Management of incidentally detected heart murmurs in dogs and cats.

A dog or a cat has an incidentally detected heart murmur if the murmuris an unexpected discovery during a veterinary consultation that was not initially focused on the cardiovascular system. This document presents approaches for managing dogs and cats that have incidentally-detected heart murmurs, with an emphasis on murmur characteristics, signalment profiling, and multifactorial decision-making to choose an optimal course for a given patient.

Atrial fibrillation in cats: 50 cases (1979-2002).

OBJECTIVE: To determine signalment, clinical signs, diagnostic findings, treatment, and outcome for cats with atrial fibrillation (AF). DESIGN: Retrospective study. ANIMALS: 50 cats. PROCEDURE: Medical records of cats that met criteria for a diagnosis of AF (ECG consisting of at least 2 leads, clear absence of P waves, supraventricular rhythm, and convincingly irregularly irregular rhythm) and had undergone echocardiography were reviewed. RESULTS: There were 41 males (37 castrated) and 9 females (7 spayed). Forty-one were of mixed breeding; 9 were purebred. Mean +/- SD age was 10.2 +/- 3.7 years. The most common chief complaints were dyspnea, aortic thromboembolism, and lethargy. In 11 cats, AF was an incidental finding. Mean +/- SD ventricular rate was 223 +/- 36 beats/min. The most common echocardiographic abnormalities were restrictive or unclassified cardiomyopathy (n = 19), concentric left ventricular hypertrophy (18), and dilated cardiomyopathy (6). Mean +/- SD left atrial-to-aortic diameter ratio (n = 39) was 2.55 +/- 0.80. The most common thoracic radiographic findings were cardiomegaly, pleural effusion, and pulmonary edema. Median survival time (n = 24) was 165 days (range, 0 to 1,095 days). Eight of 24 cats lived for > or = 1 year after a diagnosis of AF was made. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that AF occurs primarily in older adult male cats with structural heart disease severe enough to lead to atrial enlargement. Atrial fibrillation in these cats was most commonly first detected when signs of decompensated cardiac disease were evident, but also was commonly identified as an incidental finding.

Evaluation of plasma N-terminal pro-B-type natriuretic peptide concentrations in dogs with and without cardiac disease.

OBJECTIVE: To evaluate plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in a large, diverse population of dogs with and without cardiac disease and to define the upper reference limit for the biomarker in this species. DESIGN: Cross-sectional single center study. ANIMALS: 1,134 dogs. PROCEDURES: Dogs underwent blood sample collection, physical examination, ECG, and echocardiographic and thoracic radiographic evaluations. Cardiac status was graded by use of a 9-grade cardiac disease classification system and a simplified 4-stage cardiac scoring system. Vertebral heart score (VHS) was assessed in 280 dogs. Associations of plasma NT-proBNP concentrations with multiple variables were evaluated via univariate and multivariate linear regression analysis. Sensitivity and specificity of NT-proBNP concentrations and of VHS to discriminate between dogs with and without clinical signs of cardiac disease were evaluated via receiver-operating characteristic curve analysis. RESULTS: 974 dogs had cardiac disease, 37 had noncardiac-related disease, and 123 were healthy. Plasma NT-proBNP concentrations correlated with cardiac grade and stage; VHS was also associated with cardiac grade. At a cutoff of 874 pmol/L, sensitivity and specificity of NT-proBNP concentration to detect clinical signs of cardiac disease were 70% and 83%, respectively; for VHS, sensitivity and specificity were 56% and 85%, respectively, at a cutoff of 11.5. Mean NT-proBNP concentration was significantly increased in dogs with cardiac-related dyspnea or coughing, compared with dogs in which these signs were noncardiac related. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that 900 pmol/L is the upper reference limit of plasma NT-proBNP concentration in dogs. This biomarker may be a useful tool for staging of cardiac disease and identifying cardiac-related coughing or dyspnea in this species.

Foxtail-associated endocarditis in a cat.

An adult female neutered domestic shorthair cat developed right heart failure 1 week after having surgical drainage of a neck abscess of unknown etiology established at our hospital. Echocardiography revealed a large vegetative mass adhered to the tricuspid valve. Post-mortem examination revealed fibrinous endocarditis and myocarditis associated with the presence of a grass awn (Hordeum species) foreign body. Foxtail migration with subsequent thrombus and endocarditis formation on the tricuspid valve is considered a very unusual sequel to foxtail migration.