Congestive heart failure in dogs; when is it time to euthenize?


Tracheal Collapse in Dogs

Enalapril and increased coughing in dogs

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Heart mitral valve disease MVD is the leading cause of death of cavalier King Charles spaniels throughout the world. MVD is a polygenetic disease which statistics have shown may afflict over half of all cavaliers by age 5 years and nearly all cavaliers by age 10 years, should they survive that long.

When the valves open, they direct blood flow forward to where it is supposed to go, and when they close, they prevent blood from going backward to where it is not supposed to go.

The mitral valve is located between the left atrium and ventricle. As the mitral valve degenerates, the valve no longer fully closes after each pumping action, enalapril and increased coughing in dogs, allowing enalapril and increased coughing in dogs blood to flow backwards through them from the ventricle back into the atrium.

As the condition worsens, more and more blood is able to backflow through the valve as the leaflets of depression and diabetes valve begin to flail. In most dogs affected with MVD, the disease seldom progresses to heart failure. Mitral valve disease is the most common heart disorder in older dogs of all breeds. However, in the cavalier King Charles spaniel, the prevalence of MVD is about 20 times that of other breeds.

Also in cavaliers, the onset of the disease typically is much earlier in the life of the dog. It has been reported that, once diagnosed, mitral valve disease is much more rapid in cavaliers than in other breeds, possibly reaching a life-threatening stage within as little as 1 to 3 years, rather than the average 3 to 5 years, enalapril and increased coughing in dogs.

To a lesser extent, cavaliers also suffer from deterioration of their tricuspid valves. All cavaliers should be screened for heart murmurs once a year beginning at age 1 year. Once MVD is detected, its progression can be monitored with stethoscopic examinations auscultationsx-rays, echocardiograms, and color Doppler echocardiograms.

If a heart murmur is detected, it should be confirmed in 3 to 6 months. If it still is detected, the dog is considered probable for MVD. The progression of mitral valve disease can be rapid or slow. In most cavaliers, the disease shows a gradual progression in the loudness of the murmur and to more serious symptoms, in as little as 2 years after first detecting the murmur.

Drugs may help to minimize the symptoms, but eventually the drugs may be unable to control them. The drugs prescribed for cavaliers with MVD can sometimes have severe adverse side effects, and blood chemistry should be done routinely to monitor their effects upon the kidneys, liver, and other internal organs, enalapril and increased coughing in dogs.

Severe symptoms of MVD in some cavaliers will appear more quickly, although previously having been stable. The canon lithium batter and charger consequence of the disease is heart failure. Due to the pervasiveness of MVD in the breed worldwide, cavalier King Charles spaniels under the age of five years should not be bred with one limited exception -- see MVD Breeding Protocol.

Also, no cavalier should be bred after age five years if it developed an MVD murmur before the age of five years. Any littermates of breeding stock having early-onset MVD mitral valve murmurs before age 5 years should be taken into very serious consideration. All CKCS breeding stock should be examined by board certified veterinary cardiologists at least annually and cleared by the veterinary specialists for MVD, the closer the examination to the breeding the better.

It is recommended that all cavaliers, breeding stock or not, be examined annually by board certified veterinary cardiologists after age one year. See the current list of health clinics for upcoming cardiologist examinations. Veterinary cardiologists began compiling statistics on cavaliers with MVD murmurs in the United Kingdom in Specifically, the statistics show that more than half of all cavaliers aged five years have murmurs, and it is the very rare cavalier at age ten years which does not have, enalapril and increased coughing in dogs, at the very least, a low grade MVD murmur.

Mitral valve disease is a uniquely serious, life-shortening problem for cavalier King Charles spaniels and is their leading cause of death. MVD is the most common heart disorder in older dogs of all breeds. Several smaller breeds of dogs typically are predisposed to suffer from MVD. In the cavalier King Charles spaniel, statistics have shown that the prevalence of MVD is about 20 times that of other breeds of dog.

Also in cavaliers, the onset of the disease typically is much earlier in the life of the dog, with over half of all CKCSs having developing MVD by their fifth birthday by stethoscopic examinationas noted above.

For nearly all other breeds, MVD is an old-age disease, and the age of onset is between 10 and 15 years of age. It has been reported that, once diagnosed, MVD is much more rapid in cavaliers than in other breeds, possibly reaching a life-threatening stage within as little as 1 to 3 years, rather than the average 3 to 5 years.

Studies of cavaliers have concluded that it has an hereditary basis and is "polygenetic", meaning that more than one gene can be the cause.

Some research has indicated that MVD in the CKCS may be attributed to a chronic state of inflammation, as evidenced by measurements of immunoglobulin antibodies and glycoprotein and complement proteins particularly associated with immune responses to inflammation. See this Italian study. In a USA studyresearchers found that, compared with controls, dogs with chronic valvular disease had higher plasma enalapril and increased coughing in dogs of C-reactive enalapril and increased coughing in dogs CRP.

In veterinary medicine, CRP concentration has been shown to increase in inflammatory states, such as pancreatitis. Other research by Dr. He has coined the term, "dyscollagenesis" as opposed to fibrosis meaning a chronic reduction in collagen production and a disorganization and failure of maturation. See his report. It is the valve which is designed to prevent the compatibility gemini and cancer of blood from the left ventricle into the left atrium called mitral regurgitation -- MR.

