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  • Overview
  • Medical Options
  • Nutrition
  • Surgical and Interventional

Overview of Heart Disease Treatment

Heart disease and heart failure can have a variety of causes.  Because some heart diseases, even when they have progressed to cause heart failure, can sometimes be cured if the primary cause of the disease can be removed, it's critical to obtain an accurate diagnosis of your pet's heart condition as early in the course of disease as possible.  Conditions such as severe anemia, hyperthyroidism or systemic hypertension can cause or mimic the clinical signs and symptoms of heart failure, and can often be corrected before serious heart damage occurs. 

Many common congenital (present from birth) heart defects can now be corrected either surgically, or by sophisticated, catheter-based interventions. Many formerly life-threatening primary heart rhythm disturbances can also be corrected either surgically (e.g., by implantation of a permanent pacemaker - a routine procedure that is neither as expensive or as dangerous as many people assume!), or controlled medically with the use of appropriate antiarrhythmic drugs.

The most common "acquired" causes of heart disease -- those that occur most often in middle-aged and older animals, including progressive primary valvular or muscle diseases - are unfortunately not usually curable (yet!). Treatment for these diseases is currently aimed at improving the patient's capacity to enjoy life, as well as improving the duration of their life, generally through drug therapy along with certain "lifestyle" changes (diet and exercise). Most heart failure patients need to receive a combination of medications to best treat their disease, and medication adjustments may be needed from time to time.

You can learn more about treatment options for pets with heart disease by clicking on the tabs for Medical Treatment Options and Surgical and Catheter-Based Interventional Treatments.

Medical Treatment of Heart Disease and Heart Failure

Medical Treatment of Heart Disease and Heart Failure

In patients with heart disease who have not yet experienced any symptoms of their disease, the goal of therapy is directed at either eliminating the cause of the disease (if known and possible), or at delaying the onset of clinical signs.  North Carolina State University Cardiology is a leader in the development and conducting of clinical trials aimed at improving the lives of pets with heart disease. Treatment strategies for both dogs and cats with either acquired valvular heart disease or primary myocardial diseases (e.g., dilated or hypertrophic cardiomyopathy) are controversial prior to the onset of clinical signs of heart failure. You can count on your NC State cardiologist to keep you abreast of all of the latest developments and clinical trials as they apply to your pet. 

Participation in the NC State Heart Failure Program provides access for pets at all stages of heart disease to the latest developments in nutrition and exercise physiology as well as in the medical and surgical management of heart disease, with the goal of keeping pets healthy and happy for as long as possible.

For patients with acute or chronic symptoms of heart failure caused by an underlying disease that cannot be cured at this time, a combination of several types of medications is most often used - the following list includes some of the more common oral medications:

  • Diuretics (e.g., furosemide, thiazide, bumetanide) reduce the amount of fluid retained in the body (preload reduction).
  • Angiotensin converting enzyme (ACE) inhibitors (e.g., enalapril, benazapril, ramipril) improve the quality of life and survival among heart failure patients and may slow the deterioration of heart function in some heart diseases by disrupting the activation of the renin-angiotensin-aldosterone system. These drugs act as both preload and afterload reducers. 
  • Beta-adrenergic receptor blockers (e.g., atenolol, carvedilol) block the response of the heart to the "fight or flight" hormones (epinephrine / norepinephrine) and help to slow the heart rate and regulate the heart rhythm. These medications may protect the heart muscle, and help preserve heart muscle function in some kinds of heart disease.
  • Pimobendan (Vetmedin) has proven effective at improving both the quality and length of life of dogs with heart failure. Vetmedin's actions improve contractility (strengthens the heart muscle) and reduces afterload.
  • Spironolactone (an aldosterone antagonist) may be useful to prolong survival in dogs with heart failure by preventing the actions of the hormone aldosterone.
  • Digoxin, beta adrenergic blockers, and other antiarrhythmic drugs may be needed to help manage certain rhythm disturbances that are common in animals with heart failure. Digoxin is also occasionally used to strengthen the heart muscle.
  • Amlodipine, hydralazine and other drugs that dilate systemic arteries (afterload reducers) may be useful in managing heart failure that has become refractory to standard therapy with pimobendan, diuretics, and ACE inhibitors.  These drugs may also be used to treat high blood pressure (systemic hypertension).

