Dermatologic adverse effect of subcutaneous furosemide administration in a cat

Background: Furosemide is a mainstay of treatment in congestive heart failure (CHF) and is widely prescribed to dogs and cats by several formulations, including the subcutaneous one. In canine and human medicine, dermatologic adverse effects of subcutaneous furosemide (SF) have been documented; conversely, no prior case has been published describing skin reactions to this therapeutic protocol in cats. In this report, we describe, for the first time in feline medicine, a suspected dermatologic adverse effect after SF in a cat. Case description: A 2-year-old domestic shorthair cat was presented for CHF associated with lung edema and pleural effusion. Echocardiography revealed asymmetric left ventricular myocardial thickening and severe left atrial dilation. The cat was hospitalized and initially treated with oxygen, intravenous furosemide, and clopidogrel. After discharge, the route of administration of furosemide was switched from intravenous to oral. Within the following 2 weeks, the cat experienced two relapses of lung edema despite the progressive increase of the furosemide dose, the addition of spironolactone and adherence to the therapeutic protocol by the owners. The dose of furosemide was further increased and its route of administration at home was switched from oral to parental. As the owner was not able to administrate intramuscular injections, SF was prescribed. This allowed the prevention of further episodes of lung edema. However, although the cat had never presented skin problems before, multiple well-defined circular, crusted ulcerative cutaneous lesions associated with alopecia developed at the sites of furosemide injections 2 weeks later. After ruling out several differential diagnoses for these lesions, a rare side effect of furosemide, not yet described in cats but already known in canine and human medicine, was strongly suspected as the possible cause. Therefore, the ongoing injectable formulation of furosemide was interrupted and substituted with an alternative brand, maintaining the same dose and route of administration. Thanks to this change, the dermal ulcerations disappeared within 1 month. Subsequently, the cat experienced neither further skin problems nor a recurrence of lung edema. Conclusion: Although SF is sometimes prescribed in small animal practice, it should be noticed that this may lead to dermatologic adverse reactions in the cat

New insights into myxomatous mitral valve disease: study of innovative echocardiographic parameters and their clinical and prognostic role in dogs

La malattia mixomatosa della valvola mitralica (MMVM) rappresenta la più comune tra le cardiopatie canine, con una prevalenza prossima al 100% in soggetti di età adulta ed anziana, soprattutto di taglia media e piccola. Sebbene la natura cronica e tendenzialmente lenta di tale patologia le conferisca caratteristiche di benignità, la sua progressione può talvolta associarsi ad insufficienza cardiaca congestizia, condizione contraddistinta da una scarsa qualità di vita e da un elevato tasso di mortalità. L’ecocardiografia transtoracica rappresenta, ad oggi, il gold standard diagnostico in corso di MMVM canina. Diverse variabili ecocardiografiche hanno dimostrato nel cane una forte correlazione tra decorso clinico e prognosi; ciononostante, gran parte degli studi fino ad oggi pubblicati in medicina veterinaria si è principalmente focalizzata sull’indagine di parametri indicativi del grado di dilatazione e sovraccarico atrioventricolare sinistro. Al contrario poca attenzione è stata rivolta, finora, allo studio della funzione atriale sinistra, delle anomalie anatomiche valvolari e delle caratteristiche del rigurgito mitralico, parametri ecocardiografici che invece nell’uomo rivestono un imprescindibile ruolo clinico e prognostico. Pertanto lo scopo del presente progetto di ricerca, strutturato sotto forma di tre distinti studi di natura prospettica, è stato quello di indagare: a)la funzione atriale sinistra sia in cani sani che affetti da MMVM mediante ecocardiografia convenzionale e Speckle Tracking Echocardiography (STE), al fine di saggiare l’applicabilità e la ripetibilità di quest’ultima metodica ecografica, oltre che la sua utilità nello studio delle fisiopatologia dell’atrio sinistro canino; b)l’utilità clinica ed il valore prognostico di variabili ecocardiografiche inerenti la geometria e la performance atriale sinistra in cani affetti da MMVM, con particolare interesse per specifici indici di funzionalità basati sulla tecnica dello STE; c)l’utilità clinica ed il valore prognostico di specifiche variabili ecocardiografiche inerenti la patologia valvolare ed il jet rigurgitante in cani affetti da MMVM.Myxomatous mitral valve disease (MMVD) is the most common acquired canine heart disease. Prevalence of MMVD varies according to age and size, reaching values near to 100% among adult and old subjects from small breeds. The natural history of this condition is heterogeneous and not yet completely understood. Indeed, although many dogs with MMVD remains asymptomatic for years and even for life, severly affected animals can develop congestive heart failure (CHF), which confers a grave long term prognosis. Because the potential complications of this disease, its accurate diagnosis and the monitoring of its progression over time are critical clinical concerns for predicting the risk of CHF and adapting medical prescriptions. Currently, transthoracic echocardiography is considered the noninvasive diagnostic method of choice to achieve such goals. Several echocardiographic variables have been reported to predict worsening of MMVD, especially those representative of left atrial remodelling and volume overload. In contrast, to date, scarce attention has been paid on the prognostic role of echocardiographic indicators of left atrial function (LAF), mitral valve damage and mitral regurgitation. Given the clinical importance of such parameters in human cardiology and the lack of data at regard in veterinary medicine, the aims of this thesis, structured into three different research projects, were to prospectively investigate: a)the LAF in healthy dogs and subjects with MMVD by the combined use of conventional transthoracic echocardiography and Speckle Tracking Echocardiography (STE), assessing the feasibility, reproducibility and utility of selected STE indices in the study of the atrial physiology; b)the correlation between selected echocardiographic variables and survival in dogs with MMVD, with particular attention for STE indicators of LAF; c)the correlation between selected echocardiographic indicators of mitral valve damage and mitral regurgitation in dogs with MMVD

