Pimobendan em gatos / Pimobendan in cats

As miocardiopatias são as cardiopatias mais comumente diagnosticadas em felinos domésticos. A cardiomiopatia hipertrófica (CMH) soma a maioria dos casos de cardiomiopatias em pacientes atendidos na rotina da medicina interna de felinos. Gatos com doenças cardíacas podem não apresentar manifestações clínicas evidentes podendo apresentar sinais sutis de insuficiência cardíaca (IC) ao longo do tempo de modo que em um dado momento descompensam e evidenciam sinais clínicos. O pimobendan é um fármaco denominado inodilatador devido a sua capacidade de promover inotropismo positivo e vasodilatação. Apesar de escassos, os estudos existentes com a utilização de pimobendan demonstram boa tolerância em gatos saudáveis e com cardiopatias diversas. Atualmente, o uso do pimobendan em gatos é extra bula e a dose baseia-se em estudos realizados com cães. No entanto, sabe-se que as concentrações plasmáticas diferem entre as espécies o que pode requerer possíveis ajustes. A terapia da IC em gatos é bastante discutida e evidências recentes demonstram que o pimobendan pode ser um aliado no tratamento de diversas doenças cardíacas que levem à disfunção sistólica sendo capaz de prover melhora dos sinais clínicos e até aumento da expectativa de vida desses pacientes. Contudo, pesquisas são necessárias para melhor entendimento dos efeitos hemodinâmicos do medicamento em gatos com disfunção diastólica.

Myocardiopathies are the most diagnosed heart disease in domestic cats. Hypertrophic cardiomyopathy (HCM) adds up to most cases of cardiomyopathies in patients seen in the routine of feline internal medicine. Cats with heart disease may not have evident clinical manifestations and may show subtle signs of heart failure (HF) over time so that at a given moment they decompensate and show clinical symptoms. Pimobendan is an inodilator drug due to its ability to promote positive inotropism and vasodilation. Although scarce, the existing studies with the use of pimobendan demonstrate good tolerance in healthy cats with various heart diseases. Currently, the use of pimobendan in cats is off-label and the dose is based on studies conducted in dogs. However, it is known that plasma concentrations differ between species, which may require possible adjustments. The therapy of HF in cats is widely discussed and recent evidence shows that pimobendan can be an ally in the treatment of various heart diseases that lead to systolic dysfunction, being able to provide improvement in clinical signs and even increase the life expectancy of these patients. However, research is necessary to better understand the hemodynamic effects of the drug in cats with diastolic dysfunction.

Tamponamento cardíaco secundário ao hemangiossarcoma em cães / Cardiac tamponade secondary to hemangiosarcoma in a dog

Background: Nonspecific clinical manifestations such as apathy, anorexia and diarrhea are common in the clinical routine, and therefore may mask the severity of its triggering factor. When patients presenting this symptomatology are referred to the care center, it is essential that a thorough investigation is performed to clarify the primary causes of these manifestations, and for this, complementary imaging exams may be necessary. The objective of this study is to describe the clinical and imaging aspects of a canine with cardiac hemangiosarcoma and to correlate with the pathophysiology of the alterations observed, in order to optimize the clinical care of patients with nonspecific clinical signs and affected by this alteration. Case: A 10-year-old Pitbull dog was treated with a history of vomiting, loss of appetite and diarrhea. Upon clinical examination, the animal presented dehydration level and distended abdomen. On ultrasound examination, hepatomegaly was observed, associated with signs of double layer in the gallbladder wall and the presence of moderate peritoneal effusion. On chest radiography, the cardiac silhouette showed an important increase in size with loss of shape and contours. Dorsal displacement of the trachea, greater contact of the heart with the sternum and displacement of the caudal vena cava were observed. In addition, an amorphous and poorly defined structure with radiopacity of soft tissues was observed in the region of the atrium and right ventricle, causing the obliteration of pulmonary fields. On echocardiographic examination, a significant amount of free anechogenic fluid was observed in the pericardial sac, confirming the suspicion of pericardial effusion, with consequent collapse of the wall of the right heart chambers during systole. Furthermore, an amorphous, poorly defined and heterogeneous structure was observed in the right atrium wall. Due to the location of the neoformation, the patient's general clinical condition, euthanasia was chosen. During the necropsy, the ocular, oral and preputial mucosae were moderately pale. In the abdomen, the presence of hydroperitoneum and hepatomegaly was observed. In the thoracic cavity, hemothorax, enlarged heart were identified and, in the right atrium, a reddish mass was identified. In addition, the lungs were whitish and hypercrepitating at the edges of the cranial lobes; the rest of the organ was moderately hyperemic, hypocrepitating. In histopathological examination of the liver, the centrilobular region showed chronic passive congestion associated with necrosis and multifocal degeneration of hepatocytes. Neoplastic proliferation of mesenchymal cells, moderately cellular, non-encapsulated, of infiltrative growth was observed in the heart. Neoplastic cells formed bundles, with a tendency to organize themselves into small blood vessels filled with red blood cells. The cytoplasm was moderate, elongated, indistinct, eosinophilic and homogeneous. The nucleus was large, unique, elongated, with finely dotted chromatin and sometimes with one or two nucleoli evident. Anisocytosis, anisocariosis and cell pleomorphism were moderate. Interwoven with neoplastic cells, a moderate presence of multifocal lymphohistioplasmocytic inflammatory infiltrate was observed. The definitive diagnosis of cardiac changes was hemangiosarcoma. Discussion: Hemangiosarcoma is a vascular endothelial cell neoplasm with high metastatic power and unfavorable prognosis. When located in the heart, it is commonly found in the auricle and right atrium and the cardiovascular changes caused by this neoplasm as well as the severity of these changes vary according to size and location. Clinical manifestations can be quite nonspecific and are usually associated with hemodynamic impairment, causing signs of right or left congestive heart failure.