In addition to surgical, interventional and pharmaceutical (drug) therapy, nutritional and dietary management can be important after the diagnosis of heart disease or the clinical onset of heart failure. Brief guidelines and common nutritional concerns for heart failure patients can be viewed by clicking on the "Nutrition" tab above; consultation with a veterinary nutritionist with interest and experience in managing pets with heart disease is available through the NC State Cardiology Care Network.

Patients with heart failure benefit from close clinical monitoring – the NC State Heart Failure Program and the Cardiology Care Network can help you keep track of your pet’s vital signs, answer questions and solve problems associated with chronic medication issues, and help you keep up with your pet’s changing needs to keep him or her an active and vital member of your family.

Nutrition in Heart Disease

 

Nutrition is central to good health, and there are important nutritional considerations in the management of heart disease.  Some heart diseases actually have a nutritional origin (e.g., taurine deficiency causing dilated cardiomyopathy in cats and some dogs, carnitine deficiency or insufficiency in dogs).  Many other micro- or macronutrient deficiencies and imbalances can potentially cause or contribute to the occurrence or progression of heart disease.

In general, dogs with serious heart disease tend to lose weight over time - when this unintentional weight loss exceeds 10% of the initial body weight, it is termed "cardiac cachexia," and it is an independent indicator of a poor prognosis. This is a less frequent occurrence in cats. Because of the impact that unintended weight loss has on quality of life and prognosis, significant efforts to make sure that your patient is eating enough of a well-balanced diet can pay significant long-term dividends. 

The following list of specific nutrients are often of concern when feeding dogs and cats with heart disease.

Salt [Sodium (Na) and Chloride (Cl)]:
Sodium, chloride and water tend to be retained in both heart disease and failure, and this retention can contribute to undesirable clinical symptoms in our pets. By decreasing the patient's salt intake, fluid retention can also often be limited, improving clinical signs of congestive heart failure. In commercial diets, when the sodium content is altered, the chloride content is similarly altered.

Excessive salt restriction can be problematic because:
1) medications used to treat heart disease, including diuretics and angiotensin converting enzyme inhibitors, can also affect water balance in pets;

2) low sodium diets tend to be less palatable, making some pets less apt to eat when feeling ill.

Dietary management:
For both of these reasons, mild to moderate salt restriction is generally the goal, unless significant restriction is needed due to advanced heart disease that is causing refractory fluid accumulations.  Mild to moderate salt restriction is usually defined as 0.15-0.25% salt on a dry matter basis for dogs, and 0.15-0.3% of the diet on a dry matter basis for cats.  More significant restrictions for advanced heart disease with clinical signs of refractory fluid accumulations would be in the range of 0.08-0.15% of the diet on a dry matter basis for both dogs & cats.  Dietary chloride levels are generally based on sodium levels, usually 1.5 x the sodium level on a dry matter basis.

Protein:
Animals with chronic diseases, including heart disease or heart failure, tend to lose weight, including both fat and lean muscle mass. Some animals experience the unintentional loss of a large percentage of their body weight (lean body mass loss greater than 10%), a condition known as cachexia. This negatively impacts long-term prognosis in heart failure. By maintaining moderate levels of protein in the diet, fed as high-quality protein sources, it is possible to support maintenance of lean muscle mass. The only time protein needs to be restricted in the dietary management of heart disease is when there is concurrent renal disease.

Dietary management:
Protein ranges: Dog: No protein restriction is generally recommended unless there is severe concurrent kidney disease, so protein concentrations should be in the range of 21-31% of the diet on a dry matter basis. This is in contrast to diets that offer severe restriction (e.g., renal diets) = 13-17% DMB; or even moderate restriction (e.g., hepatic or some cardiac diets) = 17-18%; mild restriction = 18-20%. In the cat, diets with a normal amount of protein contain >38% protein on a dry matter basis, with severely restricted (e.g., renal and hepatic diets) = 28-32% DMB; and moderate restriction (e.g., senior diets) = 33-37%.

