Page 162 - Small Animal Internal Medicine, 6th Edition

134 PART I Cardiovascular System Disorders

BOX 6.3
VetBooks.ir Potential Sequelae of Infective Endocarditis Septic osteomyelitis

Heart
Valve insufficiency or stenosis Bone pain
Murmur Lameness
Congestive heart failure Myositis
Coronary embolization (aortic valve*) Muscle pain
Myocardial infarction Hypertrophic pulmonary osteopathy
Myocardial abscess Brain and Meninges
Myocarditis
Decreased contractility (segmental or global) Abscesses
Arrhythmias Associated neurologic signs
Myocarditis (direct invasion by microorganisms) Encephalitis and meningitis
Arrhythmias Associated neurologic signs
AV conduction abnormalities (aortic valve*) Vascular System in General
Decreased contractility
Pericarditis (direct invasion by microorganisms) Vasculitis
Pericardial effusion Thrombosis
Cardiac tamponade (?) Petechiae and small hemorrhages (e.g., eye, skin)
Obstruction
Kidney Ischemia of tissues served, with associated signs
Infarction Lung
Reduced renal function
Abscess formation and pyelonephritis Pulmonary emboli (tricuspid or pulmonic valves, rare*)
Reduced renal function Pneumonia (tricuspid or pulmonic valves, rare*)
Urinary tract infection Nonspecific
Renal pain
Glomerulonephritis (immune mediated) Sepsis
Proteinuria Fever
Reduced renal function Anorexia
Malaise and depression
Musculoskeletal Shaking
Septic arthritis Vague pain
Joint swelling and pain Inflammatory leukogram
Lameness Mild anemia
Immune-mediated polyarthritis ±Positive antinuclear antibody test
Shifting-leg lameness ±Positive blood cultures
Joint swelling and pain
*Diseased valve most commonly associated with abnormality.

echocardiographic evidence of vegetations or valve destruc- hypoalbuminemia, elevated liver enzymes, azotemia, aci-
tion. Endocarditis is likely even when blood culture results dosis, and hyperglobulinemia. Urinalysis often shows
are negative or intermittently positive if there is echocardio- hematuria, proteinuria, and pyuria. Because the kidneys
graphic evidence of vegetations or valve destruction along are a possible source of primary and secondary bacterial
with a combination of other criteria (Box 6.4). infection, culturing the urine is also recommended. Urine
Clinical laboratory findings in all species usually reflect protein/creatinine ratio is useful in cases with proteinuria;
the presence of inflammation. Neutrophilia with toxic a high ratio can signal increased risk of TE from hyper-
neutrophils or a left shift is typical of acute endocarditis; coagulability related to urinary loss of plasma antithrom-
mature neutrophilia with or without monocytosis develops bin. Rheumatoid factor and antinuclear antibody tests
with time. Variable thrombocytopenia (mild to marked) may be positive in dogs with subacute or chronic bacterial
occurs in more than half of affected dogs, as does mild endocarditis.
nonregenerative anemia. In dogs diagnosed with barton- Blood cultures should be done, although they are negative
ellosis, thrombocytopenia, eosinophilia, and monocytosis in about 40% to 70% of cases. Negative culture results do not
have been reported. Evidence for disseminated intravascu- rule out infective endocarditis, especially with chronic endo-
lar coagulation may be present in association with endo- carditis, recent antibiotic therapy, intermittent bacteremia,
carditis. Common biochemical findings in dogs include or infection by fastidious or slow growing organisms. Ideally,