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如何在家照顧心臟衰竭的寵物
14 May 2024
Home Care for Congested Heart Failure
Many owners will be worried and panic when they know their fluffy friends have congested heart failure (CHF).    Clinical signs of CHF include coughing, panting, breathing difficulty, weakness, or syncope....etc. It sounds terrible, right? But actually If we take care of the CHF animals properly, it could decrease the frequency of those terrified clinical signs recurring or deteriorating.    What should we do at home?    First, feeding medicines to CHF patients regularly. It’s important to know the CHF could be manageable although it is not curable. Feeding medicines on time could be a cornerstone to control CHF well. We sometimes see the owners not feeding medicines regularly, especially after a well-controlled period, because they usually get used to it and take it lightly. They may miss feeding meds once or twice initially, and then more often until they find the patients have difficulty breathing due to recurrent pulmonary edema or effusion.   Second, heart disease is a progressive disease which means clinical signs will recur even if controlling it with medications regularly. How could we know what’s going wrong with our patients? I will recommend a simple way to monitor it at home. And it is to count sleeping respiratory rate (SRR) at home. Owners could count respiratory rate by watching their animals’ chest. It moves in and out as the dogs and cats breathe. One breath is counted when the chest has moved in and out once. Normal sleeping respiratory rate should be less than 30-40 beats per minute. Be careful, it’s a “sleeping” respiratory rate and thus it should be counted when patients are asleep.    The respiratory rate will increase when patients are nervous, hot, or stressful, therefore, it would be inaccurate when the animals are awake. When you find your animals’ SRR has increased, the first thing to do is to count the breathing rate a few times over the next couple of hours to ensure it is a consistent finding. If the breathing rate is consistently increased, then you need to contact the vets or go to an emergency center as soon as possible.   Third, how about the water intake and which kind of food should I feed the CHF patients? The amount of water intake will not affect the severity of edema in CHF animals. Conversely, owner’s should offer enough water supply to CHF animals. The diuretics will increase the loading of kidney and the kidney parameters will sometimes elevate after long term treatments of diuretics.    The other annoying problem is a picky appetite (anorexia) for CHF patients. Anorexia will cause loss of energy and necessary protein, and wasting of muscle, finally result in cardiac cachexia.    Diet with high-digestible protein is good for CHF patients.   Finally, although CHF is not a curable disease, it could be manageable with the proper home care and regular rechecking with vets.    If the CHF could be controlled well, the life quality of ill animals will be the same as the healthy animals.   ☎️ If your pets are suspected or suffering from heart problems, please do not hesitate to contact Veterinary Emergency Centre (VEC) and book an appointment with Dr. David for further check-up.General Hotline: 2334-233424-Hour Emergency Hotline: 6828-6620

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Dr. David echo
23 April 2024
Using echocardiography in the diagnosis
Sound energy is a vibratory disturbance that moves forward in a wave through a substrate. Sound can travel well in air, solid and liquid mediums. If we yell in a valley, we will hear our voice comes back (echo) in a period. This is similar as how the work of an ultrasound machine. Body tissue just like air or other substrate will absorb some ultrasound energy. The ultrasound machine sends sound waves to a body, and different body tissue reflects different amount of the wave back to the machine, then the computer can calculate and generate the images.   The vets can diagnose the disease by these datas. Why we called the sound waves “ultrasound” is because they can’t be heard by human ears.   Echocardiography can help us to see the structure of a heart and also the beating of the heart. It’s a non-invasive diagnostic tool and useful to know how the condition and function of the heart in a real time. In the same time, we can use echocardiogram to measure the heart and check the direction and velocity of blood flow in a vessel. The trans-thoracic echocardiography also can detect any effusion or fluid inside the chest or lung. Echocardiogram shows vets what kind of the heart disease and how severe it is. In addition, it provides a quantitative data to help us to decide if the patient needs treatment and is also helpful for a periodical monitoring.   