心血管疾病8-课件-1

Cardiovascular

Diseases

In

Dogs

And

Cats狗和猫心血管疾病ClinicalCardiologyConceptsAnatomyoftheCardiovascularSystem心血管系统解剖AgeRelationofHeartDiseasesinDogs心脏病与狗的年龄关系HeartFailure–HeartDisease心力衰竭Heartfailureisthestatewhentheheartfailstomeetthemetabolicdemandsofthebody心力衰竭是心输出量不能满足身体需要Heartfailurecanalsobefoundindiseasesnotrelateddirectlytotheheart,suchasAnaemiaandHyperthyroidism心力衰竭不是独立的疾病，常伴发于贫血和甲亢Heartdiseaseisthepresenceofheartmurmurs,arrythmiasandothercardiacabnormalities心脏病表现于心动过慢，心律失常，或心脏畸形Untiltheseheartconditionsaresevere,theAnimalsshownosignsofheartfailure一般动物不表现症状，表现出来已经很严重了CongestiveHeartFailureCHF充血性心衰CHFoccurswhentheleftventricularpressureatenddiastoleiselevatedCHF发生于舒张期左心室压力增大TheresultsofCHFareelevatedvenouspressureandpulmonaryoedemaCHF结果是静脉压升高，肺水肿HeartDiseases–Congenital

先天性心脏病

VentricularSeptalDefect(VSD)心室间隔缺损AtrialSeptalDefect(ASD)心房间隔缺损PatentDuctusArteriosus(PDA)动脉导管未闭PulmonicStenosis(PS)肺动脉瓣狭窄AorticStenosis(AS)主动脉瓣狭窄SubaorticStenosis(SAS)PersistentRightAorticArch(PRAA)永久性右位主动脉弓TetralogyofFallot法乐氏四联症HeartDiseases–Acquired获得性心脏病IdiopathicHeartDiseases先天性心脏病MetabolicHeartDiseases代谢性心脏病ToxicHeartDiseases中毒性心脏病NeoplasticHeartDiseases肿瘤性InfectiousHeartDiseases感染性GeneticHeartDiseases遗传性85%ofheartdiseasesindogsarecardiomyopathies85%的心脏病属于心肌疾病HeartDiseases-AcquiredChronicValvularDisease(CVD)慢性瓣膜病DilatedCardiomyopathy(DCM)扩张性心脏病HypertrophicCardiomyopathy(HCM)肥厚性心肌病FelineThromboembolicDisease(TED)猫血栓BacterialEndocarditis(BE)细菌性心内膜炎PericardialEffusion(PE)心包积液ConstrictivePericardialDisease(CPD)压迫性心包病Dirofilariosis犬恶心丝虫ChronicValvularDisease慢性瓣膜病DegenerativedisorderoftheAV-Valves,particularlythemitralvalveCommoninolder,smallbreeddogs,acountingfor75-80%ofcaninecardiacdiseases易发于老年，小型犬CausedbythickeningandcontractionofthevalveleafletsandthechordaetendineaGeneticinCavalierKingCharlesSpanielandDachshund查理王犬和腊肠犬的遗传疾病PhysicalExamination身体检查Systolicheartmurmurormitralregurgitation(pansystolic)心脏听诊ArrythmiasinlaterCVD心律失常在后期慢性瓣膜病FemoralpulsesareoftennormalChronicnon-productiveorproductivecough咳嗽Ifheartfailureispresentdyspnoe,weakness,exerciseintoleranceandsyncopeoccur(signsofCongestiveHeartFailure)如果有虚弱，不耐运动，昏厥（充血性心衰症状）Radiologyx-检查Leftatrialenlargement左心房扩大Leftventricularenlargement左心室扩大Dislocationoftracheatodorsal气管虚脱Compressionofleftmainstreambronchus左支气管Pulmonaryoedema(accutechordalruptureshowssevereoedemawithoutatrialorventricularenlargement)肺水肿（）Splittingofthemainbronchiinlatero-lateralview支气管侧面Pulmonaryarterydilation肺动脉扩张ChronicMitralValveDisease慢性二尖瓣病变

