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Background In canine mitral regurgitation (MR) the rate of heart enlargement increases in the last year before congestive heart failure (CHF). Measurement of heart size and its rate of increase may be useful tests for CHF in MR. Objectives To determine the value of vertebral heart scale (VHS) and its rate of increase (∆VHS units/month) for diagnosing the presence and predicting the onset of CHF. Animals Longitudinal study of 94 Cavalier King Charles Spaniels (CKCS). Methods VHS was measured at intervals before CHF. ∆VHS/month was calculated from sequential pairs of VHS measurements and the interval between them. Diagnostic accuracy and utility were determined by the areas under receiver operating characteristic plots (AUROC), and likelihood ratios (LR). Results AUROC for VHS at the onset of CHF was 0.93 (95% CI, 0.96–0.90), to predict CHF 1–12 months before CHF was 0.74 (95% CI, 0.81–0.66), and for ∆VHS/month at CHF was 0.98 (95% CI, 0.99–0.96). Interval LRs and their cutoff values for CHF were for VHS: 13 (95% CI, 20–7.3) at ≥12.7; 1.2 (95% CI, 2.0–0.68) between 12.7 and 12.0; 0.04 (95% CI, 0.18–0.01) at ≤12.0, and for ∆VHS/month: 15 (95% CI, 30–7.7) at ≥0.08; 0.72 (95% CI, 2.0–0.25) between 0.08 and 0.06; and 0.05 (95% CI, 0.13–0.02) at ≤0.06. Conclusions and Clinical Importance Under the conditions of this study, VHS and particularly ∆VHS/month are useful measurements for detecting onset of CHF in CKCS with MR.

Objective—To investigate whether plasma activity of matrix metalloproteinase (MMP)-2 and -9 was associated with severity of myxomatous mitral valve disease (MMVD) in dogs and to assess potential associations between MMP activity and dog characteristics, echocardiographic variables, systolic arterial blood pressure (SAP), heart rate, cardiac troponin I (cTnI) concentration, and C-reactive protein concentration. Animals—75 client-owned dogs. Procedures—Severity of MMVD was assessed by use of echocardiography. Plasma activity of latent (pro-MMP) and active MMP-2 and -9 was analyzed via zymography. Plasma concentration of cTnI was analyzed with a high-sensitivity cTnI assay, and C-reactive protein concentration was analyzed with a canine-specific ELISA. Results—Pro-MMP-9, active MMP-9, and pro-MMP-2 were detected, but active MMP-2 was not. No significant differences were found in MMP concentrations among the 4 MMVD severity groups. Activity of pro-MMP-9 decreased with decreases in SAP and was higher in male dogs than in female dogs. Activity of MMP-9 decreased with increases in left ventricular end-systolic dimension and with decreases in SAP and cTnI concentration. Left ventricular end-systolic dimension was the variable most strongly associated with MMP-9 activity. No associations were found between the activity of pro-MMP-2 and investigated variables. Conclusions and Clinical Relevance—Plasma MMP-9 activity decreased with increases in the end-systolic left ventricular internal dimension and decreases in SAP. Hence, evaluation of MMP-9 activity has the potential to provide unique information about the myocardial remodeling process in dogs with MMVD.

Objectives: To investigate the prevalence and progression of murmurs and the development of the left ventricular outflow tract (LVOT) and flow velocities in the great arteries in boxer puppies through adolescence until three years of age. Methods: Nineteen boxer puppies with or without a low-intensity murmur, but without evidence of congenital heart disease, were studied prospectively. Examinations were carried out at 7 weeks, 3, 4, 6, 9, 12 and 36 months of age by cardiac auscultation and Doppler echocardiography. Results: Presence and intensity of heart murmurs varied in the same dog and between dogs, but flow velocities did not change. Estimated effective orifice diameter (EOD) and indexed EOD was significantly narrower than measured subvalvular and valvular diameters. Clinical Significance: The variability in presence and intensity of low-intensity ejection murmurs is high during growth in boxers.

Summary Reason for performing the study: Horses in training lose large amounts of sodium but little is known about the cardiovascular response to low sodium intake. Objectives: To investigate the effect of low sodium intake on plasma aldosterone (pAldo) concentrations and the cardiovascular system of athletic horses, and to identify markers of low sodium intake. Methods: Seven Standardbred geldings in training (trained twice a week) were randomly offered a standardised diet supplemented (NaS, 58 mg Na/kg bwt) and not supplemented (NaN, 3 mg Na/kg bwt) with NaCl for 5 weeks in a changeover design. Blood samples were taken once a week and in Week 5, before and following an exercise test until 22.30 h and analysed for blood sodium (bNa), total plasma protein (TPP), pAldo, troponin I and packed cell volume (PCV). Blood pressure (BP) was measured and pulse wave recorded at rest with high definition oscillometric-technique (HDO). ECG and echocardiography were recorded. Water intake was measured before and on the day of exercise and voluntary saline intake was measured for 2 days after each period. Faecal samples were taken weekly and analysed for sodium and potassium content. Results: The pAldo and the PCV was higher in NaN compared to NaS. There were no differences between diets in BP, ECG, plasma troponin I and echocardiogram but HDO pulse amplitude tended to be smaller on diet NaN. Water intake was lower on diet NaN and saline intake higher. The response to exercise in bNa, pAldo, PCV and TPP was different on the 2 diets. Faecal potassium/sodium ratio was higher on NaN than on NaS. Conclusion: This study shows that 5 weeks of low sodium intake increased plasma aldosterone concentration and PCV but no alterations in heart function was observed. Faecal potassium/sodium ratio could be used to assess sodium status in horses.

