A male, Mullinoise breed K9 dog, 23 kg weight and of 5.7 years old, had been brought to the Consultant Veterinary Teaching Hospital, College of Veterinary Medicine, University of Basrah, Iraq, with a patient history of acute illness of 1-4 days’ duration, Dyspnea with open-mouth breathing sometimes, lethargy, reduced food intake, an obvious distended abdomen developed gradually, reduced exercise tolerance, coughing, and occasionally weight loss with fainting only at exercise sometimes. In addition to a history of deworming and vaccination had been applied previously. Clinical examination revealed respiratory distress, severe abdominal distension, lethargy, pale gum and mucous membrane, Harsh lung sound with pulmonary crackles are typically present on the auscultation of the chest, However, a loud murmur is indicated on auscultation of the heart area, Furthermore, slight hepatomegaly, Distended jugular vein and a weak femoral arterial pulse were also detected on clinical palpation of diseased dog. Congestive heart failure was suspect, according to the clinical presentation, Hematological and biochemical results, in addition to Ultrasonography diagnosis.
A male, Mullinoise breed K9 dog, 23 kg weight and of 5.7 years old, had been brought to the Consultant Veterinary Teaching Hospital, College of Veterinary Medicine, University of Basrah, Iraq, with a patient history of acute illness of 1-4 days’ duration, Dyspnea with open-mouth breathing sometimes, lethargy, reduced food intake, an obvious distended abdomen developed gradually, reduced exercise tolerance, coughing, and occasionally weight loss with fainting only at exercise sometimes. In addition to a history of deworming and vaccination had been applied previously. Clinical examination revealed respiratory distress, severe abdominal distension, lethargy, pale gum and mucous membrane, Harsh lung sound with pulmonary crackles are typically present on the auscultation of the chest, However, a loud murmur is indicated on auscultation of the heart area, Furthermore, slight hepatomegaly, Distended jugular vein and a weak femoral arterial pulse were also detected on clinical palpation of diseased dog. Congestive heart failure was suspect, according to the clinical presentation, Hematological and biochemical results, in addition to Ultrasonography diagnosis.
A different and multiple causes had been indicated to describe ascites in dogs, Disorders of different body organs like liver and kidney, Hypoprotenemia and heart failure could be the main and a common cause associated with ascites in dogs [1, 2]. However, Ascites may indicate a serious condition that needed an immediate medical and may be rationale treatment, which must depend on proper diagnosis [3, 4]. Congestive heart failure (CHF) defined as the presence of accumulated fluids in the lungs (as a pulmonary edema), in the pleural space (as a pleural effusion), in the abdominal cavity (as ascites), or pericardial sac (as a pericardial effusion) due to cardiac dysfunctions, Moreover, in congestive heart failure, The heart cannot deliver a sufficient amount of blood to its own body which might cause by failure of the right side of the heart, or the left side or both of them [5]. Accumulation of cardiogenic fluid only occurs in dogs with elevated diastolic, ventricular, and /or atrial filling pressures, Therefor, The Left-sided Congestive heart failure might developed in dogs with high left heart filling pressures which leads to pulmonary edema with or without small volume of pleural effusion, On the other hand, The Right-sided Congestive heart failure will occur in dogs when the right heart filling pressures will elevated and is reflected as ascites with or without pleural effusion, Nevertheless, Most dogs with large volume pleural effusion might have biventricular heart failure with elevated right and left heart filling pressures [6].
The most important and common causes of congestive heart failure are valvular disease (congenital or acquired), Dilated cardiopaty, endocardiosis, mitral and tricuspid regurgitation, congenital heart disease, Heart worms, Increase blood pressure, Tumers and even pregnancy in females [7]. Furthermore, Erling and Mazzaferro 2008 [5], added that, the probable cause such as a deficiency of vitamin E and / or selenium also might play good rule in the occurrence of myocardial dystrophy, Moreover, heart failure can be primary or secondary to other diseases, such as atherosclerosis, chronic nephritis, liver disease and even obesity [8]. At the early stage of the condition, dogs show no clear clinical signs, whereas, when the disease progresses, diseased animals might show, coughing, difficult or rapid respiration, lack of performance and fast tiredness, episodes of faint, gray or blue gums, abdominal distension, collapse and finally death [5].The present case report, illustrated the diagnosis of congestive heart failure associated with ascites and its management in a male, Mullinoise breed, police dog.
Case history and present clinical and laboratory examinations of the present case
A male, Mullinoise breed a police (K9) dog, 23 kg weight and of 5.7 years old, had been brought to the Consultant Veterinary Teaching Hospital, College of Veterinary Medicine, University of Basrah, Iraq, with a patient history of acute illness of 1-4 days’ duration, dyspnea with open-mouth breathing sometimes, lethargy, reduced food intake, an obvious distended abdomen developed gradually, reduced exercise tolerance, coughing, and occasionally weight loss with fainting only at exercise sometimes. In addition to a history of deworming and vaccination had been applied previously. Clinical examination revealed respiratory distress, severe abdominal distension, (Fig 1), lethargy, pale gum and mucous membrane, Harsh lung sound with pulmonary crackles are typically present on the auscultation of the chest, However, a loud murmur is indicated on auscultation of the heart area, Slight hepatomegaly, Distended jugular vein. A weak femoral arterial pulse was also detected on clinical palpation of the diseased dog.