Clinical approach for treating dilated cardiomyopathy in a hog-nosed skunk (Conepatus chinga)

Background: Dilated cardiomyopathy (DCM) is a multifactorial disease characterized by systolic dysfunction of myocardium, affecting domestic animals like dogs, cats, and ferrets. It was sporadically described in non-domestic species, generally as a necropsy observation. The hog-nosed skunk (Conepatus chinga) is a small mammal, carnivore, belonging to the Mephitidae family, found in southern South America, and considered as concerned in a conservation status of the species. The goal of this issue is report the first clinical approach of dilated cardiomyopathy in a young hog-nosed skunk, elucidating the challenging aspects of the diagnostic, therapy, and clinical outcome. Case: A newborn hog-nosed skunk (Conepatus chinga) was found in a farm of southern Brazil in poor nutritional and behavioral conditions. Thirty days of nutritional supplementation based on cow's milk, fruits and insects were necessary to recover its body weight score and activity level. However, 2 months after adoption, the skunk showed acute dyspnea and abnormal breath sound, decreased appetite, and loss of weight. Firstly, these signs were associated with a possible pulmonary infection or other respiratory disease. However, the general cardiomegaly and pulmonary edema pattern observed on the thoracic radiography, changed the clinical approach, conducting the presumptive diagnosis to congestive heart failure (pulmonary edema) caused by an unknown cardiac disease as a dilated cardiomyopathy (CDM). An adequate physical, echocardiographic, electrocardiographic, and hematological evaluation was possible only after chemical restraint by sevofluorane. Systolic heart murmur and pulmonary cracking sounds were detected on thoracic auscultation. These findings associated to the echocardiography features of four chamber dilatation, systolic (fractional shortening-FS = 9% and ejection fraction-EF= 22%) and diastolic (mitral E/A ratio = 4.93) dysfunctions, and bilateral ventriculoatrial regurgitation (mitral and tricuspid) were highly correlated with DCM. Considering the etiologies of CDM described in domestic species and the poor nutritional condition previously observed in the case, nutritional and idiopathic etiologies of DCM were considered for this case. Therapy was based on furosemide at hospital (4 mg/kg subcutaneous, single doses) and home (2 mg/kg orally, BID), enalapril maleate (0.5 mg/kg orally, every 48 h), taurine supplementation (100 mg orally, SID), and pimobendan (0.5 mg/kg orally, BID). Clinical improvement was already observed on the second day of treatment, and monitored for 5 months, when the skunk was completely revaluated. The second echocardiographic exam showed improvement in systolic (FS = 20% and EF = 43%) and diastolic functions (mitral E/A ratio = 2.05), tricuspid regurgitation was not observed, and decrease the left atrial and ventricular dimensions were seen. Due to good clinical outcome, furosemide was gradually reduced until complete withdrawal without any clinical complications or worsening. After 30 months of therapy of pimobendan, taurine, and enalapril maleate, the skunk has good quality captive life without congestive heart failure recurrence. Discussion: The lack of information about DCM in hog-nosed skunk turns the clinical diagnosis and therapy challenging. However, the radiographic and echocardiographic features seamed to lead the same domestic animal patterns. The therapy based on decrease the cardiac overload, increase the myocardial inotropic function (pimobendan and taurine) resulted on excellent clinical and echocardiographic outcome. Although the etiologies of DCM in this species are not stablished, the diagnostic and therapeutic approaches applied resulted on excellent clinical results, and therefore may provide useful information about this cardiac condition in skunk species.

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.(AU)

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.

Função miocárdica ventricular esquerda em uma gata com cardiomiopatia fenótipo não específico / Left ventricular myocardial function in a cat with nonspecific cardiomyopathy phenotype

Background: Non-specific phenotype feline cardiomyopathy (CFNE) is one that does not fit properly in the other categories, and it is necessary to describe in detail the morphology and cardiac function. The causes of CFNE is not very clear, and it may be due to congenital or acquired disease, or also to primary or secondary myocardial dysfunction associated with other conditions. In symptomatic cases, the clinical signs observed are compatible with left congestive heart failure (ICCE). This study reports a CFNE case in an asymptomatic cat, in order to demonstrate the importance of echocardiographic examination in the early diagnosis of the disease. Case: A 6.5-year-old non-neutered crossbred cat weighing 3.1 kg was seen at the institution’s veterinary hospital for routine cardiac evaluation. No clinical signs were reported in the history. On physical examination, the animal presented calm behavior, body score 5/9, heart rate 200 bpm, systolic blood pressure of 102 mmHg, respiratory rate 64 mrp, and other normal parameters. CBC and urinalysis laboratory tests were requested, which were unchanged. The electrocardiogram showed normal patterns. In the conventional echocardiographic examination, a significant increase in the left atrium (LA) was observed, and the LA/Ao ratio was 2.05 and the diastolic function was abnormal. There was no presence of concentric hypertrophy of the left ventricle (LV), the thickness of the ventricular wall measured at different points, in the two-dimensional mode and the M mode, was less than 5 millimeters. Other parameters of conventional echocardiography were within the normal range. Through these echocardiographic findings, the suggestive diagnosis was non-specific phenotype cardiomyopathy, with a significant increase in LA. For the...

