Cardiac Radiographic Measurements in Ferrets Using the OsiriX MD Programme

Objectives: To adapt the vertebral heart scale (VHS) for use in ferrets and identify new scales and tools that allow to establish the normal heart size by means of radiography more quickly and effectively.Methods: Forty healthy pet ferrets (Mustela putorius furo) were used in this prospective study. The measurements were made on right lateral, left lateral, ventrodorsal, and dorsoventral projections, using OsiriX MD medical imaging software, to evaluate sex effect and variance within the different heart scales. Cardiac measurements were also correlated to VHS and the cardiac dimension in the same projection.Results: Most of the cardiac measurements were significantly different between males and females. The results for the VHS were: right lateral VHS (RL-VHS): 5.52 ± 0.28 v (vertebrae units); left lateral (LL-VHS): 5.55 ± 0.28 v; and dorsoventral VHS (DV-VHS): 6.22 ± 0.34 v for males and RL-VHS: 5.24 ± 0.2 v; LL-VHS: 5.25 ± 0.20 v; and DV-VHS: 5.97 ± 0.35 v for females. Regarding the sternebral heart scale (SHS), the values were: RL-SHS: 5.10 ± 0.20 s (sternebrae units) and LL-SHS: 5.11 ± 0.20 s for males and RL-SHS: 4.67 ± 0.24 s and LL-SHS: 4.67 ± 0.28 s for females. The new measurements based on determining the cardiac area were also marked by clear sexual dimorphism, as shown for the cardiac area-axis (AREA-AXIS): RL-AREA-AXIS: 3.82 ± 0.45 cm2; LL-AREA-AXIS: 3.87 ± 0.41 cm2; ventrodorsal (VD)-AREA-AXIS: 4.59 ± 0.64 cm2; and DV-AREA-AXIS: 4.80 ± 0.50 cm2 for males and RL-AREA-AXIS: 2.39 ± 0.23 cm2; LL-AREA-AXIS: 2.41 ± 0.26 cm2; VD-AREA-AXIS: 3.08 ± 0.45 cm2; and DV-AREA-AXIS: 3.06 ± 0.47 cm2 for females. The cardiac area open polygon (AREA-POL) values were: RL-AREA-POL: 6.78 ± 0.65 cm2; LL-AREA-POL: 6.88 ± 0.68 cm2; VD-AREA-POL: 7.20 ± 0.91 cm2; and DV-AREA-POL: 7.57 ± 0.88 cm2 for males and RL-AREA-POL: 4.28 ± 0.30 cm2; LL-AREA-POL: 4.35 ± 0.35 cm2; VD-AREA-POL: 4.72 ± 0.65 cm2; and DV-AREA-POL: 4.79 ± 0.66 cm2 for females, with similar differences noted from various radiographic projections. A good correlation was noted between VHS and SHS, and a very strongly positive correlation existed between cardiac area measurements and cardiac dimensions.Conclusion: The VHS adapted to ferrets, the SHS, as well as the cardiac area measurements presented in our study are ideal tools for the assessment of cardiac size in ferrets.

Determinação dos parâmetros radiográficos da silhueta cardíaca em cães de raças braquicefálicas clinicamente normais

O objetivo desse estudo foi determinar o valor de VHS em cães de raças braquicefálicas clinicamente normais com objetivo de determinar parâmetros de normalidades para raças com essa característica. O método Vertebral Heart Size (VHS) efetua a mensuração do tamanho cardíaco comparando as vertebras torácicas afim de auxiliar em diagnostico de insuficiência cardíacas e cardiomegalias. A radiografia de tórax possui uma importância na clínica medica de pequenos animais, trazendo informações para avaliações de órgãos intratorácicos, assim como a capacidade de efetuar avaliação da silhueta cardíaca. As radiografias foram avaliadas de acordo o proposto por Buchanan & Bücheler (1995), mensurando a silhueta cardíaca e profundidade, e largura do tórax. Os valores médios obtidos para VHS foram de 9,57±059v, sendo o menor valor mensurado de 8,5v e maior 10,5v. A especificação averiguou valores divergentes quando comparado com o estudo dos autores. Confirmando assim, a necessidade de determinação de valores de VHS específicos para raças com características de braquicefalia.

