Cardiovascular disease

image of Cardiovascular disease
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This chapter discusses systemic considerations in cardiovascular disease, principles of anaesthesia for the cardiovascular patient, acquired cardiovascular disease, congenital cardiovascular disease, perioperative arrhythmias and interventional cardiology.

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21.1 Flow diagram to illustrate the pathophysiology of congestive heart failure. ACE = angiotensin-converting enzyme; ADH = antidiuretic hormone; NA = noradrenaline (norepinephrine).
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21.3 Profound cardiac cachexia and ascites in a 4-year-old neutered male Dogue de Bordeaux, suffering from atrial fibrillation and right-sided heart failure.
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21.7 Normal echocardiographic images of the canine heart. (a) The left atrium (LA) normally has a square appearance in long axis and its area fits approximately twice into the area of the lumen of the left ventricle (LV). (b) The LV has a conical bullet shape with a notable apex off-midline. (c) M-mode assessment of left ventricular dimensions and function. (d) Comparison of the left atrial diameter with aortic root (Ao) diameter, measured in short axis at the heart base.
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21.8 Common arrhythmias detected electrocardiographically in patients before anaesthesia. (a) Sinus arrhythmia with a wandering pacemaker is common in healthy dogs and is uncommon in dogs with congestive heart failure. (b) Ventricular bigeminy may suggest underlying myocardial disease but rarely requires specific treatment. (c) Paroxysmal ventricular tachycardia confers a high index of suspicion regarding primary myocardial disease.
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21.9 Lateral thoracic radiographs illustrating the typical distribution of pulmonary oedema in (a) cats and (b) dogs. The diffuse, nodular distribution seen in cats should not be confused with evidence of pulmonary metastasis.
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21.10 Lateral thoracic radiographs illustrating the differences in appearance of the pulmonary vasculature, (a) before and (b) after interventional occlusion of a patent ductus arteriosus in a 10-month-old entire female Shetland Sheepdog. After occlusion, the caudodorsal vasculature appears less dense and the cranial lobar vessels are no longer distended. Reduction in left atrial size can also be appreciated.
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21.11 Right lateral thoracic radiograph from an 11-year-old neutered female Jack Russell Terrier with a pacemaker. Hyperlucency of the apical caudodorsal lung field can be seen, distal to a pulmonary thromboembolus, due to an absence of regional pulmonary blood flow (a Westermark sign). The pacemaker lead can be seen in the right ventricle.
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21.15 Schematic diagram illustrating major haemodynamic abnormalities in degenerative mitral valve disease: increased left atrial volume and pressure due to mitral insufficiency.
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21.16 Schematic diagram illustrating major haemodynamic abnormalities in hypertrophic cardiomyopathy: increased left atrial pressure due to reduced left ventricular compliance and volume.
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21.17 Schematic diagram illustrating major haemodynamic abnormalities in dilated cardiomyopathy: poor systolic function, reduced cardiac output and eccentric left ventricular hypertrophy.
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21.18 Schematic diagram illustrating major haemodynamic abnormalities in valvular pulmonic stenosis: pressure overload of the right ventricle due to valve leaflet fusion.
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21.19 Schematic diagram illustrating major haemodynamic abnormalities in subaortic stenosis: pressure overload of the left ventricle due to a subaortic ridge of fibrous tissue.
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21.20 Schematic diagram illustrating major haemodynamic abnormalities in patent ductus arteriosus: systemic-to-pulmonary flow due to low pulmonary vascular pressure relative to systemic pressure.
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21.21 Schematic diagram illustrating major haemodynamic abnormalities in ventricular septal defect: left-to-right flow due to low pulmonary vascular resistance.
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21.22 Schematic diagram illustrating major haemodynamic abnormalities in a right-to-left (‘reverse’) patent ductus arteriosus: pulmonary to systemic flow due to severe pulmonary hypertension causing high pulmonary vascular pressure relative to systemic arterial pressure. Note that admixture of blood occurs caudal to the brachycephalic trunk and left subclavian artery, leading to caudal hypoxia and cyanosis (see Figure 21.23 ).
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21.23 Caudal cyanosis, a typical clinical sign associated with right-to-left patent ductus arteriosus, in a puppy that suffered perinatal death. In this patient, the ductus arteriosus did not close and pulmonary vascular resistance remained high, mimicking a right-to-left PDA.
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21.26 Second-degree atrioventricular (AV) block in a dog with high vagal tone. The third and sixth QRS complexes are followed by non-conducted P waves. Variable P–Q interval is present (Wenckebach phenomenon; easily seen when comparing the first and second complexes), typical of Type I second-degree AV block.
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21.27 Typical appearance of pulseless electrical activity, recorded during cardiopulmonary–cerebral resuscitation of a dog. Note the long P–Q interval, wide QRS complex and right bundle branch block morphology.
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21.28 Atrial fibrillation, identified by a highly irregular arrhythmia with no P waves, an undulating baseline and supraventricular QRS complexes.
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21.29 Postoperative telemetric ECG recording from a gastric dilatation–volvulus patient. Over the first 24 hours postoperatively, frequent ventricular arrhythmias converted to sinus rhythm with infrequent ventricular ectopy, without administration of any specific antiarrhythmic treatment.
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21.30 Angiogram (digital subtraction) from a 1-year-old entire male Miniature Pinscher with valvular pulmonic stenosis. A balloon-tipped catheter can be seen in the right ventricle (accessed from the jugular vein and cranial vena cava). Opacification of the right ventricular outflow tract, pulmonic valve and pulmonary artery shows abnormal, fused valve leaflets that are not fully open during systole. MPA = main pulmonary artery; PV = pulmonic valve; RV = right ventricle.
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21.31 Thoracic radiograph of a 13-year-old, entire male West Highland White Terrier after pacemaker implantation (right lateral view). The pacemaker pulse generator can be seen in the prescapular region, with the pacemaker lead traversing the right jugular vein, cranial vena cava and right heart. The tip of the pacemaker lead is passively fixed in the apical right ventricle.
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