O papel da ecocardiografia no diagnóstico e decisão terapêutica da doença valvular crónica
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2019-07-04
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A ecocardiografia é uma técnica imagiológica, não-invasiva, que permite realizar o diagnóstico definitivo de doenças cardíacas e avaliar a progressão das mesmas. Este exame complementar, assume um papel muito importante no diagnóstico da doença valvular crónica (DVC), a doença cardíaca adquirida mais frequente em cães. Deste modo, o objetivo deste estudo retrospetivo foi avaliar a importância da ecocardiografia no diagnóstico, na classificação e na decisão terapêutica da DVC. Neste trabalho, foram incluídos 18 cães com DVC, que foram levados pelos seus tutores à consulta, no Hospital Veterinário de Portimão, durante o período de janeiro a novembro de 2018, pelos mais diversos motivos. A população deste estudo estava maioritariamente representada por machos (n=10), de raças pequenas (n=10) e geriátricos (n=17). No exame físico, foi detetado sopro sistólico (n=18), tosse (n=8), taquipneia e/ou dispneia (n=8) intolerância ao exercício (n=2) e síncope (n=1), sendo que 10 animais não apresentavam sinais clínicos de insuficiência cardíaca congestiva (ICC). Foi realizada radiografia torácica em 14 animais, em que foi detetado cardiomegalia (n=8) e edema pulmonar (n=8). À ecocardiografia foi detetado o espessamento dos folhetos da valva mitral (n=18), a regurgitação mitral (n=18), o aumento do diâmetro interno do átrio esquerdo (n=16), o aumento da relação átrio esquerdo/aorta (n=16), o aumento do diâmetro interno do ventrículo esquerdo (n=9), o prolapso do folheto anterior da valva mitral (n=5) e a regurgitação tricúspide (n=2). Dos 10 animais assintomáticos, 5 não apresentavam alterações na radiografia torácica (cardiomegalia). No entanto, na ecocardiografia, em 4 desses animais, foram observados sinais de remodelação cardíaca, permitindo a classificação na fase B2. Os animais foram classificados em B1 (n=2), B2 (n=8) e C (n=8). Na fase B1 os animais não receberam tratamento farmacológico, na fase B2 foram tratados com pimobendan e na fase C com furosemida, enalapril, pimobendan e espironolactona. A ecocardiografia permitiu o diagnóstico definitivo da DVC ao detetar alterações degenerativas nas valvas cardíacas e a classificação dos 4 animais sem alterações à radiografia torácica, em fase B2. A possibilidade de classificar corretamente os animais permitiu a iniciação de um tratamento farmacológico adequado à fase da DVC.
Echocardiography is a non-invasive imaging technique that allows the definitive diagnosis of heart disease and its progression. This complementary exam plays a very important role in the diagnosis of chronic valvular heart disease (CVHD), the most frequent acquired heart disease in dogs. Thus, the objective of this retrospective study was to evaluate the importance of echocardiography in the diagnosis, classification and therapeutic decision of CVHD. In this study, 18 dogs with CVHD were included, which were taken by their tutors to the consultation, at the Veterinary Hospital of Portimão, during the period from January to November of 2018, for a variety of reasons. The population of this study was mainly represented by males (n = 10), of small breeds (n = 10) and geriatric (n = 17). On physical examination, it was detected a systolic murmur (n = 18), cough (n = 8), tachypnea and/or dyspnea (n = 8), exercise intolerance (n = 2) and syncope (n = 1). 10 animals had no clinical signs of congestive heart failure (CHF). Thoracic radiography was performed in 14 animals in which cardiomegaly (n = 8) and pulmonary edema (n = 8) were detected. Echocardiography revealed thickening of the mitral valve leaflets (n = 18), mitral regurgitation (n = 18), increased left atrial diameter (n = 16), increased left atrium/aorta ratio (n = 16), increased left ventricular diameter (n = 9), prolapse of the anterior leaflet of the mitral valve (n = 5) and tricuspid regurgitation (n = 2). Of the 10 asymptomatic animals, 5 presented no alterations on the thoracic radiography (cardiomegaly). However, on echocardiography, in 4 of these animals, signs of cardiac remodeling were observed, allowing classification in stage B2. The animals were classified as B1 (n = 2), B2 (n = 8) and C (n = 8). In stage B1, the animals received no pharmacological treatment, in stage B2 they were treated with pimobendan and in phase C with furosemide, enalapril, pimobendan and spironolactone. Echocardiography allowed the definitive diagnosis of CVHD by detecting degenerative changes in the cardiac valves and the classification of the 4 animals without alterations to the thoracic radiography in phase B2. The possibility of correctly classifying the animals allowed the initiation of a pharmacological treatment appropriate to the phase of CVHD.
Echocardiography is a non-invasive imaging technique that allows the definitive diagnosis of heart disease and its progression. This complementary exam plays a very important role in the diagnosis of chronic valvular heart disease (CVHD), the most frequent acquired heart disease in dogs. Thus, the objective of this retrospective study was to evaluate the importance of echocardiography in the diagnosis, classification and therapeutic decision of CVHD. In this study, 18 dogs with CVHD were included, which were taken by their tutors to the consultation, at the Veterinary Hospital of Portimão, during the period from January to November of 2018, for a variety of reasons. The population of this study was mainly represented by males (n = 10), of small breeds (n = 10) and geriatric (n = 17). On physical examination, it was detected a systolic murmur (n = 18), cough (n = 8), tachypnea and/or dyspnea (n = 8), exercise intolerance (n = 2) and syncope (n = 1). 10 animals had no clinical signs of congestive heart failure (CHF). Thoracic radiography was performed in 14 animals in which cardiomegaly (n = 8) and pulmonary edema (n = 8) were detected. Echocardiography revealed thickening of the mitral valve leaflets (n = 18), mitral regurgitation (n = 18), increased left atrial diameter (n = 16), increased left atrium/aorta ratio (n = 16), increased left ventricular diameter (n = 9), prolapse of the anterior leaflet of the mitral valve (n = 5) and tricuspid regurgitation (n = 2). Of the 10 asymptomatic animals, 5 presented no alterations on the thoracic radiography (cardiomegaly). However, on echocardiography, in 4 of these animals, signs of cardiac remodeling were observed, allowing classification in stage B2. The animals were classified as B1 (n = 2), B2 (n = 8) and C (n = 8). In stage B1, the animals received no pharmacological treatment, in stage B2 they were treated with pimobendan and in phase C with furosemide, enalapril, pimobendan and spironolactone. Echocardiography allowed the definitive diagnosis of CVHD by detecting degenerative changes in the cardiac valves and the classification of the 4 animals without alterations to the thoracic radiography in phase B2. The possibility of correctly classifying the animals allowed the initiation of a pharmacological treatment appropriate to the phase of CVHD.
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Dissertação de Mestrado em Medicina Veterinária
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Ecocardiografia , cão