Função miocárdica ventricular esquerda em uma gata com cardiomiopatia fenótipo não específico / Left ventricular myocardial function in a cat with nonspecific cardiomyopathy phenotype

Background: Non-specific phenotype feline cardiomyopathy (CFNE) is one that does not fit properly in the other categories, and it is necessary to describe in detail the morphology and cardiac function. The causes of CFNE is not very clear, and it may be due to congenital or acquired disease, or also to primary or secondary myocardial dysfunction associated with other conditions. In symptomatic cases, the clinical signs observed are compatible with left congestive heart failure (ICCE). This study reports a CFNE case in an asymptomatic cat, in order to demonstrate the importance of echocardiographic examination in the early diagnosis of the disease. Case: A 6.5-year-old non-neutered crossbred cat weighing 3.1 kg was seen at the institutions veterinary hospital for routine cardiac evaluation. No clinical signs were reported in the history. On physical examination, the animal presented calm behavior, body score 5/9, heart rate 200 bpm, systolic blood pressure of 102 mmHg, respiratory rate 64 mrp, and other normal parameters. CBC and urinalysis laboratory tests were requested, which were unchanged. The electrocardiogram showed normal patterns. In the conventional echocardiographic examination, a significant increase in the left atrium (LA) was observed, and the LA/Ao ratio was 2.05 and the diastolic function was abnormal. There was no presence of concentric hypertrophy of the left ventricle (LV), the thickness of the ventricular wall measured at different points, in the two-dimensional mode and the M mode, was less than 5 millimeters. Other parameters of conventional echocardiography were within the normal range. Through these echocardiographic findings, the suggestive diagnosis was non-specific phenotype cardiomyopathy, with a significant increase in LA. For the...(AU)

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se que a disfunção miocárdica é um fator determinante de prognóstico em casos de sepse, o que ressalta a importância de seu diagnóstico e tratamento precoce.

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.

Role of adiponectin in diabetes myocardial ischemia-reperfusion injury and ischemic postconditioning

Purpose Patients with diabetes are vulnerable to myocardial I/R (ischaemia/reperfusion) injury, but are not responsive to IPO (ischaemic post-conditioning). We hypothesized that decreased cardiac Adiponectin (APN) is responsible for the loss of diabetic heart sensitivity to IPO cardioprotecton. Methods Diabetic rats were subjected to I/R injury (30 min of LAD occlusion followed by 120 min of reperfusion). Myocardial infarct area was determined by TTC staining. Cardiac function was monitored by a microcatheter. ANP, 15-F2t-isoprostane, nitrotyrosine and MDA were measured by assay kits. Levels of p-Akt, total-Akt and GAPDH were determined by Western Blot. Results Diabetic rats subjected to myocardial IR exhibited severe myocardial infarction and oxidative stress injury, lower APN in the plasma and cardiac p-Akt expression ( P <0.05). IPO significantly attenuated myocardial injury and up-regulated plasma APN content and cardiac p-Akt expression in non-diabetic rats but not in diabetic rats. Linear correlation analysis showed that the expression of adiponectin was positively correlated with p-Akt and negatively correlated with myocardial infarction area ( P <0.01). Conclusion Protective effect of IPO was tightly correlated with the expression of adiponectin, exacerbation of I/R injury and ineffectiveness of IPO was partially due to the decline of adiponectin and inactivation of Akt in diabetes mellitus.(AU)

Avaliação da deformação miocárdica pela ecocardiografia feature tracking em gatos com defeito perimembranoso do septo ventricular / Evaluation of myocardial deformation by the ecocardiography feature tracking in cats with perimembranosous defect of the septo ventricular

O desenvolvimento de novas ferramentas, como a ecocardiografia bidimensional feature tracking (2D-FTI), permite diagnosticar, de forma precoce, se há disfunção miocárdica em doenças cardíacas, inclusive as congênitas. O defeito septal ventricular (DSV) é a alteração congênita mais observada em felinos, no entanto pouco se sabe sobre a disfunção cardíaca nessa cardiopatia, especialmente em animais assintomáticos. O objetivo deste estudo foi avaliar, por meio do 2D-FTI, a deformação miocárdica ventricular esquerda pela mensuração dos índices ecocardiográficos strain (St) e strain rate (StR) radial, circunferencial e longitudinal, em gatos saudáveis e com DSV. Foram avaliados 12 gatos saudáveis e seis gatos com DSV para obtenção de St e StR em diversos segmentos miocárdicos. No sentido longitudinal, houve diferença estatística (P<0,05) para os segmentos septal basal, mediano e apical epicárdicos (P=0,0017; P<0,0001; P=0,0288), lateral mediano epicárdico (P=0,0327), septal mediano endocárdico (P=0,0035), lateral mediano endocárdico (P=0,0461), St epicárdico (P=0,0250) e St global (P=0,0382). Também houve diferença no segmento lateral mediano circunferencial endocárdico (P=0,0248), lateral mediano radial (St: P=0,0409; StR: P=0,0166) e posterior mediano radial (P=0,0369). O estudo evidenciou que, mesmo em animais assintomáticos com DSV, há redução na deformação miocárdica ventricular principalmente no sentido longitudinal, demonstrando maior vulnerabilidade dessas fibras.(AU)

