Page 1932 - Cote clinical veterinary advisor dogs and cats 4th

Tetralogy of Fallot 965

for anaphylaxis during and immediately Drug Interactions Prevention
after administration. • Narcotic analgesics (e.g., opiate drugs) can • Avoid exposure to potential sources of
VetBooks.ir ○ Antitoxin prevents further toxin binding • Parasympatholytic drugs such as atropine • Routine immunoprophylaxis (tetanus toxoid) Diseases and Disorders
infection.
depress the respiratory center and stimulate
○ Intralesional injection appears promising
other areas of the central nervous system.
(experimental studies).
is not recommended for dogs and cats.
to axons but does not eliminate currently
and rational antibiotic therapy
bound toxin. should be avoided in routine cases. • Appropriate (open) care of infected wounds
• Sedation with one of the following is recom- Possible Complications
mended: diazepam (helps enhance GABA • Aspiration pneumonia (p. 793) Technician Tips
inhibition), acepromazine, phenobarbital, • Decubital ulcers Patients can be exquisitely sensitive to light
or chlorpromazine • Respiratory paralysis: some animals may and sound; any efforts to prevent stimulating
• Muscle relaxation: methocarbamol, diazepam, require intubation (or tracheostomy) and them (e.g., signs to alert clinic staff, selection
or midazolam ventilation (p. 1185) of an appropriate location in the hospital for
• Pain control: cautious use of opioids (see housing and recovery) are important during
Drug Interactions) Recommended Monitoring convalescence. Monitor for dyspnea and
• Antibacterial treatment (C. tetani): sodium • Heart and respiratory rates regurgitation.
or potassium penicillin 20,000-50,000 IU/kg • Temperature monitoring
slow IV q 6h for 10 days and metronidazole • Seizure watch Client Education
10 mg/kg PO or IV q 8h for 10 days • Urine output • Treatment of the disease can take weeks, but
a cure is possible.
Chronic Treatment PROGNOSIS & OUTCOME • Seek veterinary attention in cases of open
• Physical rehabilitation wounds.
• Intensive nursing care to include IV fluids • Guarded; better with mild clinical signs and
and nasogastric, esophageal, or percutaneous localized disease SUGGESTED READING
endoscopic gastrostomy (PEG) tube feedings • In mildly affected animals, normal function Burkitt JM, et al: Risk factors associated with outcome
(pp. 1106, 1107, and 1109) usually returns within 3 weeks of the initial in dogs with tetanus: 38 cases (1987-2005). J Am
• Prevention of decubital ulcers treatment. Vet Med Assoc 230:76-83, 2007.
• Indwelling urinary catheter (p. 1182) • Reported survival rate in dogs is 50%-92%.
AUTHOR: Karen L. Kline, DVM, MS, DACVIM
Nutrition/Diet PEARLS & CONSIDERATIONS EDITOR: Karen R. Muñana, DVM, MS, DACVIM
Nutrition can be provided by indwelling feeding
tube with a high-quality, blendable diet. Comments
• Acepromazine is indicated due to its sedative
Behavior/Exercise and antianxiety effects.
Passive range-of-motion exercises can be chal- • Patient should be in a quiet and nonobtrusive
lenging given the nature of the limb contracture. environment.

Tetralogy of Fallot Client Education
Sheet

BASIC INFORMATION • Conotruncal malformations in keeshond, occur due to erythrocytosis. Right-sided conges-
including tetralogy of Fallot (TOF), have tive heart failure is rare with TOF.
Definition been found to be oligogenic.
The complex congenital heart defect consists HISTORY, CHIEF COMPLAINT
of a ventricular septal defect (VSD), overriding ASSOCIATED DISORDERS • Cardiac murmur in puppy or kitten
of the interventricular septum by the aortic • Patent ductus arteriosus (PDA) and • Cyanosis
root, obstruction of the right ventricular (RV) atrial septal defect (ASD) may be seen • Exercise intolerance
outflow tract, and secondary hypertrophy of concurrently. • Syncope
the right ventricle. • Systolic anterior motion (SAM) of the • Stunted growth
mitral valve may be seen secondary to the
Synonyms RV hypertrophy and altered left ventricular PHYSICAL EXAM FINDINGS
Fallot’s tetralogy, Fallot’s syndrome geometry. • Systolic murmur is most commonly heard
• Secondary polycythemia is commonly seen at the left basilar area. The murmur grade
Epidemiology due to systemic hypoxemia. varies, depending on the severity of the defect
SPECIES, AGE, SEX and blood viscosity.
Dogs and cats; present at birth; possible male Clinical Presentation • Cyanosis may be aggravated by exercise or
predisposition in cats DISEASE FORMS/SUBTYPES other systemic illness (especially respiratory).
Patients often present with cyanosis, but some
GENETICS, BREED PREDISPOSITION may be acyanotic (pink tet). The severity of the Etiology and Pathophysiology
• Keeshond, terrier breeds, retriever breeds, RV obstruction often determines the degree • The combination of RV obstruction and VSD
Siberian Huskies, toy poodles, English or lack of cyanosis. Signs of hyperviscosity allows central admixing of venous and arterial
bulldog, and French bulldog syndrome, most commonly neurologic, may blood.

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