Examples of high-quality protein sources include whole egg, dried egg, egg whites, skeletal meat (especially chicken) and organ meat.

Taurine:

Taurine deficiency has been associated with dilated cardiomyopathy in both dogs and cats. Taurine is a non-essential amino acid in dogs, meaning their bodies can make adequate taurine from amino acid precursors; whereas taurine is an essential amino acid in cats, meaning they require adequate taurine be provided in the diet, as they are unable to make adequate amounts endogenously.  Taurine supplementation has been shown to help improve some cardiac structural abnormalities and dysfunction associated with heart disease when the disease is associated with taurine deficiency or insufficiency.

Dietary management: Many cardiac management diets provide taurine at what is considered to be a therapeutic level, but taurine can also be supplemented (as a commercial product) to a diet when increased concentrations are desired. Dosing recommendations for dogs are independent of the amount included in the diet. A dose of 500 mg every 12 hours for a 40 kg dog is a recommended starting point for taurine supplementation.  Monitoring the echocardiogram to look for signs of structural improvement to the heart may help determine if the patient’s disease is taurine responsive.  Supplementation in cats with dilated cardiomyopathy should include 250mg twice daily.

L-Carnitine:
L-carnitine is a water-soluble, vitamin-like quaternary amine that is concentrated within the mammalian heart and skeletal muscles. It assists with long-chain fatty acid transport into the mitochondria of cells to allow fatty acids to be oxidized as an energy source for the body, including heart tissue. Long-chain fatty acids are utilized as the primary fuel source by heart muscle cells. Additionally, carnitine acts as a detoxifying agent scavenging free radicals in and around the cardiac cells. Animals with heart disease can either be deficient in L-carnitine or can benefit from additional supplementation in order to protect the heart muscle and cells of the heart.

Dietary management: Some cardiac management diets provide carnitine at what is considered to be a therapeutic level. Supplementation at a dose range of 50-100 mg/kg body weight up to three times daily, independent of what is included in the diet, is an alternative.

 
Potassium and Magnesium:

Potassium (K+) and magnesium (Mg) levels in the body can be impacted in heart failure due to the side effects of medications used to control heart disease. Potassium levels can be increased or decreased overall, and Mg levels tend to decrease. These electrolytes should be monitored during therapy, and the diet adjusted accordingly as needed.

Dietary management:
Recommended to maintain moderate levels in the diet: 0.4-0.52% K+ DMB and 0.04-0.06% Mg, DMB (dog & cat).

Phosphorous:
Phosphorous levels can elevate in heart disease if there is concurrent renal disease. This electrolyte can be restricted in the diet if hyperphosphatemia is a concern.

Dietary management: Restrict phosphorus (P) when concurrent renal compromise is present.  Recommended dietary level: 0.2-0.7% P, DMB (dog); 0.3-0.7% P, DMB (cat).


Omega-3 Fatty Acids:
Supplementation of omega-3 fatty acids can help decrease the production of inflammatory mediators that promote adverse clinical symptoms of heart disease, improve myocardial function, slow the rate of cachexia, and potentially help maintain a normal heart rhythm.

Dietary management:
The dose range recommended for anti-inflammatory effect is 50-200 mg/kg/day. A more specific dose range was cited as being effective in the treatment of arrhythmias in ventricular cardiomyopathy as 780 mg EPA and 497 mg DHA per day. (Smith, et al. J Vet Intern Med 2007; 21:265–273).


Water:
In severe, advanced heart disease significant sodium restriction is generally needed, therefore  distilled water is recommended as it is significantly lower in sodium content than tap or well water.

Dietary management:
Distilled water if needed. All pets with heart disease should have free access to water.