Prognostic value of echocardiographic indices of left atrial morphology and function in dogs with myxomatous mitral valve disease

Background: The prognostic relevance of left atrial (LA) morphological and functional variables, including those derived from speckle tracking echocardiography (STE), has been little investigated in veterinary medicine. Objectives: To assess the prognostic value of several echocardiographic variables, with a focus on LA morphological and functional variables in dogs with myxomatous mitral valve disease (MMVD). Animals: One-hundred and fifteen dogs of different breeds with MMVD. Methods: Prospective cohort study. Conventional morphologic and echo-Doppler variables, LA areas and volumes, and STE-based LA strain analysis were performed in all dogs. A survival analysis was performed to test for the best echocardiographic predictors of cardiac-related death. Results: Most of the tested variables, including all LA STE-derived variables were univariate predictors of cardiac death in Cox proportional hazard analysis. Because of strong correlation between many variables, only left atrium to aorta ratio (LA/Ao > 1.7), mitral valve E wave velocity (MV E vel > 1.3 m/s), LA maximal volume (LAVmax > 3.53 mL/kg), peak atrial longitudinal strain (PALS < 30%), and contraction strain index (CSI per 1% increase) were entered in the univariate analysis, and all were predictors of cardiac death. However, only the MV E vel (hazard ratio [HR], 4.45; confidence interval [CI], 1.76-11.24; P <.001) and LAVmax (HR, 2.32; CI, 1.10-4.89; P =.024) remained statistically significant in the multivariable analysis. Conclusions and Clinical Importance: The assessment of LA dimension and function provides useful prognostic information in dogs with MMVD. Considering all the LA variables, LAVmax appears the strongest predictor of cardiac death, being superior to LA/Ao and STE-derived variables

Echocardiographic values in healthy Pugs: Effect of body weight, age, and sex

Background: Transthoracic echocardiography represents the main noninvasive technique for evaluating cardiac morphology and function in dogs. In dogs with particular somatotypes, such as brachymorphic dogs, breed-specific echocardiographic values are needed for a proper echocardiographic interpretation. Nowadays, the Pug represents one of the most popular brachymorphic canine breeds worldwide. However, data on echocardiographic measurements in this breed are currently limited. Aim: We aimed to determine echocardiographic values in a population of apparently healthy Pugs, and to assess the possible effects of body weight (BW), age, and sex on selected echocardiographic variables, with particular emphasis on those related to the left-sided cardiac chambers. Methods: Apparently healthy Pugs underwent a full physical examination, a 1-minute six-lead electrocardiogram, and a complete transthoracic echocardiography. Twenty-four echocardiographic variables were measured by combining M-mode, two-dimensional and Doppler modalities, and relative values were determined by applying the statistical procedures recommended by the Clinical and Laboratory Standards Institute. Moreover, the effect of selected demographic variables on echocardiographic measurements was tested using a linear mixed model. Results: The investigation included 86 Pugs. Echocardiographic values were provided for each variable and compared with previous veterinary literature. A statistically significant effect of BW, age, and sex was documented for several of the tested variables. Doppler examination demonstrated a trivial pulmonary regurgitation in 24/86 (27.9%) Pugs. Moreover, a persistent left cranial vena cava was suspected in 4/86 (4.7%) dogs. Conclusion: Echocardiographic features of the Pug were addressed and echocardiographic values were made available for clinical use. Because our findings were obtained using a standardized echocardiographic analysis in a population of 86 healthy Pugs, they may act as a reliable guide for an accurate echocardiographic interpretation in this breed

Evaluating the accuracy of a six-lead smartphone-based electrocardiographic device compared with standard electrocardiography in brachymorphic dogs

