accurately, a "fasting-blood ammonia levels" test. Symptoms include stunted growth in the first 6–9 months, vomiting, seizures, and hydro-encephalitic episodes (from ammonia concentrating in the blood). HMD is usually treated non-surgically with antibiotics (metronidazole) and stool-softeners (lactulose).
Dog breeds commonly affected by lymphangiectasia and/or protein-losing enteropathy include the Soft-Coated Wheaten Terrier, Norwegian Lundehund, Basenji, and Yorkshire Terrier.
The consumption of grapes and raisins presents a potential health threat to dogs. Their toxicity to dogs can cause the animal to develop acute kidney injury (the sudden development of kidney failure) with anuria (a lack of urine production). The phenomenon was first identified by the Animal Poison Control Center (APCC), run by the American Society for the Prevention of Cruelty to Animals (ASPCA). Approximately 140 cases were seen by the APCC in the one year from April 2003 to April 2004, with 50 developing symptoms and seven dying.
It is not clear that the observed cases of renal failure following ingestion are due to grapes only. Clinical findings suggest raisin and grape ingestion can be fatal, but the mechanism of toxicity is still considered unknown.
Mild cases are managed by limiting activity, keeping a healthy body weight, and avoiding exposure to high ambient temperatures. Mild sedatives can be used to decrease anxiety and panting and therefore improve respiration. Corticosteroids may also be administered in acute cases to decrease inflammation and edema of the larynx.
Severe acute symptoms, such as difficulty breathing, hyperthermia, or aspiration pneumonia, must be stabilized with sedatives and oxygen therapy and may require steroid or antibiotic medications. Sometimes a tracheotomy is required to allow delivery of oxygen. Once the patient is stabilized, surgical treatment may be beneficial especially when paralysis occurs in both aretynoid cartilages (bilateral paralysis). The surgery (aretynoid lateralization, or a "laryngeal tieback") consists of suturing one of the aretynoid cartilages in a maximally abducted (open) position. This reduces the signs associated with inadequate ventilation (such as exercise intolerance or overheating) but may exacerbate the risk of aspiration and consequent pneumonia. Tying back only one of the aretynoid cartilages instead of both helps reduce the risk of aspiration. Afterwards the dog will still sound hoarse, and will need to be managed in the same way as those with mild cases of LP.
Recent studies have found that many dogs with laryngeal paralysis have decreased motility of their esophagus. Animals with a history of regurgitation or vomiting should be fully evaluated for esophageal or other gastrointestinal disorders. Dogs with megaesophagus or other conditions causing frequent vomiting or regurgitation are at high risk for aspiration pneumonia after laryngeal tie-back. Permanent tracheostomy is an alternative surgical option for these dogs to palliate their clincical signs.
Besides complications of surgery and anesthesia in general, there may be drainage, swelling, or redness of the incision, gagging or coughing during eating or drinking, or pneumonia due to aspiration of food or liquids. Undesirable complications are estimated to occur in 10-30% of cases. If medical therapy is unsuccessful and surgery cannot be performed due to concurrent disease (such as heart or lung problems) or cost, euthanasia may be necessary if the animal's quality of life is considered unacceptable due to the disease.
Commonly used dietary supplements include:
- Omega-6 fatty acids (e.g., safflower or sunflower oil)
- Omega-3 fatty acids (e.g., fish oils)
- Vitamin A.
There is no cure for this condition. Treatment is generally lifelong and takes the form of bathing and soaking in mineral oils and washing with antibiotic shampoos to try to alleviate symptoms and slow the condition's progression. Antiseptic and antibiotic shampoos (chlorhexidine or benzoyl peroxide) are used to manage further secondary bacterial infection. For some breeds, cyclosporine or corticosteroids and immunosuppressant drugs may be effective, and it is postulated, through some studies, that large doses of vitamin A given orally may result in some improvement.
It has been suggested that the more aggressively one applies the topical methods of treatment, the less aggressively one needs to employ the immunosuppressant therapy. The suggestion is that this phenomenon may be due to a feedback whereby secondary infection, when not aggressively treated with topical therapy, increases and contributes to further sebaceous gland inflammation.
An important distinction in recognizing megaesophagus is the difference between when a dog regurgitates or vomits. When a dog regurgitates there is usually not as much effort involved as when a dog vomits. Often when regurgitating, the dog will tip its head down and the liquid and/or food will almost appear to "spill out" of its throat.
One of the primary dangers to a dog with megaesophagus is aspiration pneumonia. Because the food stays lodged in the throat, it can often be inhaled into the lungs causing aspiration pneumonia. One way to avoid this is to make sure that every time the dog eats or drinks anything, that the dog sits for at least 10 minutes afterwards or is held in a sitting up or begging position. This disorder has a guarded prognosis, however a successful management technique is vertical feeding in a Bailey Chair.
It has been said by many dog owners that limber tail had been caused shortly (24 hours) after swimming in water that is too cold or on rare occasions too warm and indeed this has certainly produced this very condition. The actual cause is unknown but it may be caused by the narrowing of the space through which the spinal cord passes, typically due to degenerative change to the intervertebral disk spaces. These underlying changes may not lead to visible change until the problem is suddenly exacerbated, such as during physical activity, after trauma, etc. Occasionally other changes are seen prior to or in conjunction with limber tail disease, such as urinary or fecal incontinence, postural abnormalities in the pelvic limb, or pain in response to touching the lower back.
Immediate treatment consists of rinsing the bite site in cold water. If not too painful, ice the bite site. This constricts the blood vessels so the venom does not spread. Also recommended is papain, an enzyme that breaks down protein. Papain can be found in meat tenderizer and papaya. This deactivates the majority of the centipede venom's proteins. Depending on the type of centipede and level of envenomation, this treatment may not degrade the entire venom dose and residual pain will remain.
Individuals who are bitten by centipedes are sometimes given a urine test to check for muscle tissue breakdown and/or an EKG to check for heart and vascular problems.
Reassurance and pain relief is often given in the form of painkillers, such as non-steroidal anti-inflammatory medications, antihistamines and anti-anxiety medications. In a severe case the affected limb can be elevated and administered diuretic medications.
Wound care principles and sometimes antibiotics are used to keep the wound itself from becoming infected or necrotic.
In Barbados, a folk remedy involves applying a freshly cut onion to the site of the injury "bite" for 10 minutes. Repeat until relief is obtained.
There is antibiotic therapy for secondary infections caused by the parasite. However, surgical removal is usually the only way to get rid of the parasites.