Calculating Caloric Needs (in kilocalories or kcal) in Heart Disease / Failure
The following simple calculations can provide a general idea of whether a patient with heart disease or failure is eating enough food to maintain a healthy body weight.  Individual energy requirements may vary significantly - if you have questions or concerns about an individual animal's energy requirement or food or caloric intake, please contact the NCSU Nutrition Service.


Resting Energy Requirement (RER): The RER is the energy required to maintain a normal animal at rest in a normal environment.  RER reflects the energy needed for food digestion, absorption and metabolism, and recovery from previous activity. There are at least 2 formulas used to "guesstimate" the RER, the NCSU Nutrition Service generally uses the first formula below:

RER = [(body weight in kg) 0.75]  x  70 = kcal of metabolizable energy (ME)/day

or alternatively:

RER = [(BW kg) x 30] + 70 = kcal ME/day


The Daily Energy Requirement (DER) is the total daily energy required - including activity.  DER is calculated as RER multiplied by a numerical factor that is used to adjust for physiological factors such as age, gender, activity, and reproductive status.  The NCSU Nutrition Service uses the calculation and "DER factors" listed below:

DER = RER x DER factor = kcal ME/day

CANINE  DER Factors   
Description
1.6  x  RER    Neutered pet, optimal body condition
1.8  x  RER    Intact, optimal body condition
1.2-1.4  x  RER  Obesity-prone
1.8-2.5 x RER for weight-gain in the face of cachexia
   
FELINE DER Factors   
Description
1.2  x  RER    Neutered pet, optimal body condition
1.4  x  RER    Intact, optimal body condition
1.6  x  RER    Active adult
1  x  RER Obesity-prone adult
1.4-2.0 x RER for weight-gain in the face of cachexia

 The following tables summarize the contents of a number of commercially available diets that are commonly used by the NCSU Nutrition Service as part of a customized, balanced diet for dogs and cats with serious heart disease or heart failure.

 

 

Feline Dry Diets Kcal % protein Protein Source % Na % K % Mg Taurine Carnitine n-3 FA
Hill's g/d 297/cup 33.5 corn gluten meal; chicken by-product meal; soybean mill run; pork protein isolate; fish meal 0.32 0.77 0.049 0.14

Hill's k/d 477/cup 28.3 corn gluten meal, chicken by-product meal, dried egg product, dried chicken, fish meal 0.25 0.75 0.056 0.16
0.22
Hill's l/d 505/cup 31.8 chicken by-product meal, soybean meal, dried egg product, fish meal 0.27 0.92 0.084 0.53 1004 mg/kg
Hill's z/d low allergen 396/cup 33 hydrolyzed chicken liver 0.3 0.75 0.071 0.31
0.65
Hill's Mature Adult 7+ 475/cup 33.7 chicken by-product meal; corn gluten meal; soybean mill 0.32 0.88 0.069 0.16

Purina NF 398/cup 30.78 corn gluten meal, soybean meal, animal digest, fish meal 0.2 0.88 0.1 0.18
0.31
IAMS Intestinal Low Res 348/cup 36.7 chicken by-product meal, chicken, dried egg product 0.25 0.68 0.089 0.24

IAMS Urinary S  386/cup 37.9 chicken liver, chicken by-product meal, chicken, herring meal, dried egg product, chicken by-products 0.27 0.82 0.09 0.73





















Feline Canned Diets Kcal % protein Protein Source % Na % K % Mg Taurine Carnitine n-3 FA
Hill's g/d 165/5.5 oz 34.3 turkey; pork liver 0.32 0.72 0.088 0.44

Hill's k/d 183/5.5 oz 28.6 pork liver; beef by-product, pork by-product 0.3 1.02 0.049 0.37
0.54
Hill's l/d 183/5.5 oz 31.6 pork liver, egg, corn gluten meal, soybean meal 0.2 0.92 0.064 0.52 1,004 mg/kg
Hill's z/d ultra 169/5.5 oz 33.7 hydrolyzed chicken liver 0.3 0.8 0.064 0.38
0.45
Hill's Mature Adult 7+ 87/3 oz 37 skeletal meat; liver; meat by-products  0.28 0.84 0.072 0.48