Vital signs of the dog, (Table 1) show that, Body temperature is 38.4 C. Heart rate of 105/ min, respiratory rate 37/ min. Capillary refill time is 5/Sec. (Table1). Blood was collected for a complete blood analysis (On an automatic full digital cell counter, Beckman, USA) and the results are shown in (Table 2). Since it seems that the disease dog have a Macrocytic Hypochromic type of anemia, with high value of erythrocyte sedimentation rate, However the total platelet count was low. Serum was prepared for biochemical analysis and the results indicated low values of total protein (Hypoprotenemia). Increase value of Troponin I, Hcy, CpK-MB, and LDH, However, Triglyceride and total Cholesterol values was also high. (Table 3).
Figure 1: Abdominal Distension of the Disease Dog.
Table 1: The vital signs of the diseased dog [9].
Table 2: Complete blood analysis of the disease dog [10].
Furthermore, the dog was subjected to ultrasound examination and Abdominal ultrasonography revealed floating viscera in the anechoic abdominal fluid, Fig.2, Moreover, No abnormal echogenicity was noticed with the abdominal organs such as kidney, spleen, and urinary bladder, However slight hepatomegaly was specified. Furthermore, an expectance of ventricular hypertrophy with accumulation of cardiac effusion was also detected. Fig 3. Moreover, fecal examination reveals negative for endoparasite and intestinal protozoan infestation.
Table 3: Biochemical analysis of diseased dog [10].
Figure 2: Abdominal Ultrasonography Revealed Floating Viscera in the Anechoic Abdominal Fluid.
Figure 3: Ventricular Hypertrophy with Accumulation of Cardiac Effusion.
Moreover, A medical treatment has been prescribed includes (Nebivolol 1mg daily orally (A Beta-blockers and blood pressure regulator), Ringer's solution I.V infusion, Furosemide 4mg I.M for 5 days. After 2-3 days of giving therapy, slight improvement in physical activity, appetite and general health condition observed, however, abdominal distension was disappeared. Fig.5.
The clinical manifestations beside the hematological and biochemical results of the present case were agreed with others [5, 8, 11]. It had been mentioned that in many animals with a long history of mitral valve insufficiency, pulmonary hypertension and right side heart failure might be developed and the right side heart failure might be occurred as secondary due to persistent elevation of left atrial and pulmonary venous pressures, Furthermore, As the wall of right ventricle is thinner and more compliant as compared to the left ventricle, it can be increased in volume, However, this caused a decreased in stroke volume of the heart. As a result of elevated right atrial pressure, ascites, pleural, pericardial effusion, hepatomegaly and even splenomegaly might be developed, However, The most common manifestations of right heart failure are respiratory distress, abdominal distension due to ascites, hepato or splenomegaly [12, 13]. Moreover, Saunders and Gordon, 2015 [8], was also agreed and added that, Congestive heart failure will expected, when the heart is no longer able to compensate, as systemic congestion may result from the impaired blood flow returning to the right heart from the body and the blood will backs up and fluid leaks through the vessels into other parts of the body, resulting to ascites, pleural and pericardial effusion. Another idea that had added by [3, 4], As, In congestive heart failure cases that develop slowly, the collapse of blood pressure and the installing of a cardiogenic attach are of the most possible outcomes, in addition, A dog’s myocardium tries and managing to Adjusts to the new situation by using different restoring mechanisms, such as tachycardia, tachypnea that means rapid contractions of the heart, vasoconstriction and by increasing its volume, Moreover, After a while the poor irrigation of the internal organs will resulting in pulmonary edema, liver failure and passive venal congestion.
Figure 4: Evacuation of the Abdominal Fluid via Laboratomy.
Figure 5: Slight Improvement of the Dog after 2-3 Days.
Results of the present case show increase values of cardiac enzymes which, confirmed the diagnosis of the congestive heart failure of the dog, Since the cardiac enzymes was considered as a good biomarkers for evaluation of myocardial problems, Because they have nearly absolute myocardial tissue specificity and higher sensitivity than others [14,15].
Figure 1: Abdominal Distension of the Disease Dog.
Table 1: The vital signs of the diseased dog [9].
Table 2: Complete blood analysis of the disease dog [10].
Table 3: Biochemical analysis of diseased dog [10].
Figure 2: Abdominal Ultrasonography Revealed Floating Viscera in the Anechoic Abdominal Fluid.
Figure 3: Ventricular Hypertrophy with Accumulation of Cardiac Effusion.
Kamal M. Alsaad, Department of internal and preventive medicine, College of Veterinary Medicine, University of Basrah, Iraq.
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