PulmonaryOedemaElectrocardiology心电图R-waveamplitudeinleadIIisincreasedR波的振幅增加QRSdurationinleadIIisincreasedQRS的宽度增加Summary概述Progressivedisease病程Inearlyandmidstagesnosignsofheartfailure在早期和中期，心衰是没有明显症状的Inlaterstagesheartfailurewithpulmonarycongestion心衰后期伴发肺水肿Leftatrialenlargementwithcompressionofleftmainbronchusisresponsibleforcough左心房的扩大压迫左支气管表现为咳嗽Leftatrialrupturewithsuddendeathcanoccur左心房衰竭可能会导致猝死Ventriculaarrythmiascanleadtosuddendeath心律失常也会猝死Treatment治疗Pre-clinicalStagesofCVD:慢性瓣膜病早期治疗ACE-InhibitorsACE抑制剂Bronchodilators支气管扩张药AntitussivaCDVwithheartfailure慢性瓣膜病办法心衰Furosemide呋噻米ACE-InhibitorsPimobendanLowsodiumdietandrestrictedexercise低盐饮食和限制运动Digoxinwhensinusrhythmispresent地高辛Cardiomyopathy心肌疾病DilatedCardiomyopathy(DCM)扩张性心肌病Systolicdisfunction收缩不全Thinningofventricularwalls心壁变薄Ventricularcavitydilation心室扩张Totalventricularmassisincreased整个心室扩张经常发生在狗上

Occursoftenindogs

IncatsinconnectionwithTaurinedeficiency在猫上主要可能是牛黄酸缺乏症。Cardiomyopathy心肌病HypertrophicCardiomyopathy(HCM)肥大性心肌病DiastolicDysfunction舒张功能不全Ventricularcavitydiminisheddimension心室充盈不足Thickeningofventricularwalls心室变厚Ventricularmassincreased心室流量增加Occursoftenincats易发于猫很少见于狗RareindogsDilatedCardiomyopathy扩张性心肌病PrimaryglobaldisorderofthemyocardialtissueMainlyinlargeandgiantbreeddogs主要发生于大狗和巨型狗AlsoinCockerSpanielswithTaurindeficiency可卡犬的牛磺酸缺乏症Middleagedtoolderanimals(exceptjuvenileformasgeneticDCMinPortugueseWaterDogs)中老年狗（除了先天性的DCM葡萄牙水猎犬）Mostcasesareidiopatic,viralinfectionsarepossibleasacauseforDCM许多是由于病毒感染PhysicalExaminationSystolicheartmurmur心脏听诊Arrhythmias心率不齐,primarilyventricular心室Pulsedificits脉搏Weightloss体重下降Coolextremities四肢倔冷Dyspnoeorcough,restlessnessatnight在夜间咳嗽躁动Exerciseintolerance运动不耐受Syncope昏厥Ascites腹水RadiologyDefinitivediagnosisonlywithEchocardiography主要的诊断还是要心电图Leftventricularenlargemant左心室扩大Leftatrialenlargement左心房扩大Pulmonaryvenouscongestion(incasesofCHF)肺静脉充血Pulmonaryoedema(incasesofCHF)肺水肿Pleuraleffusion(incasesofCHF)胸膜渗出Peritonealeffusion腹膜渗出Hepatomegaly肝肿大CanineDCMElectrocardiography心电图STsegmentdepressionST段压低WideQRSdurationwithmicroscopicintramuralmyocardialinfarction心肌梗死的长QRS波TreatmentPre-clinicalDCMACE-Inhibitors(candelayonsetofCHF)DCMwithcongestiveheartfailureFurosemide呋塞米

Pimobendan

ACE-InhibitorsACE抑制剂

Arterialvasodilators(AmlodipineorHydralazine)动脉血管扩张药

Lowsodiumdietandsevereexerciserestriction低钠饮食和限制运动

TheuseofDigoxinisquestionable斟酌使用地高辛DifferenciesofHeartDiseasesinCats猫心脏病特别之处65-70%hypertropheCardiomyopathyDyspnoewithoutcoughing呼吸困难没有咳嗽Breathingwithopenmouth张嘴呼吸Hidingindarkcorners躲在黑暗角落里Inactivity不好动Weightloss体重下降Evencatswithsevereheartproblemscanappearasymptomatic即使猫有心脏的问题也不会表现明显的症状HypertrophicCardiomyopathy心脏肥大Mostcommontypeofcardiomyopathyincats在猫上面常见的心肌肥大症状Idiopaticmyocardialdisorderwithconcentrichypertophyanddiastolicdysfunctionoftheleftventricle和左心室舒张障碍HCMcanbesecondarytodisorderslike

