Page 258 - Clinical Small Animal Internal Medicine

226 Section 3 Cardiovascular Disease

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Pulmonary Hypertension

Pulmonary Arterial Hypertension Pulmonary Venous Hypertension

Primary Pulmonary Disease Thromboembolic Left-Heart Disease
Heartworm Pulmonary Fibrosis Heartworm Myxomatous Mitral Valve Disease
Congenital COPD Cushing’s Dilated Cardiomyopathy
Idiopathic Neoplasia Protein-losing Disease Left-heart Disease
Hypoxia Neoplasia Hypoxia

Figure 23.1 Pulmonary hypertension classification (see text for details). COPD, chronic obstructive pulmonary disease.

Signalment Physical Examination

The typical signalment of the patient with PH is a mid- Dogs with PH often have abnormal physical examina-
dle‐aged to older small‐breed dog, which reflects the tion findings that could be directly associated with
population of dogs that are predisposed to myxomatous increased pulmonary artery pressure or may be present
mitral valve disease and chronic pulmonary disease. The secondary to the underlying disease process that
exceptions to this typical signalment include the young resulted in the PH. These findings may include mitral
heartworm‐infected dog and the dog with congenital and/or tricuspid insufficiency, heart murmurs, split or
heart disease that results in a reverse patent ductus arte- prominent second heart sounds, pulmonary crackles,
riosus, reverse ventricular septal defect or reverse atrial cyanosis, and ascites. In most cases, detection of these
septal defect. abnormal physical examination findings in combination
with typical clinical signs leads the clinician to suspect a
diagnosis of PH.
History and Clinical Signs

The clinical history of the dog with symptomatic PH typi- Diagnosis
cally includes a combination of cough, dyspnea, lethargy,
exercise intolerance, reported heart murmurs, ascites, The goals of diagnosing PH include defining the under-
and syncope. Because PH is often a consequence of lying etiology of the PH, determining the severity of
underlying cardiac and pulmonary disease, it may be dif- PH, assessing for evidence of right heart impairment,
ficult to determine if the etiology of the clinical sign is a and to obtain information that may aid in patient
direct result of the PH or the underlying disease process. prognostication.