Page 236 - Small Animal Internal Medicine, 6th Edition

208 PART I Cardiovascular System Disorders

common. Echocardiography can be used to identify right Guglielmini C, et al. Serum cardiac troponin I concentration in
heart remodeling and quantify PAH, if present. dogs with precapillary and postcapillary pulmonary hyperten-
VetBooks.ir visualization of L 1 larvae in feces of an infected dog. The Johnson L, Boon J, Orton EC. Clinical characteristics of 53 dogs
sion. J Vet Intern Med. 2010;24:145–152.
Definitive diagnosis of A. vasorum infection involves
with Doppler-derived evidence of pulmonary hypertension:
Baermann technique is more sensitive than direct fecal
1992-1996. J Vet Intern Med. 1999;13:440–447.
smear. However, fecal shedding can be intermittent; serial Kellihan HB, MacKie BA, Stepien RL. NT-proBNP, NT-proANP,
examination is recommended, and negative fecal examina- and cTnI concentrations in dogs with pre-capillary pulmonary
tions do not rule out angiostrongylosis. Larvae also can be hypertension. J Vet Cardiol. 2011;13:171–182.
identified by airway cytology, such as with bronchoalveolar Kellihan HB, Stepien RL. Pulmonary hypertension in dogs: diag-
lavage. A. vasorum larvae can be differentiated from other nosis and therapy. Vet Clin North Am Small Anim Pract.
nematode larvae by tail morphology. 2010;40:623–641.
Recently, serologic testing has become available for A. Kellihan HB, et al. Acute resolution of pulmonary alveolar infil-
vasorum. An ELISA is available for detection of an Ag pro- trates in 10 dogs with pulmonary hypertension treated with
duced by adult female worms, similar to the HW Ag test. The sildenafil citrate: 2005-2014. J Vet Cardiol. 2015;17:182–191.
test becomes positive approximately 5 to 9 weeks postinfec- Kellum HB, Stepien RL. Sildenafil citrate therapy in 22 dogs with
pulmonary hypertension. J Vet Intern Med. 2007;21:1258–1264.
tion, and has high sensitivity and specificity (minimal cross- Mazzotta E, et al. Red blood cell distribution width, hematology,
reaction with other parasites, including D. immitis). A and serum biochemistry in dogs with echocardiographically esti-
cage-side test also is available (Angio Detect, IDEXX Labo- mated precapillary and postcapillary pulmonary arterial hyper-
ratories). This test is highly specific (100%) although less tension. J Vet Intern Med. 2016;30:1806–1815.
sensitive (85%) and becomes positive later in the disease Pariaut R, et al. Tricuspid annular plane systolic excursion (TAPSE)
process (9-11 weeks). in dogs: reference values and impact of pulmonary hypertension.
Treatment options for adult worm infections include J Vet Intern Med. 2012;26:1148–1154.
fenbendazole (25-50 mg/kg PO q24h for 7-21 days), milbe- Schober KE, Baade H. Doppler echocardiographic prediction of
mycin oxime (0.5 mg/kg PO once weekly for 4 weeks), or pulmonary hypertension in West Highland White Terriers with
moxidectin (single topical dose of 2.5 mg/kg). Additional chronic pulmonary disease. J Vet Intern Med. 2006;20:912–920.
supportive care could include glucocorticoids for pulmo- Soydan LC, et al. Accuracy of Doppler echocardiographic estimates
nary inflammation, exercise restriction, oxygen therapy, of pulmonary artery pressures in a canine model of pulmonary
hypertension. J Vet Cardiol. 2015;17:13–24.
and blood product transfusions in cases of coagulopathy Stepien RL. Pulmonary arterial hypertension secondary to chronic
and hemorrhage. Several macrolide anthelmintics have left-sided cardiac dysfunction in dogs. J Small Anim Pract.
shown efficacy in prevention of A. vasorum infections, 2009;50:34–43.
although to date none are currently licensed for this prac- Tidholm A, et al. Diagnostic value of selected echocardiographic
tice. Imidocloprid/moxidectin (Advantage Multi, Advo- variables to identify pulmonary hypertension in dogs with
cate); spinosad/milbemycin oxime (Trifexis, Milbemax); or myxomatous mitral valve disease. J Vet Intern Med. 2015;29:
afoxolaner/milbemycin oxime (NexGard) can be considered 1510–1517.
as monthly preventatives in endemic regions. Additional Visser LC, et al. Diagnostic value of right pulmonary artery disten-
prevention strategies include prompt disposal of dog feces, sibility index in dogs with pulmonary hypertension: comparison
and reducing contact with intermediate hosts (snails and with Doppler echocardiographic estimates of pulmonary arterial
slugs) when possible. Standard practices for screening, treat- pressure. J Vet Intern Med. 2016;30:543–552.
ment, and prevention of this emerging parasite have yet to Heartworm Disease in the Dog
be established. American Heartworm Society. Current canine guidelines for the
diagnosis, prevention, and management of heartworm (Dirofi-
Suggested Readings laria immitis) infection in dogs (revised July 2014). Available at:
www.heartwormsociety.org. Accessed May 29, 2017.
Pulmonary Hypertension Atkins CE. Canine and feline heartworm disease. In: Ettinger SJ,
Adams DS, et al. Associations between thoracic radiographic Feldman EC, eds. Textbook of veterinary internal medicine. 8th
changes and severity of pulmonary arterial hypertension diag- ed. St Louis: Elsevier; 2017:1316–1343.
nosed in 60 dogs via Doppler echocardiography: a retrospective Atkins CE. Comparison of results of three commercial heartworm
study. Vet Radiol Ultrasound. 2017;58:454–462. antigen test kits in dogs with low heartworm burdens. J Am Vet
Atkinson KJ, et al. Evaluation of pimobendan and N-terminal pro- Med Assoc. 2003;222:1221–1223.
brain natriuretic peptide in the treatment of pulmonary hyper- Atkins CE, Keene BW, McGuirk SM. Pathophysiologic mechanism
tension secondary to degenerative mitral valve disease in dogs. J of cardiac dysfunction in experimentally induced heartworm
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Bach JF, et al. Retrospective evaluation of sildenafil citrate as a Res. 1988;49:403–410.
therapy for pulmonary hypertension in dogs. J Vet Intern Med. Atkins CE, Miller MW. Is there a safer (better) way to administer
2006;20:1132–1135. heartworm adulticidal therapy? Vet Med. 2003;98:310–317.
Brown AJ, Davison E, Sleeper MM. Clinical efficacy of sildenafil in Atkins CE, et al. Heartworm ‘lack of effectiveness’ claims in the
treatment of pulmonary arterial hypertension in dogs. J Vet Mississippi delta: computerized analysis of owner compliance –
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