It consists enalapril and increased coughing in dogs a set of double flaps, called "leaflets", that open and close like a set of one-way doors at appropriate times during each heart beat. Normal mitral valve leaflets are comprised of three layers of tissue atrialis, fibrosa, and spongiosa and are very thin and nearly transparent. They are connected by tendons chordae tendineae to the muscles of the left ventricle. Blood flows through the pulmonary veins from the lungs into the left atrium, one of the chambers of the heart.

The mitral valve is located between the left atrium and the left ventricle, another chamber in the heart. The two leaflets of the mitral valve are controlled by the tendons -- the chordae tendineae -- which serve as thin "struts" shaped much like the chords of a parachute.

As the diseased mitral valve degenerates, myxomatous transformation -- the development of excess connective tissue that thickens the spongiosa and separates collagen bundles in the fibrosa -- causes the valve to lose its flexibility, its leaflets thickening and shortening, its fibers stiffening, and its chordae tendineae elongating.

This is the mitral regurgition MR. In the photo at the left, a healthy mitral valve leaflet at the top is compared with a damaged valve leaflet below. Photo credit to Dr. As the condition worsens, advanced lesions cause the leaflets to fold, invert, and displace toward the left atrium.

On ultrasound echocardiograph examination, MVP appears as if the valve leaflets overlap backwards into the atrium. The degree of MVP correlates with the severity of mitral valve regurgitation. This process is called cardiomegaly or dilatation.

The LA is forced to enlarge by the increase in blood coming in two directions at once. Enalapril and increased coughing in dogs LV enlarges to increase the force of its contraction, to compensate for the lessened quantity of blood the LV is intended to pump though the arteries to the body. Apart from the mitral valve itself, enalapril and increased coughing in dogs disease has severe consequences for the rest of the heart and the lungs.

The increased pressure in the left atrium decreases blood flow from the lungs to the heart, resulting in congestion in the pulmonary veins, ultimately causing fluid, called pulmonary edema, to leak out of the capillaries into the pleural cavity of the lungs.

As the left atrium enlarges, cardiac output declines. See the scientific definition of HF at this link. The decrease in output forces the body to compensate by activating angiotensin-converting enzyme ACE to excessive levels, forming angiotensin II, which causes the veins and arteries to constrict.

Angiotensin II also releases aldosterone, resulting in sodium and water retention. The left atrium enlarges first, followed by an enlarged left ventricle and the pulmonary veins. The heart enlargement may cause a tear in the left atrium, which usually results in immediate stoppage of blood flow. For an in-depth on-line seminar about the symptoms, diagnosis, progression, and treatment of mitral valve disease, watch Dr.

Andrew Beardowwith his terrific active graphics, explain MVD. Until the MVD-affected dog reaches "heart failure", there usually are no visible signs or symptoms related to the MVD.

A murmur and an enlarged heart, which come before heart failure, enalapril and increased coughing in dogs, are not considered symptoms. What is not visible outwardly, before the dog reaches heart failure, is enlargement of the heart. As greater quantities of blood leak through the damaged mitral valve from the left ventricle back into the left atrium of the heart, the thin-walled atrium gradually begins to swell and enlarge see x-ray of a severely enlarged heart, above -- called myocardial remodeling -- to accommodate the overload of blood, and there is a reduction in the ability of the ventricle to provide sufficient blood to meet the demands of the rest of the body.

The heart then has to pump harder and faster, to meet those demands. The shut-down of the distant blood vessels also has the effect of causing the left ventricle to beat against a higher resistance, causing another increase in mitral valve leakage. Also, the overload of blood in the left atrium creates increased pressure back into the pulmonary veins, which drain into the left atrium from the lungs.

When a critical pressure is reached, flooding of the lungs can occur, causing pulmonary edema. Edema results when blood vessels leak and release fluids into nearby tissues. The extra fluid accumulates, causing the tissue to swell. Edema is a normal response of the body to inflammation or injury. When the heart weakens and pumps blood less effectively, fluids can slowly build up, creating edema.

If fluid buildup occurs rapidly due to damage to the left side of the heart, fluid in the lungs -- pulmonary edema -- can develop. If there is heart failure of the right side of the heart, edema can develop in the abdomen, enalapril and increased coughing in dogs. Usually more than 30 breaths per minute while asleep or resting indicates the onset of heart failure. Breathlessness also is a most common sign, starting as excessive panting on exercise.

Note that some cardiologsists believe there enalapril and increased coughing in dogs two categories of congestive heart failure -- the traditional symptomatic one which they call the "decompensated phase", and an earlier "compensatory phase" which displays no symptoms. See this January article. Once congestive heart failure has been diagnosed, look for these additional signs: As breathing difficulties become more severe, the dog may sit or stand, holding its elbows away from the chest, and it may be reluctant to sit down.

In some cases, any of these symptoms may appear even before the onset of congestive heart failure. It is due to the enlarged left atrium of the heart pressing against and compressing the left mainstem bronchus. It may even cause the trachea to collapse. Most MVD-affected dogs with a cough are not yet in heart failure.

However, in a June preliminary study report, researchers were unable to confirm an association between left atrial enlargement and airway collapse in dogs with MVD. The enalapril and increased coughing in dogs suggested that airway inflammation was common in the affected dogs. More likely causes of coughing are unrelated to MVD.


Enalapril and increased coughing in dogs