The development of new tools, such as two-dimensional feature tracking (2D-FTI), allows early diagnosis of myocardial dysfunction in heart diseases including congenital heart disease. The ventricular septal defect (VSD) is the most frequently observed congenital abnormality in cats, however, little is known about cardiac dysfunction, especially in asymptomatic animals. The objective of this study was to evaluate the left ventricular myocardial deformation through 2D-FTI by the measurement of the radial, circumferential and longitudinal echocardiographic strain (St) and strain rate (StR) indices. Twelve healthy cats and six cats with VSD were evaluated to obtain St and StR in several myocardial segments. In the longitudinal direction, there was a statistical difference (P<0.05) for the epimyocardial basal septal, mid-septal, apical septal (P=0.0017; P<0.0001; P=0.0288), epimyocardial mid-lateral (P=0.0327), endomyocardial mid-septal (P=0.0035), endomyocardial mid-lateral (P=0.0461), St epimyocardial (P=0.0250) and St global (P=0.0382). There was also difference in the circumferential endomyocardial mid-lateral segment (P=0.0248), radial mid-lateral (St: P=0.0409; StR: P=0.0166) and radial mid-posterior (P=0.0369). The study showed that even in asymptomatic animals with VSD there is a reduction in ventricular myocardial deformation mainly in the longitudinal direction, demonstrating the fragility of these fibers.(AU)

Avaliação da deformação miocárdica pela ecocardiografia feature tracking em gatos com defeito perimembranoso do septo ventricular / Evaluation of myocardial deformation by the ecocardiography feature tracking in cats with perimembranosous defect of the septo ventricular

O desenvolvimento de novas ferramentas, como a ecocardiografia bidimensional feature tracking (2D-FTI), permite diagnosticar, de forma precoce, se há disfunção miocárdica em doenças cardíacas, inclusive as congênitas. O defeito septal ventricular (DSV) é a alteração congênita mais observada em felinos, no entanto pouco se sabe sobre a disfunção cardíaca nessa cardiopatia, especialmente em animais assintomáticos. O objetivo deste estudo foi avaliar, por meio do 2D-FTI, a deformação miocárdica ventricular esquerda pela mensuração dos índices ecocardiográficos strain (St) e strain rate (StR) radial, circunferencial e longitudinal, em gatos saudáveis e com DSV. Foram avaliados 12 gatos saudáveis e seis gatos com DSV para obtenção de St e StR em diversos segmentos miocárdicos. No sentido longitudinal, houve diferença estatística (P<0,05) para os segmentos septal basal, mediano e apical epicárdicos (P=0,0017; P<0,0001; P=0,0288), lateral mediano epicárdico (P=0,0327), septal mediano endocárdico (P=0,0035), lateral mediano endocárdico (P=0,0461), St epicárdico (P=0,0250) e St global (P=0,0382). Também houve diferença no segmento lateral mediano circunferencial endocárdico (P=0,0248), lateral mediano radial (St: P=0,0409; StR: P=0,0166) e posterior mediano radial (P=0,0369). O estudo evidenciou que, mesmo em animais assintomáticos com DSV, há redução na deformação miocárdica ventricular principalmente no sentido longitudinal, demonstrando maior vulnerabilidade dessas fibras.(AU)

The development of new tools, such as two-dimensional feature tracking (2D-FTI), allows early diagnosis of myocardial dysfunction in heart diseases including congenital heart disease. The ventricular septal defect (VSD) is the most frequently observed congenital abnormality in cats, however, little is known about cardiac dysfunction, especially in asymptomatic animals. The objective of this study was to evaluate the left ventricular myocardial deformation through 2D-FTI by the measurement of the radial, circumferential and longitudinal echocardiographic strain (St) and strain rate (StR) indices. Twelve healthy cats and six cats with VSD were evaluated to obtain St and StR in several myocardial segments. In the longitudinal direction, there was a statistical difference (P<0.05) for the epimyocardial basal septal, mid-septal, apical septal (P=0.0017; P<0.0001; P=0.0288), epimyocardial mid-lateral (P=0.0327), endomyocardial mid-septal (P=0.0035), endomyocardial mid-lateral (P=0.0461), St epimyocardial (P=0.0250) and St global (P=0.0382). There was also difference in the circumferential endomyocardial mid-lateral segment (P=0.0248), radial mid-lateral (St: P=0.0409; StR: P=0.0166) and radial mid-posterior (P=0.0369). The study showed that even in asymptomatic animals with VSD there is a reduction in ventricular myocardial deformation mainly in the longitudinal direction, demonstrating the fragility of these fibers.(AU)

Dilated cardiomyopathy in dogs - literature reviews / Cardiomiopatia dilatada em cães - revisão de literatura

A Cardiomiopatia Dilatada Canina (CMD), enfermidade que afeta principalmente cães de porte grande macho e adulto, se caracteriza por uma dilatação miocárdica das câmaras cardíacas e diminuição de sua capacidade de contração, com consequentes alterações hemodinâmicas e posterior evolução para um quadro de insuficiência cardíaca congestiva. A ecocardiográfica tem sido cada vez mais considerada como diagnóstico definitivo para a CMD canina por ser um método dinâmico e não invasivo de avaliação do coração, que permite identificar a dilatação da parede ventricular. Esta revisão bibliográfica tem objetivo de revisar aspectos relacionados à fisiopatologia da doença, manifestações clínicas e métodos de diagnósticos mais atuais e possíveis interversões terapêuticas para proporcionar melhor estabilidade ao quadro.(AU)

Canine dilated Cardiomyopathy (CMD), a disease that affects mainly male and adult large-sized dogs, is characterized by myocardial dilation of the cardiac chambers and decreased contraction capacity, with consequent alterations Hemodynamic and posterior progression to a congestive heart failure condition. The echocardiographic has been increasingly considered as a definitive diagnosis for canine CMD because it is a dynamic and non-invasive method of assessing the heart, which allows to identify the dilation of the ventricular wall. This bibliographic review aims to review aspects related to the pathophysiology of the disease, clinical manifestations and more current diagnostic methods and possible therapeutic interversions to provide better stability to the picture.(AU)