Echocardiography is a crucial test in the diagnosis of the heart disease, but it’s not the only one. We can not preform echocardiography in some circumstances, for example, a patient with severe pulmonary edema caused by congestive heart failure. This will not allow the patient lie down and keep still for about 10 minutes. Therefore, echocardiography will not be a priority choice. Vets should try to stabilize the patient and make a temporary diagnosis and treatment plan relied on physical exam, auscultation, or chest x-ray. Performing echocardiography until the condition of the patient becomes more stable is much safer.   Echocardiography has its limitation. Because it is a two-dimensional viewing but the structure of a heart is in a three-dimensional world. Alternatively, we may miss something wrong in a particular view sometimes. In addition, finding a problem of the heart should rely on the result of different tests, like auscultation, physical examination, x-ray, ECG, and echocardiogram … etc.   Fasting is not necessary for the animals who will need echocardiography except they need to be sedated as the excitement or aggression.   ☎️ If your pets are in an emergency or if you have general inquiries, please do not hesitate to contact Veterinary Emergency Centre (VEC).General Hotline: 2334-233424-Hour Emergency Hotline: 6828-6620

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Dr. David oxygen cage
9 April 2024
Oxygen Therapy in the Animals
Would all animals with heart disease have coughing, panting, or even breathing difficulty? I will say it depends on what kind of heart disease and how severe it is. First of all, we should understand heart disease is not equal to the congested heart failure. Heart disease means some problem happens in a heart but it maybe or maybe not severe to cause congested heart failure.   Congested heart failure results in the retention of overfull fluid inside the body (especially in the lung and chest), and this causes patients becoming rapid and difficult breathing. Oxygen therapy is a treatment to provide patients with extra oxygen to breathe in, and It is used to stabilize the dyspneic animals.   There are many different methods to provide oxygen therapy. Flow-by oxygen and oxygen facemask are usually used when vets need to do some short-procedure (ie, placing IV catheter) and physical exam with a patient who has respiratory distress. They are less stressful to animals but not suitable for longer term usage (ie, hospitalization or home use).   Oxygen cage is an another efficient and convenient method of supplementing oxygen to small animal patients.   However, control of temperature, humidification, and ventilation is of paramount importance. More sophisticated and expensive models enable climate control and even have soda lime systems in place to prevent rebreathing of carbon dioxide.   An advantage of oxygen cages is the physical separation of the patient. This can be helpful in animals for which handling could worsen anxiety and respiratory distress. The disadvantage of this approach is that vets cannot check patients too often. The oxygen concentration would drop very rapidly when the cage door is opened. This also limits the usefulness of this approach when frequent patient reassessment would be ideal.   For larger dogs, oxygen cages may be too confining to be comfortable. The placement of nasal oxygen lines could be more convenient.   Oxygen therapy is important in stabilizing animals with respiratory distress. But could sole oxygen therapy treat or even cure all heart disease? The answer is no and it depends on different condition.   For example, the dyspneic animal with pulmonary edema, providing pure oxygen is not enough. In this circumstance, the effect of diuretics is better than oxygen therapy. Removing overmuch fluid in the lungs by diuretics is more important than just supplementing pure oxygen.   The other scenario is animal with breathing difficulty and pulmonary edema due to pulmonary hypertension. Oxygen therapy is much better and important for these animal patients and sometimes lowering the pulmonary hypertension by oxygen could also decrease the severity of pulmonary edema which was caused by pulmonary hypertension.   ☎️ If your pets are in an emergency or if you have general inquiries, please do not hesitate to contact Veterinary Emergency Centre (VEC).General Hotline: 2334-233424-Hour Emergency Hotline: 6828-6620

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Post 9- Common heart diseases in cats -  28 Sep 2022
1 November 2023
Common heart diseases in cats