Summary Parturient paresis (p. p.) in the cow is usually associated with hypocalcaemia, the degree of which is traditionally described in terms of serum total calcium. However, since ionized calcium (CaF) is the physiologically active form of calcium we determined CaF and classified 102 cows with p.p. in four groups according to their concentrations of serum ionized calcium: Normocalcaemia 1.06–1.26mmol/l; slight hypocalcaemia 1.05–0.80mmol/l; moderate hypocalcaemia 0.79–0.50mmol/l and severe hypocalcaemia

Natriuretic peptides are useful in diagnosing heart failure in dogs. However, their usefulness in detecting early stages of myxomatous mitral valve disease (MMVD) has been debated. This study evaluated N-terminal (NT) fragment pro-atrial natriuretic peptide (NT-proANP) and NT-pro-brain natriuretic peptide (NT-proBNP) in 39 Cavalier King Charles Spaniels (CKCS) with pre-clinical mitral valve regurgitation (MR), sixteen dogs with clinical signs of heart failure (HF) and thirteen healthy control dogs. Twenty seven CKCS and ten control dogs were re-examined 4 years after the initial examination and the status of the dogs 5 years after the initial examination was determined by telephone calls to the owner. All dogs were evaluated by clinical examination and echocardiography. CKCS with severe MR had higher NT-proANP and NT-proBNP compared to controls and CKCS with less severe MR. Dogs with clinical signs of HF had markedly elevated NT-proANP and NT-proBNP. Plasma concentrations of the natriuretic peptides measured at re-examination could predict progression in regurgitant jet size.

Objective—To investigate use of signal analysis of heart sounds and murmurs in assessing severity of mitral valve regurgitation (mitral regurgitation [MR]) in dogs with myxomatous mitral valve disease (MMVD). Animals—77 client-owned dogs. Procedures—Cardiac sounds were recorded from dogs evaluated by use of auscultatory and echocardiographic classification systems. Signal analysis techniques were developed to extract 7 sound variables (first frequency peak, murmur energy ratio, murmur duration > 200 Hz, sample entropy and first minimum of the auto mutual information function of the murmurs, and energy ratios of the first heart sound [S1] and second heart sound [S2]). Results—Significant associations were detected between severity of MR and all sound variables, except the energy ratio of S1. An increase in severity of MR resulted in greater contribution of higher frequencies, increased signal irregularity, and decreased energy ratio of S2. The optimal combination of variables for distinguishing dogs with high-intensity murmurs from other dogs was energy ratio of S2 and murmur duration > 200 Hz (sensitivity, 79%; specificity, 71%) by use of the auscultatory classification. By use of the echocardiographic classification, corresponding variables were auto mutual information, first frequency peak, and energy ratio of S2 (sensitivity, 88%; specificity, 82%). Conclusions and Clinical Relevance—Most of the investigated sound variables were significantly associated with severity of MR, which indicated a powerful diagnostic potential for monitoring MMVD. Signal analysis techniques could be valuable for clinicians when performing risk assessment or determining whether special care and more extensive examinations are required.

BACKGROUND: Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. HYPOTHESIS: Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. ANIMALS: Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. METHODS: A prospective single-blinded study with dogs randomized to PO receive pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. RESULTS: Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy

Objective—To investigate whether time-frequency and complexity analyses of heart murmurs can be used to differentiate physiologic murmurs from murmurs caused by aortic stenosis (AS) in Boxers. Animals—27 Boxers with murmurs. Procedures—Dogs were evaluated via auscultation and echocardiography. Analyses of time-frequency properties (TFPs; ie, maximal murmur frequency and duration of murmur frequency > 200 Hz) and correlation dimension (T2) of murmurs were performed on phonocardiographic sound data. Time-frequency property and T2 analyses of low-intensity murmurs in 16 dogs without AS were performed at 7 weeks and 12 months of age. Additionally, TFP and T2 analyses were performed on data obtained from 11 adult AS-affected dogs with murmurs. Results—In dogs with low-intensity murmurs, TFP or T2 values at 7 weeks and 12 months did not differ significantly. For differentiation of physiologic murmurs from murmurs caused by mild AS, duration of murmur frequency > 200 Hz was useful and the combination assessment of duration of frequency > 200 Hz and T2 of the murmur had a sensitivity of 94% and a specificity of 82%. Maximal murmur frequency did not differentiate dogs with AS from those without AS. Conclusions and Clinical Relevance—Results suggested that assessment of the duration of murmur frequency > 200 Hz can be used to distinguish physiologic heart murmurs from murmurs caused by mild AS in Boxers. Combination of this analysis with T2 analysis may be a useful complementary method for diagnostic assessment of cardiovascular function in dogs.