BackgroundNo previous study has evaluated the accuracy of a six-lead smartphone-based electrocardiographic (s-ECG) device in dogs. MethodsThis was a prospective multicentre study. Patients referred for cardiologic consultation were selected. In each patient, a 30-second electrocardiogram was simultaneously acquired with a novel six-lead s-ECG and a standard six-lead ECG machine (st-ECG). A board-certified cardiologist evaluated each recording. Nineteen ECG variables, including heart rate and rhythm, as well as quantitative and qualitative features of waves, segments and intervals, were analysed. Agreement between s-ECG and st-ECG was evaluated using Cohen's kappa coefficient and the Bland-Altman test. ResultsSeventy-five dogs were enrolled, and 140 ECG tracings were analysed. There was perfect agreement between the two methodologies for heart rate and rhythm classification, both in dogs with sinus rhythm and those with pathological rhythms. Although some disagreement was found when comparing measurements of quantitative variables obtained with the s-ECG and the st-ECG, none of the differences was of clinical relevance. LimitationsThe sample size was limited, and the interobserver variability was not analysed. ConclusionThe six-lead s-ECG studied herein is comparable to the st-ECG for heart rate and rhythm assessment, and seems clinically acceptable for the interpretation of waves, segments and intervals in dogs

Clinical presentation, echocardiographic findings, treatment strategies, and prognosis of dogs with myxomatous mitral valve disease presented with pericardial effusion due to suspected left atrial tear: a retrospective case–control study

Introduction/objectives: Left atrial tear (LAT) is a life-threatening complication in dogs with myxomatous mitral valve disease (MMVD). The study objective was to describe clinical presentation, echocardiographic findings, treatment strategies, and survival in dogs with LAT compared to a control group of dogs with a similar stage of MMVD but no LAT. ANIMALS AND MATERIALS AND METHODS: two-center retrospective case-controlled study including 15 dogs with and 15 dogs without LAT was conducted. Clinical and echocardiographic data were reviewed, and survival information were collected. Results: Nine dogs in each group were in stage C of MMVD, while the remaining were in stage B2. No differences between groups were found regarding age, body weight, sex, kidney values, and echocardiography-derived cardiac dimensions. Most reported clinical signs associated with LAT included weakness, respiratory signs, and syncope. Treatment varied and was mainly focused on the management of congestive heart failure. Three dogs with LAT received a pericardiocentesis. All 15 dogs with LAT had died of cardiac causes, 5 dogs during the first 7 days after admission. The median survival time for all 15 dogs with LAT was 52 days compared to 336 days in the control group (P=0.103). When excluding 5 dogs with LAT that died during the first 7 days, the median survival increased to 407 days, not different compared to the control group (P=0.549). Conclusions: Dogs with MMVD and LAT have a high short-term mortality; however, when surviving the acute phase, the long-term prognosis may not differ from dogs with a similarly advanced degree of MMVD but without LAT

Prevalence and prognostic role of L wave and selected clinical and echocardiographic variables in dogs with atrial fibrillation

Background: Information regarding the frequency of L waves and their prognostic relevance in dogs with secondary atrial fibrillation (AF) is limited. Hypothesis/objectives: To determine whether L waves occur and ascertain their prognostic role, as well as the role of other clinical and echocardiographic variables in dogs with AF. Animals: Fifty-five dogs with AF associated with myxomatous mitral valve disease or dilated cardiomyopathy. Methods: Retrospective, multicenter observational study. In addition to L waves analysis, other clinical and echocardiographic variables, including type of antiarrhythmic treatment, were evaluated. A survival analysis was performed to test for predictors of cardiac death and all-cause mortality using Cox proportional hazards regression models. Results: L waves were evident in 33/55 dogs (60%, 95% confidence interval [CI]&nbsp;=&nbsp;47%-72%) but their presence did not influence outcome. Increased left ventricular end-systolic diameter normalized for body weight (LVSDn) was a significant predictor of both cardiac death (hazard ratio [HR]&nbsp;=&nbsp;4.41, 95% CI&nbsp;=&nbsp;1.18-16.54; P&nbsp;=&nbsp;.03) and all-cause mortality (HR&nbsp;=&nbsp;9.39, 95% CI&nbsp;=&nbsp;2.49-35.32; P &lt; .001). Heart rate assessed during echocardiography (Echo-HR) represented an additional significant predictor of cardiac death (HR&nbsp;=&nbsp;1.01, 95% CI&nbsp;=&nbsp;1.00-1.01; P&nbsp;=&nbsp;.04) and all-cause mortality (HR&nbsp;=&nbsp;1.01, 95% CI&nbsp;=&nbsp;1.00-1.01; P&nbsp;=&nbsp;.04). Conclusions and clinical importance: L waves occurred frequently in dogs with AF, but held no prognostic relevance. Conversely, LVSDn and Echo-HR represented independent predictors of negative outcome in these animals

Echocardiographic predictors of first onset of atrial fibrillation in dogs with myxomatous mitral valve disease

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