Vertebral Heart Scale for the Brittany Spaniel: Breed-Specific Range and Its Correlation with Heart Disease Assessed by Clinical and Echocardiographic Findings

The vertebral heart scale (VHS) was proposed by Buchanan and Bucheler as an objective method for estimating heart size in dogs. However, several studies have reported significant variation between breeds. The purpose of this retrospective study was to evaluate the VHS and to suggest a useful upper limit for normal heart size in Brittany Spaniels. The VHS was measured using a right lateral view in twenty-eight normal dogs and fifteen dogs with myxomatous mitral valve disease. The mean ± SD (standard deviation) VHS was 10.6 ± 0.2 vertebrae (v) in the normal dogs, which differs significantly from the mean VHS of 9.7 ± 0.5 v in Buchanan’s original study with dogs of various breeds. The VHS in the dogs with myxomatous mitral valve disease was 11.9 ± 1.1 v. With a threshold value of 11.1 vertebrae, the sensitivity, specificity, positive and negative predictive values for diagnosing a cardiomegaly are 90%, 72%, 53% and 96%, respectively.

Is Cardiomegaly an Indication of “Heart-Sparing Effect” in Small Fetuses?

<b><i>Introduction:</i></b> This study aimed to test the hypothesis that cardiac size is maintained in small fetuses presenting with cardiomegaly. <b><i>Materials and Methods:</i></b> We identified singleton fetuses with estimated fetal weight &#x3c;10th centile and with cardiomegaly without another more likely cardiac or extra-cardiac cause. We used <i>Z</i>-scores for cardiac and thoracic circumferences normalized for gestational age (GA), biparietal diameter (BPD), head circumference (HC), and femur length (FL), obtained from 188 normally grown fetuses. <b><i>Results:</i></b> When comparing chest size, small fetuses had significantly lower thoracic circumferences median <i>Z</i>-scores (IQR) for GA = −4.82 (−6.15 to −3.51), BPD = −2.42 (−4.04 to −1.48), HC = −2.72 (−4.53 to −1.90), and FL = −1.60 (−2.87 to −0.71); <i>p</i> &#x3c; 0.001 for all. When comparing heart size, small fetuses showed lower cardiac circumferences median <i>Z</i>-scores (IQR) for GA = −1.59 (−2.79 to −0.16); <i>p</i> &#x3c; 0.001, similar cardiac circumferences <i>Z</i>-scores for BPD = 0.29 (−0.65 to 1.28); <i>p</i> = 0.284 and HC = 0.11 (−1.13 to 0.96); <i>p</i> = 0.953, and higher cardiac circumferences <i>Z</i>-scores for FL = 0.94 (−0.05 to 2.13); <i>p</i> &#x3c; 0.001. <b><i>Conclusions:</i></b> Our results show that in small fetuses with cardiomegaly, the heart maintains normal dimensions when normalized to cranial diameters and higher dimensions when normalized to long bones. This provides insight into cardiac adaptation to adverse intrauterine environment.

Lamb1a regulates atrial growth by limiting second heart field addition during zebrafish heart development

During early vertebrate heart development the heart transitions from a linear tube to a complex asymmetric structure, a morphogenetic process which occurs simultaneously with growth of the heart. Cardiac growth during early heart morphogenesis is driven by deployment of cells from the Second Heart Field (SHF) into both poles of the heart. Laminin is a core component of the extracellular matrix (ECM), and although mutations in laminin subunits are linked with cardiac abnormalities, no role for laminin has been identified in early vertebrate heart morphogenesis. We identified tissue-specific expression of laminin genes in the developing zebrafish heart, supporting a role for laminins in heart morphogenesis. Analysis of heart development in lamb1a zebrafish mutant embryos reveals mild morphogenetic defects and progressive cardiomegaly, and that Lamb1a functions to limit heart size during cardiac development by restricting SHF addition. lamb1a mutants exhibit hallmarks of altered haemodynamics, and blocking cardiac contractility in lamb1a mutants rescues heart size and atrial SHF addition. Together this suggests that laminin mediates interactions between SHF deployment and cardiac biomechanics during heart development and growth in the developing embryo.