Two-dimensional (2-D) echocardiographic measurement of the left atrium (LA) has the potential to be more accurate than the standard M-mode method, because the LA body can be measured. We evaluated a 2-D method for measuring LA and aorta (AO) in a right parasternal short-axis view and compared it to the M-mode method. An index for LA size (LA/AO) was calculated in 166 cavalier King Charles spaniels, 56 normal and 110 dogs with mitral regurgitation (MR) of varying degrees secondary to chronic valvular disease. In normal dogs, the AO-2-D and LA/AO-2-D did not correlate to body weight (BW) or BW2; whereas, all M-mode values and the LA-2-D were significantly (p < .05) related to both BW parameters. In normal dogs, there was no difference between M-mode and 2-D indices. For all dogs (normal and dogs with MR) there was an 11% bias between the M-mode and 2-D index with the LA/AO-2-D being higher than the LA/AO-M. The association between the mean and the difference of the indices demonstrated a quadratic relationship. Dogs with a mean LA/AO of 2.0-2.5 showed the largest difference between the two indices. Small values for the 2-D coefficients of variation for respiration and stage of diastole were found; 3.4 and 3.1%, respectively. The 2-D index is more sensitive to LA enlargement than the M-mode index.

Adiponectin is the most abundant plasma adipokine, and is well known for its role in energy homeostasis and cardiac protection. In humans with dilated cardiomyopathy, myocardial adiponectin protein expression is reduced compared to normal hearts and has been implicated in the pathology of cardiomyopathy. Serum adiponectin levels are often conflicting, with higher levels associated with poor survival in humans with congestive heart failure (CHF). We evaluated adiponectin serum concentrations and myocardial protein expression in dogs with naturally occurring myxomatous mitral valve disease and CHF. We compared the findings to active and hibernating brown bears as bears are adapted to endure an extreme period of low cardiac output during their annual hibernation. Bears exhibited largely the active high-molecular weight (HMW) versus the low-molecular weight isoforms of myocardial adiponectin (HMW:LMW = 6.3) during both the active period and hibernation, while healthy dogs exhibited a more balanced mix of isoforms. Dogs with CHF expressed predominately HMW isoforms of adiponectin (HMW:LMW = 12.5), appearing more similar to bears. In contrast to humans, serum adiponectin was significantly lower in dogs with CHF and lowest levels in the severest CHF class. In both dogs and bears, myocardial adiponectin was expressed independent of circulating adiponectin concentrations, suggesting a local regulatory mechanism within the heart.

Background Pimobendan and benazepril are frequently used with diuretics to treat dogs in congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD). Aim To compare the short-term effects of pimobendan versus benazepril on pump function, heart size, and neuroendocrine profile in dogs with CHF caused by MMVD. Animals Sixteen client-owned dogs. Material and methods Seven-day prospective single-blinded study of dogs stabilized on furosemide monotherapy, randomized to pimobendan (0.4–0.6 mg/kg/day) or benazepril (0.25–1.0 mg/kg/day). Dogs had first-pass radionuclide angiocardiography, and heart size was measured by radiography and echocardiography. Circulating neuroendocrine hormones were measured. Results Baseline variables did not differ between treatment groups. Greater decreases in the pimobendan than in the benazepril group were found for heart rate (P = .001), heart rate-normalized pulmonary transit time (P = .02), left atrial size (P = .03), and systolic and diastolic left ventricular diameters (P

BACKGROUND: Myxomatous mitral valve disease (MMVD) is an important cause of morbidity and mortality in dogs. OBJECTIVES: To compare, throughout the period of follow-up of dogs that had not yet reached the primary endpoint, the longitudinal effects of pimobendan versus benazepril hydrochloride treatment on quality-of-life (QoL) variables, concomitant congestive heart failure (CHF) treatment, and other outcome variables in dogs suffering from CHF secondary to MMVD. ANIMALS: A total of 260 dogs in CHF because of MMVD. METHODS: A prospective single-blinded study with dogs randomized to receive pimobendan (0.4-0.6 mg/kg/day) or benazepril hydrochloride (0.25-1.0 mg/kg/day). Differences in outcome variables and time to intensification of CHF treatment were compared. RESULTS: A total of 124 dogs were randomized to pimobendan and 128 to benazepril. No difference was found between groups in QoL variables during the trial. Time from inclusion to 1st intensification of CHF treatment was longer in the pimobendan group (pimobendan 98 days, IQR 30-276 days versus benazepril 59 days, IQR 11-121 days; P = .0005). Postinclusion, dogs in the pimobendan group had smaller heart size based on VHS score (P = .013) and left ventricular diastolic (P = .035) and systolic (P = .0044) dimensions, higher body temperature (P = .030), serum sodium (P = .0027), and total protein (P = .0003) concentrations, and packed cell volume (P = .030). Incidence of arrhythmias was similar in treatment groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Pimobendan versus benazepril resulted in similar QoL during the study, but conferred increased time before intensification of CHF treatment. Pimobendan treatment resulted in smaller heart size, higher body temperature, and less retention of free water.