Dilated cardiomyopathy in dogs - literature reviews / Cardiomiopatia dilatada em cães - revisão de literatura

A Cardiomiopatia Dilatada Canina (CMD), enfermidade que afeta principalmente cães de porte grande macho e adulto, se caracteriza por uma dilatação miocárdica das câmaras cardíacas e diminuição de sua capacidade de contração, com consequentes alterações hemodinâmicas e posterior evolução para um quadro de insuficiência cardíaca congestiva. A ecocardiográfica tem sido cada vez mais considerada como diagnóstico definitivo para a CMD canina por ser um método dinâmico e não invasivo de avaliação do coração, que permite identificar a dilatação da parede ventricular. Esta revisão bibliográfica tem objetivo de revisar aspectos relacionados à fisiopatologia da doença, manifestações clínicas e métodos de diagnósticos mais atuais e possíveis interversões terapêuticas para proporcionar melhor estabilidade ao quadro.

Canine dilated Cardiomyopathy (CMD), a disease that affects mainly male and adult large-sized dogs, is characterized by myocardial dilation of the cardiac chambers and decreased contraction capacity, with consequent alterations Hemodynamic and posterior progression to a congestive heart failure condition. The echocardiographic has been increasingly considered as a definitive diagnosis for canine CMD because it is a dynamic and non-invasive method of assessing the heart, which allows to identify the dilation of the ventricular wall. This bibliographic review aims to review aspects related to the pathophysiology of the disease, clinical manifestations and more current diagnostic methods and possible therapeutic interversions to provide better stability to the picture.

Electrocardiographic markers of myocardial conduction and repolarization in Boxer dogs / Marcadores eletrocardiográficos de condução e repolarização miocárdica em cães da raça Boxer

ABSTRACT: Electrocardiographic markers have been used in people to classify arrhythmogenic risk. The aims of this study were to investigate electrocardiographic markers of conduction and repolarization in Boxers and non-Boxer dogs, and compare such findings between groups. Ten-lead standard electrocardiograms of Boxer dogs and non-Boxers recorded from 2015 to 2018 were retrospectively reviewed. Dogs >/ 4 years of age and weighing > 20kg were included. Animals with valvular insufficiencies, congenital cardiopathies, cardiac dilation, suspected systolic dysfunction, biphasic T-wave, bundle branch blocks, and those receiving antiarrhythmics were excluded. Electrocardiographic markers of conduction, QRS duration (QRSd) and dispersion (QRSD), and repolarization (corrected QT interval, Tpeak-Tend, JT and JTpeak), as well as derived indices, were measured. Two hundred dogs met the inclusion/exclusion requirements, including 97 Boxers (8.1±2.5 years old; 30±7kg) and 103 non-Boxer (8.8±2.5 years old, 30±8kg). QRSd and QRSD, and repolarization markers in lead II and left precordial lead V4 were considered similar between groups. Dispersion of late repolarization on lead rV2, Tpeak-Tend interval, was considered longer in Boxers (45±8ms vs 38±10ms, P=0.01). The Tpeak-Tend/JTpeak and the JTpeak/JT also differed between groups. Our results indicate that the dispersion of myocardial late repolarization in lead rV2 is slower in Boxers than other dog breeds.(AU)

Marcadores eletrocardiográficos têm sido estudados em seres humanos para estratificação do risco arritmogênico. Os objetivos deste estudo foram investigar os marcadores eletrocardiográficos de condução e repolarização miocárdica em Boxers e em cães de outras raças, e comparar tais resultados entre os grupos. Para tal, a eletrocardiografia convencional de 10 derivações registradas de 2015 a 2018 foram avaliadas de maneira retrospectiva. Cães com idade igual ou superior a 4 anos e pesando > 20kg foram incluídos. Animais com insuficiência valvar, cardiopatias congênitas, dilatação cardíaca, suspeita de disfunção sistólica, onda T bifásica, bloqueio(s) de ramo(s), ou aqueles que recebiam antiarrítmicos foram excluídos. Variáveis eletrocardiográficas de condução, como a duração e dispersão do complexo QRS (QRSd e QRSD, respectivamente), e repolarização (intervalo QT corrigido, Tpico-Tfinal, JT e JTpico), bem como índices derivados, foram mensurados. Duzentos cães que se adequaram aos critérios de inclusão/exclusão foram incluídos, 97 Boxers (8,1±2,5 anos; 30±7kg) e 103 não Boxers (8,8±2,5 anos; 30±8kg). O QRSd e o QRSD, e os marcadores de repolarização nas derivações II e V4 foram similares entre os grupos. O marcador de dispersão da repolarização tardia na derivação rV2, Tpico-Tfinal, foi considerado mais longo no Boxers (45±8ms vs 38±10ms, P=0.01). O Tpico-Tfinal/JTpico e o JTpico/JT também diferiram entre os grupos. Nossos resultados indicam que a dispersão da repolarização miocárdica tardia na derivação precordial direita, rV2, é mais lenta no Boxer do que nas outras raças.(AU)

Electrocardiographic markers of myocardial conduction and repolarization in Boxer dogs / Marcadores eletrocardiográficos de condução e repolarização miocárdica em cães da raça Boxer

