Clinical techniques in small animal practice最新文献

Noninvasive blood pressure measurement is now a standard diagnostic test in small animal practice. Factors such as patient selection, environment, technical support staff, and necessary equipment and supplies will be discussed. Step by step techniques for obtaining reliable blood pressure measurements in both cats and dogs are presented.

Transvenous cardiac pacing is a commonly employed treatment for symptomatic bradyarrhythmias in dogs. Medical management of these conditions has not proven to be successful leaving pacing as the only viable alternative. The technique of pacemaker implantation is not difficult, but successful pacemaker therapy requires an understanding of electrophysiology, cardiac fluoroscopic anatomy, pacemaker instrumentation, and programming. Proper patient selection and identification of the underlying rhythm disturbance is essential to a successful clinical outcome. This article discusses the indications, equipment, techniques, complications, and outcome of permanent transvenous cardiac pacing.

Balloon valvuloplasty has become the accepted method of therapy for the majority of dogs with valvular pulmonic stenosis. Success rate of balloon valvuloplasty is excellent but the procedure can have a steep learning curve. An understanding of the equipment used and specifics of the procedure is important to maximize success and minimize risk. This paper will review criteria for choosing candidates for balloon valvuloplasty, discuss the equipment used, discuss the procedure in detail, and finally discuss assessment of success and possible complications.

The asymmetric shape of the heart, small acoustic window, and range of interindividual variation in normal and abnormal states all can limit the extent of echocardiographic studies in small animal medicine. Beyond these uncontrollable variables, however, there are a number of additional potentially complicating factors that the echocardiogapher controls. Understanding and handling this second category of variables is critical for optimizing the quality and diagnostic value of echocardiographic studies. These variables range from such simple issues as proper restraint and an indissociable association between echocardiographic findings and clinical information, to specific points relating to simultaneous electrocardiogram display, good visualization of cardiac structures using multiple overlapping imaging planes, and avoidance of oblique or tangential views. The basic overview presented here aims to describe these commonly encountered, clinically relevant points in a way that helps veterinarians improve the quality of echocardiograms they perform.

Holter monitoring is a valuable noninvasive tool for the monitoring of the cardiac rhythm over a prolonged period during normal daily activities. The advent of this diagnostic test has demonstrated that the incidence of serious arrhythmias is much greater than previously determined using routine electrocardiography. A resting electrocardiogram is typically recorded for several seconds to several minutes and is likely to miss or underestimate the underlying arrhythmia. This article will present the clinical indications, equipment, technical application, and assessment of holter monitoring.

Left to right shunting patent ductus arteriosus (PDA) is the most common canine congenital heart defect. If not occluded PDA is associated with high morbidity and mortality. Historically, surgical ligation has been the standard method of correction. Although highly successful, surgical ligation is associated with some operative morbidity and mortality. More recently, minimally invasive transcatheter techniques have been employed for PDA occlusion. Transarterial PDA coil embolization is a safe, cost effective, less invasive alternative offered by many specialty centers for PDA occlusion. This procedure involves catheterization of the femoral artery under general anesthesia. An angiogram is then performed to delineate PDA morphology and facilitate coil selection. Coils are commercially available and composed of surgical stainless steel with prothrombotic poly-Dacron fibers. Coils are advanced through a catheter into the PDA under fluoroscopic guidance until satisfactory angiographic occlusion is documented. Patients are then recovered and released the following day. This procedure requires substantial technical expertise and specialized equipment.

It may be unusual to think of a physical examination as a technique, but what better “instruments” do we have than our eyes, our ears, and our hands? Therefore, I will describe several “techniques” that I felt should be included in this journal, but that do not warrant an article of their own. This article will cover some parts of the routine physical examination, correct positioning of cats and consequences of bad positioning, radiographic techniques that will help diagnose heart failure more consistently, examination of dogs with lower airway disease, and examination of cats with aortic thromboembolism (ATE). Several “pearls” that may get lost in the other information is sprinkled throughout the article.

Pericardial effusion is a potentially life-threatening problem leading to a rise in the intrapericardial pressure resulting in varying degrees of hemodynamic compromise. Cardiac tamponade occurs when the intrapericardial pressure equals or exceeds right ventricular diastolic filling pressures leading to a decreased cardiac output. In dogs, the most common causes of pericardial effusion that require pericardiocentesis are cardiac neoplasia and idiopathic pericardial effusion (IPE). The incidence of cardiac neoplasia in dogs is low, and it is rare in cats. In dogs, hemangiosarcoma and chemodectoma are the two most common types of cardiac neoplasia. In cats, lymphosarcoma is the most common form of cardiac neoplasia, but they are more likely to develop pericardial effusion secondary to congestive heart failure or feline infectious peritonitis. Common histories include lethargy, dyspnea, anorexia, collapse, and abdominal distension. Pericardiocentesis is used to stabilize animals with life-threatening cardiac tamponade, relieve the pressure leading to right-sided heart failure, and obtain fluid samples for diagnostic evaluation. The fluid should be quantified and characterized. Serious complications associated with pericardiocentesis are rare. Complications include cardiac puncture, arrhythmias, and laceration of a tumor or coronary artery resulting in intrapericardial hemorrhage or sudden death.