Objectives: The objective of the study was to examine the changes in vertebral heart scale, and left atrial and ventricular dimensions before and at onset of congestive heart failure in cavalier King Charles spaniels with mitral regurgitation. Methods: Records and radiographs from 24 cavalier King Charles spaniels with mitral regurgitation were used. Vertebral heart scale (24 dogs), and left atrial dimension and left ventricular end diastolic and end systolic diameters (18 dogs) and their rate of increase were measured at intervals over years to the onset of congestive heart failure. They were plotted against time to onset of congestive heart failure. Results: Dimensions and rates of change of all parameters were highest at onset of congestive heart failure, the difference between observed and chance outcome being highly significant using a two-tailed chi-square test (P

The practice of cardiac auscultation remains one of the most widely used diagnostic techniques in veterinary medicine. Technical considerations of cardiac auscultation and interpretation of heart sounds and murmurs are therefore of wide interest to the veterinary practitioner. Although it may not be possible to establish the diagnosis of a specific heart disease with the sole use of a stethoscope, or in combination with a phonocardiogram (PCG), optimal use can narrow down the list of differential diagnoses substantially. A gentle approach and quiet environment are essential for the animal to relax and for the auscultator to be undisturbed. It is also essential to auscultate all cardiac areas to detect local murmurs and, in the case of a heart murmur, the point of maximum intensity (PMI). The chapter covers Stethoscopes; Origin of murmurs; Auscultation and the point of maximum intensity; and the Differential diagnoses for different cardiac murmurs.

Objectives: To measure accuracy and variability of diagnosis by radiography of heart enlargement (HE) and heart failure (HF) in mitral regurgitation (MR). Methods: Sixteen readers representing four levels of experience evaluated 50 sets of radiographs with varying severity of MR for presence or absence of HE, left atrial enlargement (LAE) and HF. The performance of the readers was compared with a reference standard, using area under the curve (AUC) of receiver operating characteristic (ROC) curves. The interreader agreement value kappa (K) was calculated. A subset of difficult cases of HF was analysed before and after removing an outlying reader from each group. Results: AUC for HE was 0·89, for LAE it was 0·93 and for HF it was 0·92. Experience increased certainty of diagnosis but not accuracy. K ranges were HE, 0·53 to 0·67; LAE, 0·61 to 0·69 and HF, 0·49 to 0·58. When only difficult cases of HF were read, accuracy decreased and experienced readers performed better than inexperienced. When outlying readers were excluded, the differences between experienced and inexperienced readers increased. Clinical Significance: LAE, not HE, should be used to evaluate the heart size and indirectly the severity of MR on radiographs. For HF, agreement among individual readers was only moderate. Studies of reader accuracy should consider the effects of interreader variability.

Background: The contribution of right heart (RH) chamber enlargement to general heart enlargement seen on thoracic radiographs in mitral regurgitation (MR) is not known. Objectives: To determine the size and shape of the RH chambers in normal dogs and dogs with varying degrees of MR. Animals: Fifty-four privately owned dogs: 13 normal, 41 with varying degrees of MR including 25 with congestive heart failure (CHF). Methods: Archived first pass radionuclide angiocardiograms were used to produce static images of the RH and left heart (LH) chambers. Indexes of size and shape of the RH and LH chambers were related to severity of MR determined by heart rate-normalized pulmonary transit time (nPTT), vertebral heart scale (VHS), and clinical status. RH shape was measured by a circularity index of RH short axis/long axis. Results: A 2nd degree polynomial fit best described the ratios; RH/LH dimension to nPTT (R2= 0.62) and to VHS (R2= 0.43), RH/LH area to nPTT (R2= 0.64) and to VHS (R2= 0.58), all P < .001. RH circularity was decreased in CHF, P < .001. In CHF, the RH chambers of 16 dogs were both flattened and enlarged, whereas 9 had convex septal borders. Conclusions: RH chambers are not significantly dilated in dogs with mild to moderate MR without CHF. In CHF, RH chambers enlarge and also may be compressed by the LH chambers. Pulmonary hypertension probably is present in some dogs with CHF. Increased sternal contact is not a useful sign of right-sided heart dilatation in MR.

SUMMARY Objective To study the responses of atrial natriuretic peptide (ANP), N-terminal fragment of pro-atrial natriuretic peptide (NT-proANP) and brain natriuretic peptide (BNP) to varying severity of mitral regurgitation (MR) in dogs with myxomatous valve disease (MVD). Design Case-control. Dogs 103 Cavalier King Charles Spaniels, 27 normal individuals and 76 with varying degree of MR. Procedure Dogs were evaluated by physical examination, collection of venous blood, thoracic radiography and echocardiography. NT-proANP, ANP and BNP were measured in plasma using radio immunoassay (RIA). Results The mean concentrations of NT-proANP were 37.4 and 83.5 times higher than ANP and BNP, respectively. The mean ANP to BNP molar ratio was 2.6. Plasma concentrations of NT-proANP and ANP were slightly increased in asymptomatic dogs with increased cardiac dimensions; those with signs of decompensated heart failure (HF) had mean concentrations of NT-proANP and ANP 3 to 7 times higher than normal dogs. The BNP concentrations were increased only in dogs with decompensated HF and the levels were approximately twice as high in these dogs as in normal individuals. Univariate and multiple regression analysis showed that primarily left atrial and ventricular size influenced the plasma concentrations of all 3 peptides (increased with increasing measurement). Analyses of response operating characteristic (ROC) curves indicated that NT-proANP and ANP were more discriminating than BNP for either cardiomegaly of HF. Clinical Implications Natriuretic peptides, particularly NT-proANP and ANP, may be of benefit in the overall assessment of dogs with naturally occurring MR. Analysis of NT-proANP may be more useful than ANP owing to easier handling of the samples and less laborious assay.