Purina CV 223/5 oz 42.53 liver; beef; fish 0.2 1.33 0.07 0.31 0.03
Purina NF 193/5 oz 31.39 poultry by-products, beef, meat by-products, chicken 0.23 1.48 0.11 0.38
1.02
IAMS Maximum Calorie 333/6 oz 41.4 chicken, chicken by-product meal 0.23 1.01 0.089 0.32

RC Renal LP Modified 219/6 oz 29.61 pork by-products, chicken, chicken liver, pork 0.3 1.07 0.13 0.77





















Canine Dry Diets Kcal % protein Protein Source % Na % K % Mg Taurine Carnitine n-3 FA
Hill's b/d 358/cup 18.9 chicken by-product meal, boybean meal, fish meal, dried egg product 0.18 0.87 0.166
299 mg/kg
Hill's g/d 358/cup 18.7 chicken by-product meal; dried egg; pork protein isolate 0.21 0.61 0.068 0.1
0.78
Hill's h/d 407/cup 18.6 soy protein, chicken by-product meal, dried egg 0.08 0.8 0.122 0.14 307 mg/kg
Hill's j/d 336/cup 20.1 chicken by-product meal; soybean mill run; soybean meal; dried egg product 0.17 0.84 0.145 0.13 351 mg/kg 3.51
Hill's k/d 396/cup 14.5 dried egg product, corn gluten meal 0.24 0.65 0.101

1.51
Hill's l/d 437/cup 17.6 dried egg product, soybean meal, pork protein isolate 0.22 0.9 0.086
301 mg/kg
Hill's w/d 243/cup 18.9 chicken by-product meal, soybean meal, dried egg product 0.21 0.59 0.098
318 mg/kg
Hill's w/d with chicken 236/cup 18.9 chicken by-product meal, chicken, soybean meal, corn gluten meal, dried egg 0.23 0.66 0.102
328 mg/kg
Hill's  Advanced Protect 7+ 363/cup 19.2 chicken by-product   meal; soybean mill run; corn gluten meal; dried egg product 0.17 0.83 0.117 0.13 302 mg/kg
Hill's Mature Adult 7+ 363/cup 19.3 chicken by-product meal, corn gluten meal, dried egg product 0.18 0.83 0.109


Hill's Mature Adult 7+ Sr. 357/cup 19.2 chicken by-product meal, dried egg product 0.17 0.82 0.108
319 mg/kg
Hill's Light Adult 295/cup 24.4 chicken by-product meal, corn gluten meal, soybean meal, dried egg product 0.24 0.8 0.119
314 mg/kg
Purina DRM 394/cup 30.2 salmon meal, trout 0.24 0.78 0.17

1.18
Purina HA 311/cup 21.33 hydrolyzed soy protein isolate  0.24 0.69 0.11 0.12

Purina NF 459/cup 15.89 dried egg product, animal digest 0.22 0.86 0.07

0.3
Purina Pro Plan                    Weight Management Chicken & Rice 337/cup 30.49 chicken, by-product meal, corn gluten meal, fish meal, animal digest 0.27 0.63 0.11


IAMS Wt Loss Restrict Cal 217/cup 25.3 chicken by-product meal, dried egg product, fish meal 0.25 0.77

40 mg/kg
RC Early Cardiac EC 22 287/cup 23.1 chicken meal; fish meal; soy protein isolate 0.22 0.82 0.077 0.22

RC Diabetic HF 213/cup 22.53 chicken meal 0.29 0.91 0.08 0.11

RC Hepatic LS 14 324/cup 17.03 soy protein isolate 0.19 0.91 0.05 0.23

RC Mobility Support JS 23 321/cup 26.92 chicken meal, corn gluten meal 0.29 0.91 0.09 0.23

RC Renal LP Modified 271/cup 13.74 chicken meal, corn gluten meal 0.22 0.98 0.07 0.22