Hyperthyroidism伴发于甲亢

Systemicarterialhypertension高血压GeneticpredispositioninMainCoon,Persian,AmericanandBritishShorthair库恩猫，波斯猫，美短和英短的先天性易病症Middleagedcats中年猫PhysicalExaminationGallopcardiacrhythms

奔马音Systolicheartmurmur心脏收缩音Dysrhythmia节律不齐Muffledheartsoundsduetopleuraleffusion胸腔积液的排水音Pulsedeficits脉搏短促OfteninconnectionwithThromboembolicDisease(TED)也常会和血栓病联系SuddenDyspnoe突然的呼吸困难Anorexia厌食Lethargy/Syncope昏睡或昏厥RadiologyValentine-shapedheartCardiomegaly心脏扩大Pleuraleffusionwithobscurecardiacsilhoutte渗出物的隐影Pulmonaryvenousdistension肺静脉扩张Airbronchograms支气管扩张Peribronchalpatterns

不明阴影Fissurelines狭长缝隙Cotton-likedensities

云絮状阴影FelineHCMTreatmentIncreasecontractility,reducepreload,reduceafterload

Betablockers(Atenolol,Metoprolol)Calciumchannelblockers(Diltiazem)ACE-Inhibitors血管紧张素抑制剂Reducepulmonaryoedema减轻肺水肿

Diuretics(Furosemide)利尿剂（呋塞米）Preventthrombolicdisease

预防血栓病Ifpresenttreatunderlyingdisorders(Hyperthyroidism,SystemicHypertension)有必要先治疗原发病（甲亢，高血压）

ThromboembolicDisease血栓病Frequentcomplicationoffelinemyocardialdisease常伴发猫的心肌病Clotformationincardiacchamberorvessel(atrialthrombi)血凝块形成于心房或静脉Clotfragmentlodgesindistantvessel游离血栓到达末端血管

(distalaortictrifurcation,sometimesrenalorcerebralarteries)（末梢动脉，有时是肾或脑动脉）Oftenthefirstsignofunderlyingcardiomyopathy潜在的心肌病PhysicalExamination身体检查AcuteonsetofparesiswithextremepainandhardmusclesintheaffectedlegsCyanoticnailbeds黏膜发绀Weakorabsentarterialpulse虚弱或动脉微弱Cooltopalpation低温Ridingaorticthrombuswithchanginglamenessinhindlegs后肢无力SignsofHCMwithgalloprhythmsandmurmurs(50%ofthecatswithTED)奔马音（50%的猫是血栓）Diagnosis诊断Clinicalsyptoms临床症状Radilogical,echocardiologicalandelectrocardiologicalsignsasinHCMX-检查和心电图Bloodworkindicatingmusclenecrosis(CK)血液指标心肌坏死Metabolicacidosis代谢性酸中毒Acuterenalfailure急性肾衰Hyperthyroidism甲亢Therapy治疗Inhibitionofclotformation抑制血栓形成

LowdoseASA(5mg/catevery3days)

Clopidogrel氯吡格雷(抗凝药)

Heparin肝素(Lowmolecularweightheparin低浓度)

Closemonitoringforhemorrhageisnecessary监测出血Painmanagment(Fentanyl,Morphine)止痛药（芬太尼，吗啡）Supportivecare(nutrition,warming)支持疗法（监护，温暖）TreatmentofCHF治疗充血性心衰Monitoringofrespiratoryrate,renalfunction,temperature,heartrhythmetc.监测呼吸，肾功能，体温，心率Prognosis预后Studyof127cases(Smithetal.2003)63%diedorwereeuthanizedduringinitialepisode63%死亡或安乐死在开始治疗阶段35%survivedanaverageof4month35%存活平均四个月25%ofthesurvivorshadre-embolization25%存活者重新患有血栓