Objectives The aim of this study was to investigate whether contrast echocardiography could enhance the subcostal Doppler signal for aortic flow measurements and achieve myocardial opacification, in Boxer dogs with and without AS. Background In evaluating dogs for aortic stenosis (AS) subcostal Doppler echocardiography was used for measurement of the aortic flow velocity, a measurement that can sometimes be difficult to perform in Boxer dogs. Animals, materials, and methods Cardiac auscultation, phonocardiographic and echocardiographic examinations, including a contrast study with Optison, were performed on 29 Boxer dogs selected based on previous examinations. Results The initial subcostal Doppler signal was weak in 66% of the dogs and a marked improvement was seen in all dogs after contrast injection. The peak aortic flow velocity increased 5% from 2.58 ± 1.42 m/s before contrast to 2.71 ± 1.54 m/s after contrast (p = 0.003). This corresponds to a 2.8 mmHg increase in the pressure gradient from 26.6 mmHg before to 29.4 mmHg after contrast. A dose of 0.05–0.1 mL of Optison administered intravenously resulted in approximately 4 min of Doppler signal enhancement. With the present technique contrast echocardiography did not achieve myocardial opacification. Conclusions Single use of the contrast agent Optison can be recommended for enhancement of the subcostal Doppler signal in dogs, in which plain Doppler signals are difficult to obtain. Albeit statistically significant, the mild increase in peak aortic flow velocity after contrast was not considered biologically or clinically significant.

The vertebral heart size (VHS) method by Buchanan is based on anatomic landmarks. A potential source of variation among observers is differences in the selection of measurement points. The objective was to test variability between observers with different levels of training in thoracic radiology and small animal clinical practice. Fifty sets of thoracic radiographs of cavalier King Charles spaniels, were divided into five groups; (Normal) normal cardiopulmonary structures, (I) slight cardiomegaly, (II) moderate cardiomegaly, (II +) moderate cardiomegaly with congestive heart failure, and (III +) severe cardiomegaly with congestive heart failure. Cardiomegaly was confirmed by echocardiography to be caused by mitral regurgitation because of myxomatous mitral valve disease. Sixteen observers representing four levels of experience (four observers/level) evaluated the radiographs; (1) European Diplomates in Veterinary Diagnostic Imaging, (2) Experienced small animal clinicians, (3) Trainees in small animal clinical practice (4) Veterinary students. Almost identical mean VHS values were found among the four experience levels for each of the five groups of radiographs with a low coefficient of variation, range 1.5-3.2%. Mean difference among the 16 observers was 1.05 +/- 0.32 vertebrae (v). Mean difference among individuals in each observer group was approximately 0.5 v for all but the groups of trainees were the difference was 0.6-0.9 v. The conclusion is that VHS method for heart size is independent of observer experience but dependent of individual observers selection of reference points and transformation of long and short axis dimensions into VHS units.

Degenerative mitral valve disease (DMVD) is the most common cardiac disease in dogs. Although the disease is frequently described in the veterinary literature, many aspects are still unknown or controversial. Based on recent research findings, this article addresses the etiology, pathogenesis, inheritance, diagnosis of early DMVD, diagnosis of mild decompensated heart failure, and efficacy of early medical intervention in clinically compensated dogs.

Inter-observer variation in the detection and grading of low intensity heart murmurs in boxer dogs was investigated. Six veterinarians with different levels of experience examined 27 boxers by cardiac auscultation. The dogs were auscultated before and after exercise, and the results were compared with phonocardiographic and echocardiographic examinations performed at rest and during two different stress tests. A subvalvular aortic ridge was identified in six dogs on two-dimensional echocardiography. Using dogs with low intensity murmurs or dogs free of heart murmurs, inter-observer agreement was positively correlated to the level of experience at rest (weighted kappa [kappa] 0.14 to 0.75), while the agreement was poor after exercise (weighted kappa 0.01 to 0.36). The presence of a subvalvular aortic ridge was associated with higher aortic flow velocities (P

Pulmonary transit time (PTT) normalized to heart rate (nPTT) is a measure of the pulmonary blood volume (PBV) to stroke volume ratio (PBV/SV). It is an index of cardiac performance. To determine the effect of compensated mitral regurgitation (CMR) and decompensated mitral regurgitation (DMR) caused by valvular endocardiosis on the index nPTT, we measured nPTT by first-pass radionuclide angiocardiography and ECG in 13 normal dogs, 18 dogs with CMR, and 13 dogs with DMR. PTT was measured as time between onset of appearance of activity at the pulmonary trunk and the left atrium. In the normal dogs, the relationship between PTT and mean R-R interval (mRR) was PTT = 4.08 x mRR + 0.15 (R2 = 0.71). Normal nPTT was 4.4 +/- 0.6 (SD) (range. 3.6-5.3). in CMR, 6.3 +/- 1.6 (SD) (range, 4.0-9.7). and in DMR, 11.9 +/- 3.4 (SD) (range, 8.0-18.8). The differences among all groups were significant. Heart rates were 110 +/- 22 bpm in normal dogs, 111 +/- 20 in dogs with CMR, and 144 +/- 18 in dogs with DMR (P < .001 for difference between DMR group and normal and CMR groups). Increased nPTT in CMR indicates preclinical heart pump dysfunction. Heart rate-normalized pulmonary transit times may be a useful index of heart function in mitral regurgitation.