A cat is not a small dog. Common heart diseases in cats are different in dogs. We already knew common acquired heart disease in dogs in the previous topic. They are degenerative and progressive diseases. Although the common acquired heart disease in cats are progressive, the nature of the development of the disease is slightly different than in dogs. The most common acquired heart disease in cats is hypertrophic cardiomyopathy (HCM). HCM is a genetic disease and causes the muscular wall of a heart to thicken, decreasing the heart’s efficacy and sometimes creating symptoms, like spiritless, decreased appetite, and open mouth breathing. The condition are more prevalent in certain breeds (including British Shorthair, Maine Coon, Exotic Shorthair, and Ragdoll).   The rate of increasing thickness of heart muscle may vary considerably and the onset time of muscle getting thickened is also different in each cat. For example, some cats may have normal left ventricle for a period of time and then suddenly become very thickened in 1 day. Others may have mild thickened left ventricle and never getting more thickened for many years. HCM can affect cats of all ages. Proper diagnosis and treatment can decrease the chance that a cat with HCM experiencing certain symptoms and can improve his or her quality of life.   The left ventricle is thickened in a cat with HCM, leading to a decrease in the volume of the heart chamber and to abnormal relaxation of the heart muscle. These changes cause increased oxygen usage and possibly to oxygen starvation of the heart muscle. This oxygen starvation may cause heart cells to die, worsening heart function and even the development of arrhythmia. In addition to these changes, less efficient blood pumping may result in congestive heart failure or/and the formation of blood clots in the heart.   Clinical signs of congestive heart failure are labored or rapid breathing, open mouth breathing, and lethargy. A serious and potentially life threatening consequence of HCM is the formation of blood clots in the heart. These blood clots may travel through the bloodstream and obstructs flow in other parts of the body. The effect of the clot depends on its location. In cats with HCM, clots most commonly result in blockage of blood flow to the hind limbs, causing acute hind limb pain and even hind limb paralysis. Although relatively rare, cats with HCM are at risk for sudden death. Diagnosing and treating the HCM properly can help decrease severity of the signs and may decrease the likelihood of blood clots.   The most commonly diagnosed congenital heart disease in cats are ventricular septal defect (VSD), patent ductus arteriosus (PDA), and mitral valve dysplasia (MVD). The pathophysiology of MVD is similar as MMVD in dogs but it’s the problem since birth. PDA in cats is as same as in dogs. VSD is a hole in the ventricular septum. The septum is a muscular tissue that separates the left and right ventricle and prevents blood being diverted from one chamber to the other. The severity of VSD depends on the size of the hole. A small VSD is commonly of no significance, and an affected kitten can be expected to live a normal life. A moderate or larger hole, may cause enough shunting of blood to produce clinical signs, such as rapid breathing and exercise intolerance.   If your pets are in an emergency or if you have general inquiries, please do not hesitate to contact Veterinary Emergency Centre (VEC). General Hotline: 2334-2334 24-Hour Emergency Hotline: 6282-8179

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Post 8 - Acquired heart diseases in dogs - 14 Sep 2022
25 October 2023
Acquired heart diseases in dogs
Let’s talk about common heart diseases in dogs. First of all, we should know heart diseases could be congenital or acquired. There are 2 common acquired heart diseases in dogs.   One is failure of the heart muscles caused by genetic factor and usually occurs in large breeds of dogs (over 20 kgs) called dilated cardiomyopathy (DCM), and the other one is the abnormality of the mitral valves caused by degeneration and common be found in small breeds of dogs called myxomatous mitral valve disease (MMVD) or degenerative mitral valve disease (DMVD).   DCM is a degeneration of the heart muscle and this degeneration result in the muscle becomes thinner and more weakness. Failure of the heart muscles unable to pump enough blood to the organ and the pressure of the blood inside the heart causes these thin walls to stretch leading to a much larger heart. It is common in certain large breeds of dogs, include Doberman Pinschers, Great Danes, Irish Wolfhounds, Boxer, and Saint Bernards. Occasionally, some medium-sized breeds, such as Cocker Spaniels and English Springer Spaniels are also affected.   DCM may have a sudden onset of clinical signs, however, the disease have actually been developing slowly and subtly. When it develops into congestive heart failure, rapid heavy breathing, a blue tongue, or collapse maybe the first signs. Annual checkups with your veterinarian may lead to a diagnosis of heart problem before clinical signs are present. There are several drugs used to treat the symptoms of DCM. Initial stabilization depends upon the use of oxygen, diuretics and drugs which improve the heart muscle strength. Many dogs with DCM have arrhythmias, therefore, some antiarrhythmic drugs may be added in cautiously.   