Echocardiography in dogs

Kumar, P Heart is one of the vital organs of the body. It is responsible for maintaining blood circulation in whole of the body. It supplies oxygen and nutrition to body tissues and removes carbon dioxide from tissues. If heart fails to pump, then death occurs due to hypoxia. Heart is a muscular pump divided in to four chambers by cardiac valves and septa. It is located in middle mediastinum. Inter-atrial septum and inter-ventricular septum separate right atrium from left atrium and right ventricle from left ventricle, respectively. Right and left atria are communicated to right and left ventricles through tricuspid and bicuspid valves, respectively which prevent back flow of blood from ventricles to atria. Aortic and pulmonary valves prevent back flow of blood from aorta and pulmonary artery during diastole (Evans, 1993). Heart problems are common in humans as well as in dogs. Vengsarkar (1988) studied the cardiac disease in and around Bombay city and opinioned that each and every dog should be examined for cardiac function during routine examination with a high index of suspicion for cardiac diseases. American Veterinary Medical Association says one in ten dogs has heart disease. Dogs kept at home are fed human diet which may develop degenerative heart conditions as a result of multiple dietary factors, including nutritional deficiencies, obesity or cachexia (Dove, 2001). Heart diseases are broadly classified in to two categories i.e. congenital heart diseases and acquired heart diseases. Congenital heart disease includes morphologic and functional abnormalities of the heart and adjacent great vessels that are present at birth (Oyama et al., 2005). Prevalence of congenital heart diseases is low (0.68%). Patent ductus arteriosus is most common congenital heart anomaly seen in dogs followed by pulmonic stenosis, subaortic stenosis, persistent right aortic arch and ventricular septal defect (Wisner, 2009). Acquired heart diseases are common in geriatric dogs. Chronic valvular heart disease is the most common geriatric cardiac disorder followed by dilated cardiomyopathy, arrhythmias, heartworm disease and infective endocarditis (Kibar and Alkan, 2005). Heartworm (Dirofilaria immitis) disease is also commonly observed in dogs. It is often life-threatening due to its various complications including right side heart failure (Lee et al., 2008). Cardiac tumours are uncommon in humans and animals alike. In dogs, primary tumours are more frequent than metastasis. Haemangiosarcoma followed by chemodectoma are most commonly diagnosed primary cardiac tumours in dogs (Palacio, 2007). Affections of pericardium are common in dogs. Diseases affecting primarily the pericardium account for approximately 1% of all patients with cardiovascular disease. These may be congenital or acquired. Peritoneo-pericardial diaphragmatic hernia (PPDH) is the most common type of congenital pericardial disease followed by partial pericardial defects and intrapericardiac cysts. Acquired pericardial diseases include pericardial effusion and constrictive pericarditis (Miller, 2005).

The diagnosis of cardiac affection is mainly based on history, clinical signs, clinical examination, radiography and electrocardiography (ECG). Angiocardiography has been used for definitive diagnosis of certain congenital cardiac anomalies since many decades (Thomas and Sisson, 1999). Nuclear scintigraphy, computed tomography and magnetic resonance imaging are specialized imaging techniques which facilitate noninvasive assessments of cardiac structure as well as systolic and diastolic dysfunction. These techniques are useful to evaluate certain cardiovascular disorders (Daniel and Bright, 1999). But all these have their limitations. Clinical signs observed in cardiovascular affections and pulmonary diseases are ambiguous. Radiography is very useful in differential diagnosis of certain cardiac and pulmonary affections as it shows the size, shape and position of the heart and chest contents and also permits the veterinarian to examine the lungs. Radiography is helpful in diagnosis of hypertrophic and dilated cardiomyopathy in advance stage (Fox, 2007). Evaluation of chamber enlargement accurately by radiography is not possible. Cardiac shape is influenced by breed, obesity, pleural effusions, stage of respiration and cardiac cycle. Cardiac function cannot be directly assessed by radiography. In certain cardiac disorders like small atrial and ventricular septal defects, mild aortic and pulmonic stenosis, focal myocarditis, mild mitral or aortic regurgitation, constrictive pericarditis and neoplasm, the cardiac silhouette may appear normal on radiograph (Lord and Suter, 1999). Angiographic techniques provide valuable clinical data but are invasive and costly, alter physiological function and pose inherent risks to the patient (Thomas and Sisson, 1999). Nuclear imaging also represents invasive technique but requires expensive, elaborate equipment and considerable technical expertise. Computed tomography and magnetic resonance imaging are expensive and require technical expertise (Daniel and Bright, 1999). Recently, a nonhazardous, noninvasive, relatively inexpensive imaging device has become commercially available i.e. Echocardiography. Echocardiography is the accepted term for the study of cardiac ultrasound. Echocardiography employs piezoelectric crystal or ultrasound transducer to generate high frequency sound waves (1 to 7 MHz). Ultrasound when transmitted through the thorax can penetrate the heart and subsequently be collected and processed to delineate cardiac structures. Such imaging is possible because ultrasound behaves according to the laws of optics and will reflect (echo) from the interface of cardiac tissues of different acoustic densities. The hand-held transducer can be directed to transmit ultrasound, collect the reflected sound waves, and dispense the resultant signal to echocardiogram for spatial arrangement and display (Bonagura, 1983). Echocardiography is a safe, noninvasive method that provides quantitative information of cardiac wall thicknesses, internal cavity dimensions, valve motion, ventricular function and the presence or absence of intra-cardiac structures (Allen, 1982). It provides a wealth of data concerning cardiac morphology and function. It provides real time visualization of the cardiac chambers and valves. This harmless technique is particularly suitable when repeated and frequent measurements are taken for clinical (Bonagura, 1983) or research purposes (Allen, 1982). The main advantages of echocardiography over other imaging systems are the innocuous nature of the examination, availability of series evaluations, ability to assess both structure and function, lower expense when compared with other

imaging systems and unperturbed physiologic state. For moving organs such as the heart, the size, tissue character and muscle function can be assessed in what is called a "real time" examination that resembles a motion Two-dimensional (2D) and M-mode echocardiography has been used to evaluate the normal as well as pathological heart by various authors (Allen, 1982; Bonagura, 1983; Muzzi et al., 2006). Little work has been done on echocardiographic examination of canine heart in India. Rao et al (2008) used M-mode echocardiogram for measurement of echocardiographic indices and found it useful technique in recognizing left ventricular dilation and poor contractile function in dogs with dilated cardiomyopathy. Echocardiography has become the most important diagnostic tool in the investigation of congenital and acquired heart disease in small animal veterinary medicine. Since its introduction into clinical practice during the late 1970s considerable effort has been directed towards establishing reference ranges for measurements made during a standard examination. Echocardiography indices are highly correlated with body size and body conformation (Torre et al., 2000). Echocardiography indices are different for different breeds of dog. Normal echocardiographic indices of one breed cannot be used for interpretation of echocardiogram obtained from another breed (Morrison et al., 1992; Snyder et al., 1995). Very less work has been done in mongrel dogs. Normal echocardiography indices of dogs of mongrel breed in different age group are not available. In our clinic (Teaching Veterinary Clinical Complex) we get good number of old aged dogs suffering from heart diseases but their diagnosis is difficult without echocardiography. Understanding the severity of cases, it is urgent to study with the following objective: 1. To obtain normal echocardiography indices of dogs of mongrel breed at different age. 2. To obtain echocardiography indices of dogs suffering from heart diseases.