RC Renal MP Modified 320/cup 17.03 chicken meal, dried egg product 0.27 0.98 0.07 0.23





















Canine Canned Diets Kcal % protein Protein Source % Na % K % Mg Taurine Carnitine n-3 FA
Hill's g/d  377/13 oz 18.1 pork liver, beef by-products, turkey 0.22 0.78 0.067

0.67
Hill's h/d  480/13 oz 17.3 soy protein, chicken by-product meal, dried egg product 0.11 0.81 0.131 0.21 332 mg/kg
Hill's j/d 498/13 oz 19.6 liver, meat by-products, lamb, soybean meal, egg product 0.19 0.81 0.112
317 mg/kg 4.24
Hill's k/d 496/13 oz 13.8 pork liver, dried egg white 0.2 0.77 0.141

1.75
Hill's l/d 472/13 oz 17.9 egg product, soybean meal, corn gluetn meal 0.23 0.91 0.094
306 mg/kg
Hill's n/d 569/13 oz 38 beef by-products, pork liver, chicken 0.27 1.1 0.062

7.29
Hill's r/d 257/13 oz 25.3 pork by-products, pork liver, soybean meal 0.24 0.73 0.118
371 mg/kg
Hill's w/d 329/13 oz 17.9 egg product, chicken, pork liver 0.24 0.64 0.088
364 mg/kg
Hill's z/d ultra 360/13 oz 19.6 hydrolyzed chicken liver 0.2 0.65 0.057

0.49
Purina CV 638/12.5 oz 17.82 liver, beef, egg product 0.12 1.21 0.06 0.24 0.02
Purina NF 500/12.5 oz 16.5 liver, beef, dried egg product 0.24 0.72 0.08

0.59
IAMS Maximum Calorie 333/6 oz 41.4 chicken, chicken by-product meal 0.23 1.01 0.089 0.32

RC Renal LP Modified 661/13.6 oz 18 pork by-products, chicken by-products, dried egg product 0.29 0.97 0.09 0.67

Dietary Energy (Calorie) Requirements in Heart Disease

Calculating the Caloric Needs (in kilocalories or kcal) of the Heart Disease and Heart Failure Patient

Resting Energy Requirement (RER)

Definition: The energy requirement for a normal, un-fasted animal at rest in a normal environment.
RER reflects the energy needed for food digestion, absorption and metabolism, and recovery from previous activity. There are at least 2 formulas used to "guesstimate" the RER.

RER Calculations:

RER = [(body weight in kg) 0.75]  x  70 = kcal of metabolizable energy (ME)/day

or alternatively:

RER = [(BW kg) x 30] + 70 = kcal ME/day


Daily Energy Requirement (DER)

Definition: The total daily energy (DER) is calculated as RER multiplied by a numerical factor that is used to adjust for physiological factors such as age, gender, activity and reproductive status.

DER Calculation: DER = RER x DER factor = kcal ME/day

CANINE  DER Factors   
Description
1.6  x  RER    Neutered pet, optimal body condition
1.8  x  RER    Intact, optimal body condition
1.2-1.4  x  RER  Obesity-prone
1.8-2.5 x RER for weight-gain in the face of cachexia
   
FELINE DER Factors   
Description
1.2  x  RER    Neutered pet, optimal body condition
1.4  x  RER    Intact, optimal body condition
1.6  x  RER    Active adult
1  x  RER Obesity-prone adult
1.4-2.0 x RER for weight-gain in the face of cachexia

Surgical and Interventional Treatments for Congenital and Acquired Heart Diseases

North Carolina State University Cardiology is an internationally recognized leader in the development and delivery of surgical and interventional treatments for both congenital and acquired heart disease in dogs and cats. Many diseases that were previously managed by open surgical or palliative medical therapy can now be successfully treated by catheter-based interventional or "hybrid" surgical procedures. 

