Page 646 - Cote clinical veterinary advisor dogs and cats 4th

294 Endocarditis, Infective

Initial Database underlying disease is identified, treatment of PEARLS & CONSIDERATIONS
• CBC, serum biochemistry profile: evaluate that condition is recommended to prevent Comments
VetBooks.ir • Urinalysis by cystocentesis: screen for proteinuria Acute General Treatment Although previously thought to be uncommon,
recurrence.
for underlying disease, thrombocytopenia
cerebrovascular disease is a well-recognized
○ Urine protein to creatinine ratio: if pro-
teinuria present to confirm protein-losing
tuted in an animal that presents with
and increases in frequency with age.
nephropathy • Anticonvulsant therapy should be insti- cause of brain dysfunction in dogs and cats,
• Serial blood pressure measurements: systolic seizures. Therapy should be continued for
pressure greater than 180 mm Hg in the a minimum of 3-6 months and can then Prevention
presence of neurologic signs supportive of potentially be tapered if no further seizures Appropriate treatment of underlying disease is
hypertensive encephalopathy are noted. important to prevent further cerebrovascular
• Funduscopic examination: evaluate for • For vestibular signs: maropitant 1 mg/kg accidents. For some hypercoagulable states,
hemorrhage or tortuous vessels SQ q 24h (dog) or 2 mg/kg PO q 24h chronic use of platelet antagonists or antico-
• Thoracic radiographs: screen for cardiovas- for up to 5 days; 1 mg/kg SQ or PO q agulants may be indicated.
cular disease and metastatic neoplasia 24h for up to 5 days (cat), or meclizine
• Abdominal ultrasound, if indicated 25 mg PO q 24h (dog); 12.5 mg PO q 24h Technician Tips
• Testing for adrenal and thyroid disease, if (cat) is recommended to treat nausea and Recovery from a cerebrovascular accident should
indicated ptyalism. be slow and steady. Worsening signs call for
reevaluation of the diagnosis.
Advanced or Confirmatory Testing Chronic Treatment
• Thromboelastography (TEG): evaluate for Treat any underlying condition. Client Education
hypercoagulability Strokes tend to have a much better prognosis
• Coagulation profile (prothrombin time/ Possible Complications for dogs and cats than humans. In most cases,
partial thromboplastin time): evaluate for • Aspiration pneumonia associated with recovery can be expected to occur over the
hypocoagulability recumbency or vestibular dysfunction course of several weeks.
• MRI of brain (p. 1132): diagnostic test of • Recurrence of vascular event
choice SUGGESTED READING
○ Diffusion-weighted imaging to confirm Recommended Monitoring Garosi LS: Cerebrovascular disease in dogs and cats.
ischemia • Serial neurologic examinations Vet Clin North Am Small Anim Pract 40:65-79,
○ Gradient recalled echo sequences to • Serial blood pressure measurements if 2010.
evaluate for hemorrhage hypertensive
• Cerebrospinal fluid analysis (p. 1323): may AUTHOR: Sheila Carrera-Justiz, DVM, DACVIM
EDITOR: Karen R. Muñana, DVM, MS, DACVIM
be normal or show mild, nonspecific changes PROGNOSIS & OUTCOME
TREATMENT The prognosis for focal cerebrovascular accidents
in dogs and cats is generally good. Global ische-
Treatment Overview mic events carry a more guarded prognosis.
There is no definitive treatment for brain
infarction other than supportive care. If an

Endocarditis, Infective Client Education
Sheet

BASIC INFORMATION RISK FACTORS Clinical Presentation
• Conditions causing endothelial damage DISEASE FORMS/SUBTYPES
Definition can lead to colonization of affected tissue Endocarditis can be classified based on mode
Endocarditis is inflammation of the endocardium by circulating bacteria. of presentation (acute, subacute, or chronic)
(inner surface) of the heart. Infective endocarditis ○ Dogs with congenital subaortic stenosis or according to location.
(IE) is a microbial infection of the endocardium, (SAS) are predisposed to IE, presumably
involving the valve leaflets, chordae tendineae, due to valvular endothelial damage by HISTORY, CHIEF COMPLAINT
and/or mural surfaces. Vegetative endocarditis turbulent blood flow. Sporadic cases of • Nonspecific signs such as lethargy, weakness,
describes the formation of small masses IE have been reported with other forms weight loss, and anorexia
(vegetations) composed of platelets, fibrin, of congenital heart disease. • History of fever is common.
microorganisms, and inflammatory cells at the ○ Endocardial trauma (e.g., heart surgery, • Reluctance to move (back pain, polyarthritis)
site of infection. Endocarditis (term and disease) interventional cardiac catheterization) • Intermittent lameness (muscle embolization,
is unrelated to the most common form of chronic • Bacteremia: possible sources include intravenous polyarthritis)
valvular heart disease in dogs, myxomatous/ catheters, discospondylitis, prostatitis, periodon-
degenerative valve disease or endocardiosis. tal disease, pneumonia, and pyoderma. PHYSICAL EXAM FINDINGS
• Immune suppression may be a factor. Most patients diagnosed with IE have a heart
Epidemiology murmur:
SPECIES, AGE, SEX GEOGRAPHY AND SEASONALITY • Auscultation may reveal a new murmur or
• Uncommon in dogs, rare in cats IE is recognized more frequently in warmer worsening of a known murmur (change in
• Middle-aged to older, large-breed, male dogs climates (e.g., southern and western United intensity, quality, timing, or duration). Some
are most commonly affected. States). animals with IE have a pre-existing heart

www.ExpertConsult.com