The diagnostic and therapeutic approach to the patient in acute congestive heart failure.

The patient presented in acute congestive heart failure represents a diagnostic challenge. Life-threatening compromise of respiratory or cardiovascular function renders the patient vulnerable to the stresses associated with many diagnostic tests. Before risking any test in this situation, it is important to understand the information that each test will give, and how that will impact the diagnostic and therapeutic approach in this crucial early phase of patient management. This article describes the diagnostic tests commonly used in the evaluation of patients in acute heart failure and the information that each provides, and discusses how this information can be used to guide therapy. Pericardiocentesis is discussed in detail.

Femoral artery occlusion in Cavalier King Charles Spaniels.

OBJECTIVE: To investigate development of femoral artery occlusion in Cavalier King Charles Spaniels. DESIGN: Prospective study. ANIMALS: 954 Cavalier King Charles Spaniels. PROCEDURE: 1,750 cardiovascular examinations consisting of visual inspection of mucous membranes, thoracic auscultation in areas associated with the heart valves, thoracic palpation, and palpation of the femoral arteries were made at 10 dog shows on 954 dogs. Findings of clinically normal, weak, or undetectable femoral pulses were recorded. Pathologic changes in occluded femoral arteries of 2 dogs were examined histologically. RESULTS: Of the 954 dogs, 22 (2.3%) had an undetectable right or left femoral pulse on 1 or more examinations. Forty (4.2%) additional dogs had weak unilateral or bilateral femoral pulses. Only 1 dog had exercise intolerance, and it had coexistent congestive heart failure. Histologic examination of serial sections of an occluded femoral artery from 1 dog revealed intimal thickening with breaks in the internal elastic lamina proximal to the occluded segment. The occluded segment of the femoral artery was contracted and filled with an organizing, recanalizing thrombus. Similar histopathologic changes were found in sections of a femoral artery from another dog. CLINICAL IMPLICATIONS: Femoral artery occlusion is rare in other breeds and is not clinically important in dogs because of adequate collateral circulation; however, its rather common development in Cavalier King Charles Spaniels indicates a genetic predisposition and probable weakness in the femoral artery wall.

Chronic mitral valve disease in cavalier King Charles spaniels: 95 cases (1987-1991)

Systolic heart murmurs caused by chronic mitral valve disease are particularly common in Cavalier King Charles Spaniels (CKCS) in Great Britain. To determine if American-bred CKCS have a similar high prevalence of chronic valve disease, results of stethoscopic examinations on 394 CKCS were analyzed. Left apical systolic heart murmurs were found in 22% of the dogs. The prevalence ranged from 9% in dogs < 1 year old to 100% in those > or = 10 years old; prevalence was 56% in dogs > or = 4 years old. Differences were not found in prevalence between sexes and among various coat colors. Reexamination of 79 dogs after 1 year revealed an incidence of new murmurs of 21%. Comparison of ages at initial examination in 128 referral hospital cases with chronic mitral valve disease revealed a mean age of 6.25 years in 17 CKCS, in contrast to a mean age of 12 years in other breeds. Echocardiographic and necropsy findings indicated that ruptured chordae tendineae and mitral valve prolapse are major components in the chronic valve disease process in CKCS.