Persistenceoflowrectaltemperatureisasignofpoorshort-termprognosis持续体温也是预后不良BacterialEndocarditis细菌性心内膜炎Multisystemicdisorderwithbacteremiaandinfectionofkidneys,jointsandcardiacvalves多系统障碍肾脏，关节，心瓣膜的Dysrhythmias(prematurebeats,tachycardia)节律不齐（，心动过速）Mitralvalveinsufficiency二尖瓣闭锁不全Aorticvalveinsufficiency主动脉瓣闭锁不全Ruptureofchordaetendinaewithmitralvalveinsufficiency,pumonaryoedemaanddeathPhysicalExaminationLargebreeddogs,middleageorolder大型狗或，中老年狗Primarilyinmales大部分公狗Anorexia厌食Vomiting呕吐Lameness跛行Fever高烧Jointpains,swelling,heat关节疼，有肿块，高温Palemucousmembranes可视粘膜惨白Dyspnoe呼吸困难Congestiveheartfailure充血性心衰DiagnosisRadiology,ECGandEchocardiographycanallbeinconclusiveinBEX片，心电图，心超都可以用来诊断细菌性心内膜炎Diagnosiscanbemadeby

诊断建立于

Clinicalsymptomsofcongestiveheartfailure充血性心衰的临床症状

Evidenceofsepticorimmunejointdisease炎性或免疫性关节病

Positivebloodcultures血液培养

Positiveurineculture尿液培养

Jointsynovialculture关节液培养

TreatmentAntimicrobialTherapy消炎

MostcommonbacteriaareStreptococci,大部分是链球菌StaphylococciandE.coli葡萄球菌和革兰氏阴性菌引起的

TreatwithGyrase-Inhibitors,Penicillins盘尼西林,Trimethoprim-Sulfadizine甲氧汴氨嘧啶orGentamycin庆大霉素

for5-6weeks治疗5-6周Fluidandnutritionalsupport输液和营养支持Treatmentofheartfailure治疗心衰PericardialDiseases心包疾病Congentialpericardialdisorders先天性心包病

Peritoneal-pericardialdiaphragmatichernia

Pericardialdefects

Pericardialcysts心包囊肿Acquiredpericardialdisorders获得性心包病

Pericardialeffusion心包积液

Constrictivepericarditis压迫性心包炎

Pericardialmasslesion创伤心包炎PericardialEffusion心包积液Accumulationoffluids(blood,serous,pus)inthepericardialsac血，脓液在心包囊内Canbecausedbytransudates(hydropericardium心包积液)exudate(pericarditis),hemorrhagic(hemopericardium心包积血),septic(fungus,bacteria真菌细菌),sterile(uremic尿毒素),CHF充血性心衰(increasedhydrostaticpress，ure)neoplastic肿瘤

andtrauma外伤Impedesthefillingabilityoftheheart压迫心脏

(diastolicdysfunction心舒张障碍)Neoplasticetiologiesaremostcommonindogs(heartbasetumour,hemangiosarcoma),veryrareincats肿瘤原因在狗上很常见，猫很少见PhysicalExaminationLargebreeddogsaremorecommonlyaffected大狗易感Middleagedandolder中老年狗Increasedresproatoryeffort呼吸影响Suddenweakness突然虚弱Exerciseintolerance运动不耐受Muffledheartsounds心音低Weakarterialpulse脉搏弱Jugularvenousdistension颈静脉充盈Signsofrightheartfailure右心衰竭Diagnosis诊断Echocardiography心超RadiologyX片Electrocardiography心电图Haematology(nucleatedRBCinHAS)血常规（）Cytologyofpericardialfluids

心包液细胞Pneumopericardiography

(InjectionofCOintothepericardialsacafterpericardiocentisisandfollowingradiologytoidentifyHBT)Echocardiography心超TestofchoiceDetectionofpericardialeffusion心超可测出有无渗出液Presenceoftumours肿瘤

(rightatrium,rightventricle=HAS)右心房室肿瘤

(BaseofAorta=HBT)血管肉瘤Cardiactumoursareeasiertoseewhilethefluidsarestillpresent(beforepericardiocentesis)心脏肿瘤很容易诊断当穿刺后液体还存在心包RadiologyRadiologyallowsapresumptivediagnosisVerylarge,globoseheartX片检查可见圆形扩张的心脏影印