Effect of Pravastatin as an Adjunctive Therapeutic for Mitral Insufficiency with Hyperlipidemia in a Dog

Pravastatin (PS) has been found to increase left ventricle (LV) expansion capacity and decrease LV constriction and left atrial pressure in healthy dogs. To date, there are no available reports on the effects of PS in dogs with hypercholesterolemia with chronic heart failure (CHF). This case report demonstrates a successful long-term treatment plan using PS in a dog suffering from mitral insufficiency with hyperlipidemia. A 12-year-old, castrated male Chihuahua dog had mitral insufficiency with hyperlipidemia. The dog presented with symptoms of chronic coughing. PS was orally administered (1 mg/kg, SID) in addition to general treatment for mitral insufficiency. The follow-up period was 375 days. PS administration decreased the heart rate (HR), vertebral heart size (VHS), and N-terminal probrain natriuretic peptide (NT-proBNP) concentration of the dog. In addition, PS administration also improved chronic cardiac failure induced by mitral insufficiency and hyperlipidemia. This report suggests that PS can be useful as an adjunctive therapeutic for dogs with hypercholesterolemia with mitral insufficiency.

Abstract P103: A PATIENT'S 45 YEAR STORY AFTER 1 3/4 ADRENALECTOMY FOR PRIMARY ALDOSTERONISM DUE TO ADRENAL HYPERPLASIA: IMPROVED CONTOL WITH LO NA DASH DIET.

This report relies on detailed hospital/clinic records from the UK provided by the patient(PK) and his physicians for review and synthesis. In 1976 an asymptomatic, 24 y/o college lad had a routine health screening BP of 245/125. He was admitted. HPI was negative for symptoms or prior history of HBP. FH was - for low K or HBP, + for CAD in men <50. PE: ? increased heart size, Fundi Grade II. Hypokalemic alkalosis was noted, a renal arteriogram was normal. Adrenal (Ad) CT showed a normal L Ad but the R was not visualized, plasma aldosterone (PALDO) was elevated but 24 hr urine ALDO was not. PRA was not available at this time. Ad venography was negative, but the R Ad could not be cannulated. The DX was bilateral disease. Spironolactone (S) was started at 300 mg/d. He was readmitted for surgery 2 months later. BP = 160/100 and K was normal. At surgery, L Ad was said to be 2x normal and it and 3/4 of the R Ad were excised. Oral cortisol coverage was needed for 2 months, then ACTH gel for 2 months. BP was lowered for about 2 months off medications but then returned to 200/110. S was restarted at 400 mg/d with good control but gynecomastia developed. BP control was attempted with S and hydralazine for several years but despite being normal at home was always high in the office. Age 33 noted to have K of 3.2 and muscle “fasciculations”. S was increased. AFIB developed at 51. He converted to NSR with Amiodarone. BP continued to be difficult to control till age 56 when he began to move to the DASH diet recommended by my (CEG) patient online support Group which I have managed now for 19+ years. At 58, he retired from teaching early to care for his wife. At 62, PALDO was 1300 and Renin was 10 on S+DASH diet (ENa 55, EK 139 mM/d). Then 600/1 off S + on high salt intake (ENa 125, EK 100 mM/d). At 60, MRI showed “adenoma R” Ad. Rx with S/enalapril continued with home BPs 122/84. At 65, non-ST MI diagnosed, PTA/stenting was performed. BP has been stable for last 3 years with home BP 120/80 on DASH Diet, Spiro 100/enalapril 20 mg/d. Statin myalgia prevented statins. Lipids and BP have improved on DASH. HBP returns when he deviates from DASH. This case shows that long-term survival after 1 3/4 adrenalectomy for Conn’s (due to hyperplasia) is possible and suggests moving to the DASH diet improves BP control (last 3 year AVE 112/73).