Blood samples were collected for the determination of platelet counts from 102 cavalier King Charles spaniels which had no history of bleeding disorders. Thrombocytopenia was found in 31 per cent of the samples when the lower reference limit was set at 100 X 109/litre. The platelet count of the males (mean ± SD, 147 X 109/litre ± 15 X 109/litre) was found to be significantly (P

We evaluated the long-term effect of early angiotensin-converting enzyme (ACE) inhibition (enalapril maleate) as monotherapy to postpone or prevent congestive heart failure (CHF) in asymptomatic dogs with mitral regurgitation (MR) attributable to myxomatous valvular disease (MVD) in a prospective, randomized, double-blinded, placebo-controlled multicenter trial involving 14 centers in Scandinavia. Two hundred twenty-nine Cavalier King Charles (CKC) Spaniels with MR attributable to MVD but no signs of CHF were randomly allocated to treatment with enalapril 0.25-0.5 mg daily (n = 116) or to placebo groups (n = 113). Each dog was evaluated by physical examination, electrocardiography, and thoracic radiography at entry and every 12 months (+/-30 days). The number of dogs developing heart failure was similar in the treatment and placebo groups (n = 50 [43%] and n = 48 [42%], respectively; P = .99). The estimated means, adjusted for censored observations, for the period from initiation of therapy to heart failure were 1,150 +/- 50 days for dogs in the treatment group and 1,130 +/- 50 days for dogs in the placebo group (P = .85). When absence or presence of cardiomegaly at the entrance of the trial was considered, there were still no differences between the treatment and placebo groups (P = .98 and .51, respectively). Multivariate analysis showed that enalapril had no significant effect on the time from initiation of therapy to heart failure (P = .86). Long-term treatment with enalapril in asymptomatic dogs with MVD and MR did not delay the onset of heart failure regardless of whether or not cardiomegaly was present at initiation of the study.

Eight horses (mean weight 438 kg) with chronic obstructive pulmonary disease (COPD) were studied for clinical signs, ventilation/perfusion relationships (VA/Q) and lung morphology. Four horses were killed and necropsied after the study. In horses with COPD, minute ventilation was almost twice as high as normal, whereas PaO2 was significantly decreased. Cardiac output was normal, but pulmonary artery pressure and pulmonary vascular resistance were significantly increased. The VA/Q distribution was abnormal with an increased scatter of VA/Q ratios. However, shunt (VA/Q = 0) was increased in one horse only. Ventilation of dead space and high VA/Q regions (VA/Q greater than 10) were increased markedly and comprised 74 per cent of minute ventilation. On lung biopsy, all horses showed chronic bronchiolitis with epithelial hyperplasia and metaplasia. Diffuse acinar hyperinflation also was evident at necropsy. There was a significant inverse correlation between the respiratory rate and the fractional ventilation of normal VA/Q regions. Also, there was a significant agreement between the extent of bronchiolar epithelial hyperplasia in necropsy specimens of lungs and the degree of ventilation of high VA/Q regions and dead space. The findings suggest that hyperinflation of the lung due to obstructed airways may be the common denominator of increased ventilation of high VA/Q regions and dead space ventilation and of elevated pulmonary artery pressure in horses with COPD from chronic bronchiolitis.

Summary The anatomical basis of gas exchange impairment in the anaesthetised horse was studied by computerised tomography (CT; three Shetland ponies) and morphological analysis (one pony and three horses). By means of CT, densities were seen in dependent lung regions early during anaesthesia, both with spontaneous breathing and with mechanical ventilation. The densities remained for some time where they had initially been created when the animal was turned from dorsal to sternal recumbency. Deep insufflation of the lungs reduced the dense area. Gas exchange was impaired roughly in proportion to the dense area. On histological analysis, the densities were atelectatic and congested with blood. Gravimetry showed no more extravascular water per unit lung tissue in the atelectatic than in the ‘normal’ regions, and the blood content was increased only slightly. It is concluded that the horse develops atelectasis in dependent lung regions early during anaesthesia in dorsal recumbency, and that atelectasis is the most likely explanation for the large shunt and impaired arterial oxygenation regularly seen during anaesthesia.

Summary M-mode echocardiography is a safe and practical means of using ultrasound to evaluate the dynamic movements of cardiac structures. The technique can be refined by using a simple contrast medium in the form of carbon dioxide mixed with heparinised blood to provide a strong echogenic result. This technique was employed in a series of 15 normal conscious standing horses and in three animals with specific cardiac defects. In the clinical cases it was possible to confirm the diagnosis and differentiate between a congenital septal defect and mitral regurgitation. The method was found to be safe and relatively simple to perform using percutaneous insertion of catheters. The intracardiac catheterisation was trouble free and no clinical side effects to direct injection of the carbon dioxide contrast medium into the heart were demonstrated.