Electrocardiographic markers have been used in people to classify arrhythmogenic risk. The aims of this study were to investigate electrocardiographic markers of conduction and repolarization in Boxers and non-Boxer dogs, and compare such findings between groups. Ten-lead standard electrocardiograms of Boxer dogs and non-Boxers recorded from 2015 to 2018 were retrospectively reviewed. Dogs >/ 4 years of age and weighing > 20kg were included. Animals with valvular insufficiencies, congenital cardiopathies, cardiac dilation, suspected systolic dysfunction, biphasic T-wave, bundle branch blocks, and those receiving antiarrhythmics were excluded. Electrocardiographic markers of conduction, QRS duration (QRSd) and dispersion (QRSD), and repolarization (corrected QT interval, Tpeak-Tend, JT and JTpeak), as well as derived indices, were measured. Two hundred dogs met the inclusion/exclusion requirements, including 97 Boxers (8.1±2.5 years old; 30±7kg) and 103 non-Boxer (8.8±2.5 years old, 30±8kg). QRSd and QRSD, and repolarization markers in lead II and left precordial lead V4 were considered similar between groups. Dispersion of late repolarization on lead rV2, Tpeak-Tend interval, was considered longer in Boxers (45±8ms vs 38±10ms, P=0.01). The Tpeak-Tend/JTpeak and the JTpeak/JT also differed between groups. Our results indicate that the dispersion of myocardial late repolarization in lead rV2 is slower in Boxers than other dog breeds.(AU)

Marcadores eletrocardiográficos têm sido estudados em seres humanos para estratificação do risco arritmogênico. Os objetivos deste estudo foram investigar os marcadores eletrocardiográficos de condução e repolarização miocárdica em Boxers e em cães de outras raças, e comparar tais resultados entre os grupos. Para tal, a eletrocardiografia convencional de 10 derivações registradas de 2015 a 2018 foram avaliadas de maneira retrospectiva. Cães com idade igual ou superior a 4 anos e pesando > 20kg foram incluídos. Animais com insuficiência valvar, cardiopatias congênitas, dilatação cardíaca, suspeita de disfunção sistólica, onda T bifásica, bloqueio(s) de ramo(s), ou aqueles que recebiam antiarrítmicos foram excluídos. Variáveis eletrocardiográficas de condução, como a duração e dispersão do complexo QRS (QRSd e QRSD, respectivamente), e repolarização (intervalo QT corrigido, Tpico-Tfinal, JT e JTpico), bem como índices derivados, foram mensurados. Duzentos cães que se adequaram aos critérios de inclusão/exclusão foram incluídos, 97 Boxers (8,1±2,5 anos; 30±7kg) e 103 não Boxers (8,8±2,5 anos; 30±8kg). O QRSd e o QRSD, e os marcadores de repolarização nas derivações II e V4 foram similares entre os grupos. O marcador de dispersão da repolarização tardia na derivação rV2, Tpico-Tfinal, foi considerado mais longo no Boxers (45±8ms vs 38±10ms, P=0.01). O Tpico-Tfinal/JTpico e o JTpico/JT também diferiram entre os grupos. Nossos resultados indicam que a dispersão da repolarização miocárdica tardia na derivação precordial direita, rV2, é mais lenta no Boxer do que nas outras raças.(AU)

Pharmacological modulation of b-adrenoceptors as a new cardioprotective strategy for therapy of myocardial dysfunction induced by ischemia and reperfusion

Purpose: To evaluate the cardioprotective response of the pharmacological modulation of β-adrenergic receptors (β-AR) in animal model of cardiac ischemia and reperfusion (CIR), in spontaneously hypertensive (SHR) and normotensive (NWR) rats. Methods: CIR was induced by the occlusion of left anterior descendent coronary artery (10 min) and reperfusion (75 min). The SHR was treated with β-AR antagonist atenolol (AT, 10 mg/kg, IV) 5 min before CIR, and NWR were treated with β-AR agonist isoproterenol (ISO, 0.5 mg/kg, IV) 5 min before CIR. Results: The treatment with AT increased the incidence of VA, AVB and LET in SHR, suggesting that spontaneous cardioprotection in hypertensive animals was abolished by blockade of β-AR. In contrast, the treatment with ISO significantly reduced the incidence of ventricular arrhythmia, atrioventricular blockade and lethality in NWR (30%, 20% and 20%, respectively), suggesting that the activation of β-AR stimulate cardioprotection in normotensive animals. Serum CK-MB were higher in SHR/CIR and NWR/CIR compared to respective SHAM group (not altered by treatment with AT or ISO). Conclusion: The pharmacological modulation of β-AR could be a new cardioprotective strategy for the therapy of myocardial dysfunctions induced by CIR related to cardiac surgery and cardiovascular diseases.(AU)

Cardiomiopatia dilatada em cães: revisão de literatura / Dilated cardiomyopathy in dogs: literature review

A presente revisão tem por objetivo aprimorar o conhecimento sobre Dilated Cardiomyopathy (DCM) em cães, visando à compreensão dos aspectos clínicos, diagnóstico e tratamento. A DCM é caracterizada por dilatação ventricular, disfunção sistólica e arritmias que podem culminar em insuficiência cardíaca e morte. É a segunda cardiopatia mais frequente em cães, acometendo principalmente animais de grande porte e machos. A etiologia é idiopática, mas alguns genes associados à doença já foram identificados. A manifestação clínica é dividida basicamente em estágios oculto e sintomático. O estágio oculto é caracterizado pela presença de alterações elétricas e/ou morfológicas e ausência de sinais clínicos. Os cães podem apresentar o estágio oculto longo até o desenvolvimento de insuficiência cardíaca de forma aguda ou morte súbita. O estágio sintomático é definido pela presença de insuficiência cardíaca esquerda ou biventricular. O diagnóstico somente é confirmado por meio de ecocardiograma e/ou Holter. Estes exames são considerados padrão-ouro, uma vez que apresentam alta sensibilidade na identificação precoce da doença. Cães de raças predispostas devem ser monitorados anualmente a partir dos três anos de idade. O tratamento tem o intuito de minimizar os efeitos da insuficiência cardíaca, sendo instituído de acordo com a fase em que o animal se encontra. O prognóstico após início dos sinais clínicos é desfavorável. Alguns fatores podem influenciar a sobrevida de forma positiva ou negativa. A realização de exames periódicos é de grande importância para obter o diagnóstico precoce e intervir de maneira a retardar a progressão da doença.