DCM is a serious disease that must be accurately diagnosed and aggressively treated. Doberman Pinschers have been shown to live as little as 3 months once diagnosed. Other dogs have been known to live between 6 to 24 months if they respond well to treatments. Dogs that have developed clinical signs of heart failure have a worse prognosis than those that are put onto cardiac medication in the early stages of the disease.   MMVD should be the most common heart disease in dogs in Hong Kong. Because Hong Kong people usually have small breeds of dogs, and MMVD is the most common heart disease in small breeds of dogs. The most susceptible breeds are Cavalier King Charles Spaniels, Poodles, Schnauzers, and Chihuahua. The mitral valve is located on the left side of the heart between the left atrium and the left ventricle. It closes completely and prevents blood flowing back to the left atrium when the left ventricle contracts. MMVD occurs when the mitral valve becomes thickened. The thickened valve results in incomplete closure of the valve allowing blood to leak backward into the left atrium. This backward blood flow is called mitral regurgitation. The leak worsens over time causing increased pressure within the heart and also causing heart to enlarge. Eventually, the heart will go into the congestive heart failure.   Most dogs with mild to moderate MMVD may not show any signs of disease. Regular checkups with the vet can pick up the disease in the early stage. Coughing is a more common sign seen the dogs with MMVD. Patients can cough for two reasons. Enlargement of the heart compressing on the airway or fluid accumulation in the lungs from congestive heart failure. It has been shown that early starting the medication in moderate to severe MMVD can delay the time to development of congestive heart failure by a median time frame of 15 months.   If your pets are in an emergency or if you have general inquiries, please do not hesitate to contact Veterinary Emergency Centre (VEC). General Hotline: 2334-2334 24-Hour Emergency Hotline: 6282-8179

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Post 7- Congenital heart diseases in dogs -  5 Oct 2022
18 October 2023
Congenital heart diseases in dogs
In addition to acquired common heart diseases, there are also common congenital heart diseases. At first glance, congenital heart disease sounds very scared and difficult to manage. In contrast to acquired heart diseases (most are degenerative disease and could not be cured), some congenital heart diseases can be cured if it is early diagnosed. After successful treatment, the expectancy and quality of pets’ life will be as same as normal animals.   Patent Ductus Arteriosus (PDA) is one of the more common congenital heart defects in dogs. Every normal fetus has a ductus arteriosus. This enables the umbilical circulation to supply oxygen, allowing blood bypass the fetus’ non-functional lungs. The ductus arteriosus is a small channel that connects the aorta and the pulmonary artery. At birth, this system is no longer needed as dogs can breath and lungs work, allowing blood easier to flow to the lungs rather than through the ductus. The ductus closes within the first 3-10 days of life. If the ductus does not close it or “patent”, the blood from aorta will flow to the pulmonary artery not the body as it is supposed to. The increased circulation will cause more workload of the heart and finally will result in congestive heart failure.   A PDA has a characteristic murmur can be heard by a veterinarian during your pet’s first check-up. And an echocardiogram can evaluate the heart function and the chamber size, also can visualize the ductus. PDA is a treatable congenital heart disease and can be cured once early diagnosed (before congestive heart failure, usually before 1 year old). There are many ways to occlude the patent ductus, including traditional ligation of the ductus by opening chest, or interventional occlusion of the ductus by a coil or a special device. Finally, I would like to introduce pulmonary hypertension (PHT) in the rest of this topic. PHT means the blood pressure of lungs is over normal range. Unlike systemic hypertension, it is only indicated elevated blood pressure of lungs. The reason of PHT can be increased pulmonary artery pressure (like heartworms infestation), or parenchymal lung disease caused by chronic respiratory disease (like collapsing trachea, asthma, lung consolidation...etc). PHT could be developed due to MMVD.   Moderate to severe PHT with diffused parenchymal lung disease will also result in pulmonary edema and then breathing difficulty. As mention previously, heart disease will cause pulmonary edema, too. In addition, dogs with MMVD are usually the breeds which are predisposed to the airway disease also. X-ray and echocardiogram can help it to differentiate pulmonary edema is from heart disease or airway disease. Oxygen and Viagra are the useful tools to treat PHT.   If your pets are in an emergency or if you have general inquiries, please do not hesitate to contact Veterinary Emergency Centre (VEC). General Hotline: 2334-2334 24-Hour Emergency Hotline: 6282-8179

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