Chronic coughing dog case Flashcards
What might cause tachypnea in dog
1) Physiologic (exercise, pain, fear, high temp)
2) Upper airway disorders (cervical tracheal disease, laryngeal disease, nasal disease)
3) Lower airway disease (thoracic tracheal disease, bronchial disease)
4) Pulmonary parenchymal disease (pulmonary edema, pulmonary ifbrosis, neoplasia)
5) Pulmonary vascular disease (pulmonary hypertension)
6) Restrictive disorders (pleural effusion, pneumothorax)
What are differentials for a cough in a dog
1) Laryngeal disease
2) Tracheal disease (tracheal or bronchial collapse)
3) Hilar lymphadenopathy
4) Left atrial enlargement, bronchial compression
5) Heart base mass or parenchymal neoplasia
6) Airway disease /chronic bronchitis
7) Pneumonia
8) Congestive heart failure
9) Heartworm disease
What breathing pattern is seen with upper airway obstruction in dog
inspiratory dyspnea
externally audible noise (eg. stertor, stridor)
Why do patients with heartworm disease cough
pneumonitis from the inflammation
What might cause upper airway obstruction in dogs
1) Brachycephalic airway disease
2) Laryngeal paralysis
What breathing pattern do you see with lower airway obstruction
what might be a cause
Expiratroy dyspnea
Wheeze (audible with stethoscope)
Asthma might cause this
What might cause pulmonary parenchymal disease
1) Pneumonia
2) Interstitial lung disease
3) Pulmonary edema
4) Pulmonary contusions
What might cause vascular respiratory distress
Pulmonary thromboembolism
Patients with abdominal distension from ascites or organomegaly will have what breathing pattern
Inspiratory dyspnea
Patients with pleural space disease from a pneumothorax or pleural effusion will have what breathing pattern
Inspiratory dyspnea, rapid shallow breathing or generalized paradoxical breathing
Reduced lung sounds on auscultation
What diagnostics can you use for chronic coughing dog *
Thoracic Rads
Thoracic POCUS
+/- Blood gas
+/- echo
if applicable to case: CBC, Chem, UA, coagulation profile, heartworm disease, thoracic CT, bronchoscopy
What are two ways to assess cardiac size on radiographs
1) Vertebral Heart Score (VHS)
2) Vertebral Left Atrial Score (VLAS)
What is the normal vertebral heart score in the dog
8.5-10.7
wide range of variation in breed conformation
How do you do a vertebral heart score
1) First line on carina to apex
2) Second line - 90 degrees from first line at widest part of cardiac silhouette
*Add the two values together. number of vertebral bodies from T4
What vertebral body do you start measuring with when you do a vertebral heart score
T4
How do you do a Vertebral Left Atrial Score (VLAS)
one line- carina to caudal aspect of LA where it intersects with the dorsal border of caudal vena cava
compare to vertebral T4 bodies
Reference interval for normal dogs 1.4-2.3
What are your top differentials for seeing R ventricular hypertrophy on echo
1) Pulmonary Stenosis
2) Pulmonary hypertension (acquired)
How might there be interstitial pattern from pulmonary hypertension
the leaking of fluid from increased hydrostatic pressure
How do you get the definitive diagnosis of Pulmonary hypertension
right heart cardiac catherization for invasive pressure measurements
Echocardiography can be used a clinical tool to help assess the probability that a dog has pulmonary hypertension
What might cause pulmonary hypertension **
1) Left sided heart failure
2) Heartworm
3) Shunts- PDA, VSD, ASD
4) Respiratory disease, hypxoia, or both (chronic bronchitis or pulmonary fibrosis) - older patients
5) Pulmonary thromboemboli (PTE)
6) Idiopathic, heritable, drug;s/toxins
7) Multifactorial causes or masses compressing PAs
What are the 3 broad categories of what can cause pulmonary hypertension
1) Increased pulmonary blood flow (congenital shunts)
2) Increased pulmonary vascular resistance -Endothelial dysfunction (NO), increased blood viscosity, lung parenchyma destruction, vascular luminal obstruction
3) Increased pulmonary venous pressure - left heart disease or compression of a large pulmonary vein
What diseases predispose patients to hypercoagulability and then pulmonary hypertension due to PTE
DIC
HWD
Hyperadrenocorticism
IMHA
Neoplasia
Protein losing enteropathy
Protein losing nephropathy
Sepsis
Corticosteroid admin
indwelling IV catheters
on echo, how is pressure told
Simplified Bernoulli Equation
P=4v^2
tells you how pressure correlates with velocity
What is the bernoulli equation
4*v^2
How do you treat pulmonary
1) Sildenafil or tadalafil - PDE5 inhibitors that cause vasodilation of pulmonary arteries
2) Oxygen supplementation - potent vasodilator
3) Sedation (butorphanol)
+/- Pimobendan (PDE3 inhibitor) to support right heart function
Severe pulmonary hypertension is anything over
80mmHg
Phosphodiesterase 5 inhibitor used to vasodilate the pulmonary arteries in cases of pulmonary hypertension
Sildenafil or tadalafil
Sildenafil or tadalafil mechanism of action
Phosphodiesterase 5 inhibitor used to vasodilate the pulmonary arteries in cases of pulmonary hypertension
Sildenafil: 1-3mg/kg PO q8hrs
Tadalaful: 1-2 mg/kg PO q24hr
Why should you provide patients with pulmonary hypertension oxygen supplementation
Oxygen is a potent vasodilator
How should you sedate patients with pulmonary hypertension
butorphanol 0.2mg/kg IV or IM
Phosphodiesterase 3 inhibitor used to support right heart function
might be given in cases of pulmonary hypertension
Pimobendan
What can you give patients with PTE disease
1) tissue plasmingoen activator (TPA) - if you see a clot with advanced imaging
2) Anticoagulants- heparin, apixaban, rivaroxaban
3) Clopidogrel
What should you do for patient with chronic cough do to left heart disease
treat left heart disease
What should you do for a patient with chronic cough due to respiratory disease, hypoxia
Hydrocodone (cough suppressant)
Treat secondary infection
steroids
What specific respiratory diseases might cause pulmonary hypertension
1) Chronic obstructive
-Tracheal or mainstem bronchial collapse
-Bronchomalacia
2) Primary pulmonary parenchymal disease
-Interstitial lung disease
-Infectious pneumonia
-Diffuse pulmonary neoplasia
3) Obstructive sleep apnea
4) Chronic exposure to high altitude