The risk of serious complications or death associated with catheter-based interventions is extremely low at NC State. Thanks to a dedicated, multidisciplinary team of cardiologists, surgeons, anesthesiologists, and criticalists, less than 2% of all interventional cases experience serious problems.  Risks associated with hybrid and other surgical procedures depend on a number of patient and disease-related factors - your NC State cardiologist will discuss both the risks and the potential benefits of any procedure your pet may need to treat his or her heart disease at the time of your evaluation.

Links to brief summaries of the most common congenital and acquired heart diseases that are treated by interventional or surgical methods can be found below.

Congenital Heart Diseases

Acquired Heart Diseases


Patent Ductus Arteriosus (PDA)

 
Before
(PDA) is the term used to describe the persistence after birth of a vessel that normally connects the descending aorta to the main or left pulmonary artery in the fetus (see glossary).  PDA is the most common congenital heart disease in dogs (it is relatively uncommon in cats).  Most often found at the time of routine veterinary examination by the presence of the typical continuous murmur heard best high in the left armpit on auscultation, PDA should be treated as soon as it is suspected, since early repair provides an excellent long-term prognosis for a completely normal life. Left untreated, approximately 2/3 of dogs with PDA will die from congestive heart failure within their first year of life.

Several interventional devices, including the Amplatz Canine Ductal Occluder, are available for PDA closure, depending on the circumstances and morphology of the lesion. In addition, experienced, ACVS board-certified cardiothoracic surgeons are available for the patients in whom surgical ligation remains the best option. 

Typical diagnostic echocardiographic views of a PDA before treatment, as well as trans-esphageal and angiographic "before and after" images of PDA closure in the  NC State cardiac catheterization laboratory are illustrated. The average total cost of evaluation and interventional PDA closure at NC State is approximately $3,000.00; when necessary, open surgical occlusion through an incision into the chest is often somewhat more expensive, and carries a somewhat higher risk of significant complications. 

Pulmonary Valve Stenosis (Pulmonic Stenosis)

 

Pulmonic stenosis is the term used to describe a narrowing of the pulmonary valve.  This narrowing may be caused by varous malformations of the valve structure, and subtle differences in the anatomy of the valve can significantly impact treatment.  Pulmonic stenosis is a relatively common in congenital heart defect in dogs; it is less common in cats. Depending on the anatomy of the malformed valve and it’s surroundings, a variety of interventional procedures can successfully relieve the obstruction. Both conventional and cutting balloon valvuloplasty are available at NC State, with initial success rates greater than 95%, and sustained benefit without restenosis achieved in greater than 85% of cases.

In some cases of severe subvalvar pulmonic stenosis, a surgical or a hybrid interventional-surgical procedure may be needed to best address the defect.

Images illustrate a typical pulmonic balloon valvuloplasty in the NC State cardiac catheterization laboratory. Cost of valvuloplasty depends on the complexity of the lesion and the procedure, but averages approximately $3,200.00, including the cost of the initial diagnostic work-up.

Subaortic Stenosis

Subaortic stenosis describes a fibrous congenital narrowing below the aortic valve that increases the resistance to the flow of blood from the left ventricle into the aorta.  Subaortic stenosis has been treated by a variety of balloon procedures in the past with variable (but poor) long-term success, and depending on the clinical signs, echocardiographic severity, and Holter monitoring results, conservative medical management may be best for many of these cases.  Newer techniques (including hybrid surgical and interventional procedures) are being developed for the treatment of subaortic stenosis, but these are investigational at this time.  If your pet has subaortic stenosis, your cardiologist will discuss all appropriate options for management with you at the time of your evaluation.

Tetralogy of Fallot

Tetralogy of Fallot is a constellation of congenital defects (including pulmonic stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy) that cause a variety of different clinical signs in both dogs and cats, depending on the nature of the defect in cardiac septation that causes the problem. Various interventional and surgical options are available to help animals with tetralogy of Fallot at NC State; the best option can often be determined by your cardiologist at the initial visit, although sometimes further information available only from cardiac catheterization is needed to determine the best treatment option. Treatment may include catheter-based, surgical, or hybrid intervention, depending on the anatomy and pathophysiology of the defect.