The aim of the present review is to improve the knowledge about Cardiomyopathy dilata (CMD) in dogs, in order to understanding clinical aspects, diagnosis and treatment. CMD is characterized by ventricular dilation, systolic dysfunction, and arrhythmias that may culminate in heart failure and death. It is the second most common heart disease in dogs, affecting mainly large animals and males. The etiology is idiopathic, but some genes associated with the disease have already been identified. The clinical manifestation is basically divided into occult and symptomatic stages. The occult stage is characterized by the presence of electrical and/or morphological changes and absence of clinical signs. Dogs may present the long occult stage to the development of acute heart failure or sudden death. The symptomatic stage is defined by the presence of left or biventricular heart failure. The diagnosis is only confirmed by echocardiography and/or Holter. These exams are considered gold standard, since they present high sensitivity in the early identification of the disease. Dogs of predisposed breeds should be monitored annually from the age of three. The treatment is intended to minimize the effects of heart failure, and is instituted according to the stage in which the animal is. The prognosis after onset of clinical signs is worse. Some factors may influence survival in a positive or negative way. Periodic examinations are great importance to obtain early diagnosis and interpose in order to delay the progression of the disease.

Cardiomiopatia dilatada em cães: revisão de literatura / Dilated cardiomyopathy in dogs: literature review

A presente revisão tem por objetivo aprimorar o conhecimento sobre Dilated Cardiomyopathy (DCM) em cães, visando à compreensão dos aspectos clínicos, diagnóstico e tratamento.  A DCM é caracterizada por dilatação ventricular, disfunção sistólica e arritmias que podem culminar em insuficiência cardíaca e morte. É a segunda cardiopatia mais frequente em cães, acometendo principalmente animais de grande porte e machos. A etiologia é idiopática, mas alguns genes associados à doença já foram identificados. A manifestação clínica é dividida basicamente em estágios oculto e sintomático. O estágio oculto é caracterizado pela presença de alterações elétricas e/ou morfológicas e ausência de sinais clínicos. Os cães podem apresentar o estágio oculto longo até o desenvolvimento de insuficiência cardíaca de forma aguda ou morte súbita. O estágio sintomático é definido pela presença de insuficiência cardíaca esquerda ou biventricular. O diagnóstico somente é confirmado por meio de ecocardiograma e/ou Holter.  Estes exames são considerados padrão-ouro, uma vez que apresentam alta sensibilidade na identificação precoce da doença. Cães de raças predispostas devem ser monitorados anualmente a partir dos três anos de idade. O tratamento tem o intuito de minimizar os efeitos da insuficiência cardíaca, sendo instituído de acordo com a fase em que o animal se encontra. O prognóstico após início dos

The aim of the present review is to improve the knowledge about Cardiomyopathy dilata (CMD) in dogs, in order to understanding clinical aspects, diagnosis and treatment. CMD is characterized by ventricular dilation, systolic dysfunction, and arrhythmias that may culminate in heart failure and death. It is the second most common heart disease in dogs, affecting mainly large animals and males. The etiology is idiopathic, but some genes associated with the disease have already been identified. The clinical manifestation is basically divided into occult and symptomatic stages. The occult stage is characterized by the presence of electrical and/or morphological changes and absence of clinical signs. Dogs may present the long occult stage to the development of acute heart failure or sudden death. The symptomatic stage is defined by the presence of left or biventricular heart failure. The diagnosis is only confirmed by echocardiography and/or Holter. These exams are considered gold standard, since they present high sensitivity in the early identification of the disease. Dogs of predisposed breeds should be monitored annually from the age of three. The treatment is intended to minimize the effects of heart failure, and is instituted according to the stage in which the animal is. The prognosis after onset of clinical signs is worse. Some factors may influence survival in a positive or negative way. Periodic examinations are great importance to obtain early diagnosis and interpose in order to delay the progression of the disease.(AU)

Cardiomiopatia dilatada em cães: revisão de literatura / Dilated cardiomyopathy in dogs: literature review

A presente revisão tem por objetivo aprimorar o conhecimento sobre Dilated Cardiomyopathy (DCM) em cães, visando à compreensão dos aspectos clínicos, diagnóstico e tratamento.  A DCM é caracterizada por dilatação ventricular, disfunção sistólica e arritmias que podem culminar em insuficiência cardíaca e morte. É a segunda cardiopatia mais frequente em cães, acometendo principalmente animais de grande porte e machos. A etiologia é idiopática, mas alguns genes associados à doença já foram identificados. A manifestação clínica é dividida basicamente em estágios oculto e sintomático. O estágio oculto é caracterizado pela presença de alterações elétricas e/ou morfológicas e ausência de sinais clínicos. Os cães podem apresentar o estágio oculto longo até o desenvolvimento de insuficiência cardíaca de forma aguda ou morte súbita. O estágio sintomático é definido pela presença de insuficiência cardíaca esquerda ou biventricular. O diagnóstico somente é confirmado por meio de ecocardiograma e/ou Holter.  Estes exames são considerados padrão-ouro, uma vez que apresentam alta sensibilidade na identificação precoce da doença. Cães de raças predispostas devem ser monitorados anualmente a partir dos três anos de idade. O tratamento tem o intuito de minimizar os efeitos da insuficiência cardíaca, sendo instituído de acordo com a fase em que o animal se encontra. O prognóstico após início dos