The effect of selective mechanical ventilation of dependent lung regions were studied in anaesthetized horses (mean weight 486 kg) in dorsal recumbency. Blood-gas measurements were performed with the horse in the lateral position during spontaneous breathing (before selective intubation) and in dorsal recumbency during spontaneous breathing, general mechanical ventilation, and spontaneous breathing + selective mechanical ventilation. Arterial oxygen tension (PaO2) was 32.3 kPa in the lateral position during spontaneous breathing with a high inspired oxygen fraction (FlO2 greater than 92%). In dorsal recumbency PaO2 decreased to 10.9 kPa during spontaneous breathing and was not significantly affected by general mechanical ventilation (PaO2 12.6 kPa). The institution of selective mechanical ventilation with a selective positive end-expiratory pressure (PEEP) of 20 cm H2O caused a marked increase in PaO2 to an average of 35.3 kPa. It is concluded that selective intubation of dependent regions in the diaphragmatic lobes is a feasible procedure and that selective mechanical ventilation with PEEP markedly improves arterial oxygenation in the anaesthetized horse in dorsal recumbency.

Summary The respiratory pressure changes in the trachea were recorded in five normal experimental standardbred horses (trotters) at rest and during standardized exercise produced by trotting on a treadmill at different speeds. For recording of the intratracheal pressure, a teflon catheter supplied with devices to prevent kinking was inserted into the trachea by a special technique. The catheter was connected to a pressure transducer placed on the horse's neck. The signals from the transducer were recorded with an ink jet writer. The studies of the intratracheal pressure were carried out both with the horses in the intact state and — in two horses — after crushing the recurrent laryngeal nerve. On investigation of the horses in the intact state, it was found that two of them displayed an “anomaly” in the respiratory pressure course that has not been described previously in the trotting horse. After crushing the recurrent laryngeal nerve, the intratracheal pressure course at the high work loads showed a radical change. The most obvious alterations were a prolongation of the inspiratory phase, an increase in the inspiratory negative pressure and a tendency towards formation of a plateau on the pressure curve during inspiration. The evaluation of the pressure recordings included measuring of the area on the recording paper that was delimited by the zero line and the inspiratory pressure graph. This variable, which is supposed to be influenced by the three above-mentioned factors, increased with the work load to a much greater extent in the horses that had been subjected to crushing of the recurrent laryngeal nerve than in the same horses in the intact stale and in the controls. The authors propose a method for calculating an approximate “comparison factor” for the mean resistance in the upper airways during the inspiratory phase, based on the recordings of the intratracheal pressure. Zusammenfassung Untersuchungen uber den intratrachealen Druck beim arbeitenden Pferd Bei funf normalen Versuchspferden (Traber) wurden die atmungsbedingten Druckveranderungen in der Trachea wahrend der Ruhe und wahrend eines standardisierten Trabs verschiedener Geschwindigkeit auf einem Laufband registriert. Fur die Registrierung des intratrachealen Drucks wurde ein Teflon-Katheter mit einer Vorrichtung, die das Abknicken verhinderte, mit einer speziellen Technik in die Trachea eingefuhrt. Der Katheter wurde mit einem am Hals des Pferdes plazierten Druckwandler verbunden. Die Wandlersignale wurden mit einem Tinten-Dusen-Schreiber registriert. Der intratracheale Druck wurde bei gesunden Pferden und bei zwei Pferden nach Quetschung des Nervus recurrens laryngealis untersucht. Bei den Untersuchungen an den gesunden Pferden wurde bei zwei Tieren eine “Anomalie” im Druckverlauf wahrend der Atmung festgestellt, die bisher bei Trabern noch nicht beschrieben worden war. Nach Quetschung des Nervus recurrens laryngealis zeigte der Verlauf des intratrachealen Drucks bei starker Arbeit ausgepragte Veranderungen. Die auffalligsten Veranderungen waren eine Verlangerung der Inspirationsphase, eine Zunahme des inspiratorischen negativen Drucks und eine Tendenz zur Plateaubildung im Verlauf der Druckkurve wahrend der Inspiration. Die Auswertung der Druckaufzeichnungen schlos die Bestimmung der Flache auf dem Registrierpapier ein, die durch die Null-Linie und die wahrend der Inspiration registrierte Druckkurve begrenzt wurde. Diese wahrscheinlich durch die drei oben erwahnten Faktoren beeinfluste Grose nahm bei den Pferden nach Quetschung des Nervus recurrens laryngealis mit zunehmender Arbeitsleistung sehr viel starker zu als bei den Pferden im unversehrten Zustand und den Kontrolltieren. Die Autoren schlagen, von den Aufzeichnungen des intratrachealen Drucks ausgehend, eine Methode zur Berechnung eines “Vergleichsfaktors” zur Beurteilung des mittleren Stromungswiderstandes der oberen Luftwege wahrend der Inspirationsphase vor.

Summary The multiple inert gas elimination technique was adapted for use in the conscious standing horse. The modifications included increased infusion rate of the inert gases (30 ml/min), extended infusion time (60 mins) in order to reach steady state, and construction of a nose mask mixing box system for collection of expired gas. Eight adult horses with a mean weight of 454 kg and a mean age of 6.1 years were studied while standing under resting conditions. Ventilation was 65.2 litres/min and cardiac output measured by thermodilution 40.2 litres/min. Systemic and pulmonary artery mean pressures were 114 and 26 mmHg, respectively. Three horses showed a unimodal VA/Q distribution centred upon a mean VA/Q of one. Five horses had a bimodal distribution with an additional high VA/Q mode comprising 2 to 18 per cent of ventilation. The mean logarithmic standard deviation of perfusion was 0.41. There was no perfusion of Mow' VA/Q regions, but minor shunting on an average of 1 per cent was noted. Inert gas dead space (minus apparatus dead space) averaged 38 per cent of total ventilation. Arterial oxygen tension varied from 11 to 14 kPa and the mean arterial CO2 tension was 5.7 kPa. It is concluded that the standing horse in general has a good match between ventilation and perfusion but that some individuals display high VA/Q regions, possibly explained by poor perfusion of upper lung regions.