The NC State cardiology service offers a complete range of interventional, surgical, and hybrid treatment procedures for a wide variety of other congenital heart defects (including atrial and ventricular septal defects, subaortic stenosis, and complex congenital heart diseases). The first step in helping any animal with congenital heart disease is to get the earliest, most accurate diagnosis possible. If you suspect your pet or patient may have a congenital heart defect, consultation with a board certified veterinary cardiologist is always recommended regardless of the pet’s current clinical status or size.

Supraventricular and Ventricular Tachyarrhythmias

Various persistent tachyarrhythmias, including some supraventricular and ventricular tachycardias and atrial fibrillation, may soon be amenable to permanent, catheter-based interventional correction. NC State Biomedical Engineering, in collaboration with NC State Cardiology and Duke University is helping to develop a robotic catheter that will allow cardiologists and electrophysiologists to accurately target and eliminate many of these arrhythmias. Availability of these new procedures is planned to coincide with the opening of the new NC State-CVM Terry Center. 

 

Mitral Valve Disease

Chronic, degenerative changes of the mitral valve are the most common heart disease in dogs.  NC State cardiology in collaboration with other institutions is actively working to develop a catheter-based or hybrid solution to reducing mitral valve insufficiency.

High-grade AV block

Artificial cardiac pacing is frequently a life-saving procedure – pacemakers are used to treat a variety of rhythm conditions in dogs and cats, most frequently high grade atrioventricular block (complete heart block) and sick sinus syndrome. 

The type of pacemaker, chambers sensed and paced, and method of pacing (transvenous or epicardial) will generally be decided in consultation with your cardiologist at the time of hospital admission.

Cardiac pacing is a routine procedure at NC State with a low complication and high success rate, and it is often much less expensive than many clients and veterinarians imagine. NC State participates in the ACVIM CANPACERS central clearinghouse for donated pacemakers, which keeps equipment costs to a minimum.  Including the cost of the initial diagnostic workup, the average cost of pacemaker implantation at NC State is approximately $3,200.00. Click on the image to see a radiograph of a typical dog with an implanted pacemaker. The prognosis of dogs with pacemakers for a normal life is excellent.

Sick Sinus Syndrome

Artificial cardiac pacing is frequently a life-saving procedure – pacemakers are used to treat a variety of rhythm conditions in dogs and cats, most frequently high grade atrioventricular block (complete heart block) and sick sinus syndrome. 

The type of pacemaker, chambers sensed and paced, and method of pacing (transvenous or epicardial) will generally be decided in consultation with your cardiologist at the time of hospital admission.

Cardiac pacing is a routine procedure at NC State with a low complication and high success rate, and it is often much less expensive than many clients and veterinarians imagine. NC State participates in the ACVIM CANPACERS central clearinghouse for donated pacemakers, which keeps equipment costs to a minimum.  Including the cost of the initial diagnostic workup, the average cost of pacemaker implantation at NC State is approximately $3,200.00. Click on the image to see a radiograph of a typical dog with an implanted pacemaker. The prognosis of dogs with pacemakers for a normal life is excellent.

Pericardial Diseases

Pericardial diseases often present as emergent cases of collapse, because fluid build-up within the pericardium puts pressure on the heart (a situation called cardiac tamponade). Ultrasound-guided pericardiocentesis is used to remove this fluid, and assess the cause of its build-up. In some cases, surgical removal of the pericardium (either by open surgery or thoracoscopy) is needed; in other cases, balloon pericardiotomy, medical therapy, or other therapy may be indicated. 


Call the Cardiology Care Network Hotline tollfree at 888-962-7763 for answers to any questions that you have about your pet's heart disease, or to schedule an appointment through the NC State Heart Failure Program. The Cardiology Care Network Technician is available between the hours of 9AM - 5PM Monday - Friday; Outside of regular business hours, emergency assistance is available 24 hours / day, 7 days / week through the NC State-VTH Emergency service (phone 919-513-6911).

Sponsored by an educational grant
from Boehringer Ingelheim Vetmedica, Inc.