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676 Nasal Cutaneous Disorders

electrocardiogram (ECG), and imaging • In acute viremia, parvovirus isolation may noninvasive), dyspnea watch and respiratory
rate
be attempted.
abnormalities consistent with myocarditis • MRI is an emerging modality, and early • Chronic monitoring: periodic ECG or
VetBooks.ir acute CHF and cardiac biomarker, ECG, and studies show high diagnostic accuracy for Holter monitor, echocardiogram, thoracic
• Probable acute myocarditis: patient with
imaging abnormalities (echocardiographic or
radiographs, renal and electrolyte parameters
myocarditis.
MRI) consistent with myocarditis
titers for suspected infectious diseases
• Definite myocarditis: histopathologic TREATMENT if receiving diuretics, convalescent serologic
confirmation
Treatment Overview PROGNOSIS & OUTCOME
Differential Diagnosis Treatment mainly consists of medications to
• Infective endocarditis control arrhythmias and CHF if present. If Because myocarditis is an elusive diagnosis and
• Idiopathic DCM a bacterial or protozoal cause is suspected, uncommon disease, good information regarding
• Sepsis antimicrobial treatment is recommended. prognosis and outcome is not known. The pos-
• Supportive care is the first line of therapy. sibility of lethal arrhythmia and/or progression
Initial Database • Treatment of hemodynamically significant to DCM and CHF warrants an initial guarded
• CBC, serum biochemistry profile, urinalysis: arrhythmias prognosis.
inflammatory leukogram possible • Pacemaker implantation for complete AV
• Blood cultures for diagnosis of bacterial block PEARLS & CONSIDERATIONS
cause • Treatment of CHF with diuretics and
• Cardiac troponin I (p. 1389) or other bio- vasodilators; support of cardiac output with Comments
marker of cardiac necrosis: serum troponin positive inotropes may be necessary. • In the author’s clinical experience, myocardi-
levels usually are markedly elevated. • Treatment with an antimicrobial agent if a tis is strongly suspected when a dog presents
• Thoracic radiographs: may show signs of bacterial or protozoan cause is suspected with clinical signs attributable to a sudden
pulmonary edema and cardiomegaly • Immunosuppressive therapy has played an onset of complex ventricular arrhythmias or
• Electrocardiogram (p. 1096): usually tachyar- important role in some cases of myocarditis complete AV block with no clear underlying
rhythmias (often ventricular arrhythmias in humans; equivalent information for dogs cause.
[p. 1033]); occasionally bradyarrhythmias and cats is lacking. • Myocarditis is likely an underdiagnosed cause
(AV block [p. 101]) of acute CHF in an atypical dog breed with
• Echocardiogram (p. 1094): may show cardiac Acute and Chronic Treatment DCM.
chamber dilation and global or regional • Severe ventricular arrhythmias (p. 1033)
myocardial dysfunction • High-grade second-degree or third-degree Technician Tips
• Infectious disease serologic tests for AV block (p. 101) Cardiac troponin I is the gold standard
Toxoplasma, Neospora, Bartonella; based on • CHF (p. 408). biomarker to assess myocardial cell damage.
geographic location, Babesia, Lyme, Chagas, • Antimicrobial therapy: see specific infectious
and/or fungal titers may be indicated. disease topics for recommendations. SUGGESTED READINGS
Calforio ALP, et al: Myocarditis: a clinical overview.
Advanced or Confirmatory Testing Possible Complications Curr Cardiol Rep 19:63, 2017.
• Endomyocardial biopsy and/or histopatho- • Chronic CHF Sagar S, et al: Myocarditis. Lancet 379:738-747, 2012.
logic evaluation (usually postmortem) • DCM
○ Considered the diagnostic gold standard • Complete AV block AUTHOR: Teresa DeFrancesco, DVM, DACVIM,
DACVECC
○ Rarely performed, due to invasive nature • Death EDITOR: Meg M. Sleeper, VMD, DACVIM
○ Classic findings include lymphocyte
infiltrates with myocyte necrosis (Dallas Recommended Monitoring
criteria); parvovirus inclusion bodies in • Acute monitoring: continuous ECG, frequent
cardiomyocytes are also possible. blood pressure measurement (invasive or

Nasal Cutaneous Disorders Client Education
Sheet

BASIC INFORMATION dermatomyositis, hereditary nasal parakera- • Systemic lupus erythematosus (SLE) and
tosis, juvenile cellulitis cutaneous (discoid) lupus erythematosus
Definition • Epitheliotropic (cutaneous) lymphoma (DLE): collies, Shetland sheepdogs, German
Dermatoses affecting the bridge of the nose and nasodigital hyperkeratosis are more shepherds
(haired) or the nasal planum (hairless). This commonly seen in older dogs. • Proliferative arteritis of the nasal philtrum:
distribution of lesions is relatively common in Saint Bernards
dogs and cats, and lesions can be restricted to GENETICS, BREED PREDISPOSITION • Alopecia and melanoderma: Yorkshire terriers
the nasal area or be part of a more generalized • Nasal parakeratosis: Labrador retrievers • Familial vasculopathy: German shepherds,
condition. • Zinc-responsive dermatosis: Alaskan Mala- Scottish terriers
mutes, Siberian Huskies, bull terriers • Acrodermatitis: bull terriers
Epidemiology • Dermatomyositis: collies, Shetland sheepdogs, • Lentigo simplex: orange cats
SPECIES, AGE, SEX Beauceron shepherds • Vitiligo: Siamese cats, Belgian sheepdogs,
• Affects dogs and cats • Uveodermatologic syndrome: Akitas, Alaskan rottweilers, Old English sheepdogs, Dober-
• Diseases more likely to appear in dogs < 1 Malamutes, Samoyeds, Siberian Huskies, man pinschers
year of age: demodicosis, dermatophytosis, chow chows, Australian shepherds, others • Ulcerative nasal dermatitis: Bengal cat

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