Serum ionized calcium concentrations (Ca(F)) were determined in 87 Swedish red-and-white cows and 10 Swedish Friesian cows with clinical signs of parturient paresis. All cows were in the week prior to or after parturition. A classification of the severity of hypocalcemia in terms of serum ionized calcium was devised. Eight cows had normal serum ionized calcium concentrations (Cap 1.06–1.26 mmol/1); 15 had slight (Ca(F) 0.80–1.05 mmol/1); 43 a moderate (Ca(F) 0.50–0.79 mmol/1), and 31 asevere (Ca(F) < 0.50 mmol/1) hypocalcemia. All cows were given 8 or 8.3 g of calcium intravenously. Of 8 normocalcemic cows 7 (87.5 %) reached a maximum posttreatment serum ionized calcium concentration > 1.80 mmol/1 (severe hypercalcemia). This was also found in 13 of 15 (86.7 %) slightly hypocalcemic cows and in 31 of 43 (72.1 %) moderately hypocalcemic cows. In the severe hypocalcemia group 14 of 31 (45.2 %) had maximum posttreatment Cap > 1.80 mmol/1). These findings emphazise the need of a rapid pretreatment evaluation of the degree of hypocalcemia. The present study also underlined the difficulty in predicting serum ionized calcium from serum total calcium concentrations.

Summary Using thiopentone and halothane, nine healthy horses were anaesthesized twice for approximately 3 hours each time. They were placed in dorsal recumbency in one series of experiments and in left lateral recumbency in the other. The anaesthetized animals displayed a significantly lower arterial oxygen tension (PaO2) when placed in dorsal than in left lateral recumbency. A significant gradual decrease in PaO2 occurred during the prolonged anaesthesia in dorsal recumbency. The level of PaO2 during 3 hours of anaesthesia in dorsal recumbency eventually approached or fell just below 11 kPa even though the inspiratory gas consisted of more than 90% oxygen. Arterial blood pressure and heart rate did not differ significantly in anaesthesized horses placed in dorsal compared to left lateral recumbency. ECG changes were observed between standing and anaesthetized recumbency. Differences were also found between dorsal and left lateral recumbency. Significant ECG changes were seen during the course of anaesthesia in the T wave and R-S amplitude during left lateral recumbency. Evaluation of ECG changes in the individual horse can, however, be difficult within the range of anaesthetic status observed in this study. Zusammenfassung Lage-Effekte auf Blutgas-Partialdrucke, Blutdruck, Herzfrequenz, EKG und Atmungsfrequenz wahrend der lang dauernden Anasthesie beim Pferd Neun gesunde Pferde wurden zweimal jeweils 3 h mit Thiopenton und Halothan anasthesiert. Sie wurden in einer Versuchsserie in Ruckenlage, in der anderen in Seitenlage verbracht. Wahrend der Anasthesie sank der arterielle Sauerstoffdruck (PaO2) in Ruckenlage auf niedrigere Werte ab als in Seitenlage. Dabei ergab sich fur den PaO2 in Seitenlage ein signifikanter allmahlicher Abfall. Wahrend der 3stundigen Anasthesie in Seitenlage erreichte der PaO2 Werte um 11 kPa, obgleich das inspirierte Gas aus 90% Sauerstoff bestand. Der arterielle Blutdruck und die Herzfrequenz unterschieden sich wahrend der Anasthesie in Seiten- bzw. Ruckenlage nicht. EKG-Veranderungen gegenuber dem stehenden Tier ergaben sich beim liegenden Tier im Verlauf der Anasthesie. Unterschiede ergaben sich auch zwischen der dorsalen und lateralen Lage. Im Verlauf der Anasthesie wurden in linker Seitenlage signifikante Veranderungen der T-Zacke sowie der R-S-Amplitude festgestellt. Die Auswertung der EKG-Veranderungen wahrend der Anasthesie gestaltete sich jedoch bei einzelnen Pferden schwierig.

A breeding program with the aim of reducing the prevalence of mitral regurgitation (MR) caused by myxomatous mitral valve disease (MMVD) in Cavalier King Charles Spaniels (CKCS) is currently ongoing in Sweden. In this investigation 353 CKCS were selected as a sample of the population and 150 were examined by auscultation for heart murmurs when they reached the age of six years in 2007 and 2009. The aim with this investigation was to study the prevalence of heart murmurs in six-year-old CKCS and to estimate if prevalence has decreased since the breeding program was introduced 2001. The effect of the breeding program was evaluated by comparing the prevalence of heart murmurs in the two groups. In 2007, the prevalence of heart murmurs was 52% (50% for females and 54% for males) and in 2009, the prevalence was 55% (44% for females and 67% for males). No significant difference was found in the prevalence of heart murmurs between 2007 and 2009 (P = 0.8). For all six-year-old CKCS, the prevalence of heart murmur was 53% (females 46% and males 61%), which is higher than previous Swedish investigations.