The aim of the present review is to improve the knowledge about Cardiomyopathy dilata (CMD) in dogs, in order to understanding clinical aspects, diagnosis and treatment. CMD is characterized by ventricular dilation, systolic dysfunction, and arrhythmias that may culminate in heart failure and death. It is the second most common heart disease in dogs, affecting mainly large animals and males. The etiology is idiopathic, but some genes associated with the disease have already been identified. The clinical manifestation is basically divided into occult and symptomatic stages. The occult stage is characterized by the presence of electrical and/or morphological changes and absence of clinical signs. Dogs may present the long occult stage to the development of acute heart failure or sudden death. The symptomatic stage is defined by the presence of left or biventricular heart failure. The diagnosis is only confirmed by echocardiography and/or Holter. These exams are considered gold standard, since they present high sensitivity in the early identification of the disease. Dogs of predisposed breeds should be monitored annually from the age of three. The treatment is intended to minimize the effects of heart failure, and is instituted according to the stage in which the animal is. The prognosis after onset of clinical signs is worse. Some factors may influence survival in a positive or negative way. Periodic examinations are great importance to obtain early diagnosis and interpose in order to delay the progression of the disease.

Outbreaks of nutritional cardiomyopathy in pigs in Brazil / Surtos de cardiomiopatia nutricional em suínos no Brasil

Dilated cardiomyopathy (DCM) is a condition that affects the myocardium, seldom reported in pigs. The DCM is characterized by ventricular dilation, which results in systolic and secondary diastolic dysfunction and can lead to arrhythmia and fatal congestive heart failure. This study described the clinical, pathological, chemical and toxicological findings of nutritional dilated cardiomyopathy (DCM) in nursery pigs through natural and experimental studies. Naturally occurring cases of DCM in three swine farms were investigated through necropsy (fourteen pigs), microscopic, virological, chemical and toxicological exams for the detection of the etiology. The experimental study was conducted with nine 40 days-old piglets, which were divided into three groups of three piglets each. Group 1 was fed with the suspected diet of the naturally occurring cases, Group 2 with half of the suspected diet and half of a control diet, and Group 3 received only the control diet. Clinical signs were recorded. All pigs were submitted of euthanized, necropsie and collection sample for laboratories exams, after 15 days of experiment onset. At the necropsy, all naturally occurring cases had bilateral cardiac dilatation associated to hepatic enhanced lobular pattern (nutmeg liver) and lungs edema. Microscopically, the heart revealed severe hypertrophy and vacuolization of cardiomyocytes, as well as myofiber disarray. Feed analysis revealed low-quality standard soybean meal. After the suspected feed was replaced, clinically ill pigs recovered, and mortality ceased. At the experimental study, two piglets from Group 1 had cough, dyspnea and diarrhea. At the necropsy, these animals had similar gross and microscopic lesions to the natural cases. The nutritional DCM in pigs may be associated to the diet with low-quality soybean meal, as it was further confirmed through an experimental study.(AU)

Cardiomiopatia dilatada (CMD) é uma condição que afeta o miocárdio, raramente relatada em porcos. A DCM é caracterizada por dilatação ventricular, que resulta em disfunção sistólica e disfunção diastólica secundária e pode levar a arritmias e insuficiência cardíaca congestiva fatal. Este estudo descreve os achados clínicos, patológicos, químicos e toxicológicos da CMD em suínos de creche através de estudos naturais e experimentais. Investigaram-se três granjas com surtos de mortalidade por CMD através de exames de necropsia (catorze suínos), microscópicos, virológicos, químicos e toxicológicos para a detecção da etiologia. O estudo experimental foi conduzido com nove leitões de 40 dias de idade, divididos em três grupos de três leitões cada. O grupo 1 foi alimentado com a dieta suspeita dos casos naturais; o 2 com metade da dieta suspeita e metade de dieta controle; e o 3 recebeu apenas a dieta controle. Sinais clínicos foram registrados. Todos os suínos foram submetidos a eutanásia, necropsia para a coleta de amostras para exames laboratoriais após 15 dias do início do experimento. Na necropsia, todos os leitões dos casos naturais apresentavam dilatação cardíaca bilateral associada a padrão lobular hepático aumentado (fígado de noz-moscada) e edema pulmonar. Microscopicamente, o coração revelou hipertrofia severa e vacuolização de cardiomiócitos, bem como desordem de miofibras. A análise da ração demonstrou que o farelo de soja apresentava baixa solubilidade o que indica baixa qualidade. Após a substituição da ração suspeita, os porcos clinicamente doentes recuperaram e a mortalidade cessou. No estudo experimental, dois leitões do grupo 1 apresentaram tosse, dispneia e diarreia. Na necropsia, esses animais apresentavam lesões macroscópicas e macroscópicas similar aos casos naturais. A CMD nutricional em suínos pode estar associado à dieta com farelo de soja de baixa qualidade, como foi confirmado através de um estudo experimental.(AU)