Pulmonaryoedmanisunusual肺水肿很少见

Pleuraleffusionsareunusual胸腔积液少见

Pulmonarymetastaticlesion肺转移性损伤IncatsbothpleuralandpericardialeffusionoccurinHCM胸膜积液和心包积液发生于肥大性心肌病在猫上PericardialEffusion心包积液PericardialEffusionPleuralAndPericardialEffusion胸膜炎和心包积液Treatment治疗Pericardiocentesis心包穿刺

Fastcontrolesp.ifcardiactamponadeispresent

IfeffusionrecursrepeatedpericardiocentesisCorticosteriods(Prednisolone5mg/kg2xd)Surgicalremovalofpericarialsac

(Alsofordeterminationofunderlyingneoplasticprocesses)CardiacTamponade心脏栓塞MostsevereformofpericardialeffusionHeartfailureduetoseverepericardialeffusionresultinginreductionorlossofrightventricularfunctionWeakarterialpulsesmuffledheartsounds,jugularvenousdistension,syncope,weaknessRepresentscardiacemergencyandrequiresimmediatepericardiocentesisConstrictivePericardialDisease压迫性心包疾病（心包炎）Fibrosisofthepericardium纤维化渗出Usuallywithoutpericardialeffusion一般没有心包积液Middleageddogs,mainlylargebreedsSamesymptomsascardiactamponadeandpericardialeffusion和心脏栓塞，心包积液相同的症状RadiographyshowsabsenceofgloboseheartandpulmonaryoedemaX片显示没有球型心影。EchcardiographyshowsabsenceofpericardialeffusionSurgicalpericardectomyhasexcellentprognosisPeritoneal-PericardialDiaphragmaticHernia膈疝Congenitaldisorderwithgeneticpredispositionincatsanddogs(Persian,Himalayan,Weimaraner)先天遗传（波斯猫，希玛拉亚猫，威马犬）Oftenasymptomatic,dependingonherniatedorganandrestrictionofbloodflow.Inmanycasesareomentumandliverherniated,sometimessmallintestine,spleenandstomachGastrointestinalproblemssuchasanorexia,vomitinganddiarrhoeaarecommon胃肠问题：厌食，呕吐，拉希很常见Respiratorysymptomsalsooccur呼吸症状SignsofCHForcardiactamponadearerare充血性心衰和心脏栓塞发生很少Diagnosiswithradiology,ifnecessarycontrastradiologyandechocardiographyX片检查，有必要也可以增加心超Surgicaltreatmenthasexcellentprognosis手术的预后Peritoneal-PericardialDiaphragmaticHerniaHeartwormDiseaseHeartwormisaparasiticpulmonaryarterydiseaseduetoinfectionwithDirofilariaimmitis心丝虫是肺动脉寄生虫病Mosquitosingeststhemicrofilaria,after2weeksinsidethemosquitothemicrofilariaarematureenoughtodevelopinadog蚊子吞下微丝蚴，2周后，微丝蚴就发育感染狗4-5monthafterinfectionlarvaearepresentintheheartandpulmonaryarteries4-5个月后可以在心脏和肺动脉里发现幼虫6-7monthafterinfectionadultparasitesarepresentandreadytoproducemicrofilara6-7个月后发育为成虫，产生微丝蚴PhysicalExaminationDogsatleast6monthofage6月龄以上的狗Weightloss,anorexia体重减轻，没胃口Chronicnon-productivecough慢性咳嗽Respiratorydistress,dyspnoe呼吸困难Exerciseintolerance,syncope运动不耐受，昏厥Distendedabdomen腹部膨胀Signsofrightheartfailure–elevatedrightheartpreload右心衰竭症状Diagnosis诊断Microfilarialdetection微丝蚴检查

Concentrationtechniques(Knottstest,wetmound)Antigentests抗原检测(ELISA酶联免疫,Immunochromatographictests免疫层析)

Testsareverysensitive,falseresultsrare监测很灵敏Radiologyx片检查Electrocardiography(limitedapplication)心电图（不多）Echocardiography(limitedapplication)心超Hematology(eo