Cardiorespiratory Diseases

Cardiorespiratory Diseases

Heart Chambers 4 Chambers R atrium R ventricle L atrium L ventricle
Receives deoxygenated blood from body Vena cava R ventricle Pumps deoxygenated blood to lungs Pulmonary artery L atrium Receives oxygenated blood from lungs Pulmonary vein L ventricle Pumps oxygenated blood to body Aorta

Cardiorespiratory Physiology
R side of heart Blood Low O2 High CO2 Pressure Low—short distance to lungs L side of heart High O2 Low CO2 High—far distance to body

Alveoli-Capillary Gas Exchange
Alveoli surrounded by capillaries Incoming RBCs low in O2 Exiting RBCs rich in O2 Thin capillary membrane (epithelium?)

Electrical Conduction of Heart
SA node Pacemaker (fastest rate of contraction) In R atrium AV node Impulse travels along internodal tract Slight delay Filling of ventricles Bundle of HIS Interventricular septum Purkinje fibers To myocardial cells Apex contracts first

Electrocardiogram (ECG)
P wave Contraction of atria QRS complex Contraction of ventricles Repolarization of atria (hidden by vent activity) T wave Repolarization of ventricles Measures electrical activity of heart at skin surface

Cardiovascular Diseases
Heart Failure—returning blood is not pumped fast enough to meet body’s needs Heart failure is not a heart attack 2 causes Myocardial (heart muscle) dysfunction Cardiomyopathy Myocarditis Taurine (an amino acid) deficiency in cats Circulatory failure Hypovolemia (shock, hemorrhage, dehydration) Anemia Valvular dysfunction Congenital shunts or defects Congestive heart failure—when failing heart leads to fluid congestion a) in lungs (pulmonary edema), b) in body (edema) Heart failure almost always progresses to congestive heart failure

Cardiomyopathy: 2 Types
Dilated Cardiomyopathy (DCM) Hypertrophic Cardiomyopathy (HCM)

Canine Dilated Cardiomyopathy
One of the most commonly acquired heart diseases in dogs Boxers, Dobermans Seen in older large/giant breeds Heart chambers dilate because heart wall becomes thin, weak, flabby ↓ CO (cardiac output), ↑ blood left in heart after systole

Signs Giant/large breed dogs; older (4-10 y) Exercise intolerance R sided failure Ascites/abdominal distension Hepatomegaly Wt loss L sided failure Coughing Pulmonary edema Syncope

Canine DCM PE Weakness, depression
Hypokinetic femoral pulse from low CO Pulse deficits Jugular pulses HR – fast

Dx X-rays may show dilated heart Ultrasonography will show dilated heart chambers ECG widened/large QRS and P waves rhythm disturbances Rx—no cure Diuretics to ↓ fluid buildup Furosemide Digoxin ↑strength of contraction (↑CO) Nitroglycerin x hrs OXYGEN!!! Vasodilators (enalopril,etc) Pimobendan - + inotrope, increases survival

Canine DCM Client info Fatal disease (6mo to 2 y) – SUDDEN DEATH
More prevalent in large breeds Diet – decrease Na intake Minimal exercise – let patient be guide

Canine Hypertrophic Cardiomyopathy
Uncommon in dogs L ventricular muscle enlarges, decreasing chamber size of L ventricle Heritable Signs Fatigue Cough Tachypnea Syncope ± cardiac murmurs Sudden death Some animals will be asymptomatic PE Systolic heart murmur Cardiac gallop rhythm LH failure: cough, dyspnea, cyanosis, exercise intolerance Normal Hypertrophy

Canine HCM Dx Rx—none routinely used unless signs of HF Client info
X-rays may be normal, have La or LV enlargement and/or pulmonary edema Ultrasound shows thickened L vent wall EKG: Normal or ST segment and T wave abn Rx—none routinely used unless signs of HF Client info Sudden death and CHF may occur Certain breeds more susceptible (G Shep, Rott, Dalm, C Span, Bostons, Shih Tzu)

Feline Dilated Cardiomyopathy
Prior to late 1980’s, this was frequently seen in cats Associated with taurine deficiency; addition to cat feed has greatly reduced incidence Similar pathology to DCM in dogs Signs Older, mixed breed (Siamese, Burmese, Abyssinian) Dyspnea, tachypnea Inactivity Anorexia Acute lameness/paralysis (rear legs) Pain/lack of circulation in affected limbs (no pulse due to thromboemboli)

Feline DCM PE: HR variable (fast, normal or slow)
Systolic heart murmur Gallop rhythm +/- arrhythmia Hypothermia Increased CRT Tachypnea Quiet lung sound (if pleural effusion) Crackles if pulmonary edema Hypokinetic femoral pulses +/- posterior paresis/paralysis

Feline DCM Dx Clin signs; ECG; ultrasound Taurine levels X-rays

Feline Dilated Cardiomyopathy
Rx Oral taurine supplement ( mg/d) Furosemide Oxygen Digoxin Aspirin or heparin – prevent thromboemboli Vasodilator; ↓vascular resistance Hydralazine Cutaneous nitroglycerin paste Client info Most dangerous time is first 2 wks of treatment If cat responds to taurine treatment, good Px Unresponsive to taurine treatment, poor long-term Px

Feline Hypertrophic Cardiomyopathy
Similar to HCM in dogs L vent hypertrophy is predominant pathology More common in neutered males Signs Soft, systolic murmur (grade 2-3/6) Gallop rhythm and other arrhythmias Acute onset of heart failure or thromboembolism Dx X-rays—may be normal ECG ↑P wave duration ↑QRS width Sinus tachycardia Ultrasound ↑L vent wall; dilated L atrium

Feline Hypertrophic Cardiomyopathy
Rx Diuretics to decrease fluid load on heart Furosemide Beta blocker to decrease sinus heart rate Propanolol Calcium channel blocker to reduce blood pressure Diltiazem Client info Affected cats may experience heart failure, arterial embolism, sudden death Cats with HR <200 bpm have better Px than >200 bpm Median survival time ~2 y

Thromboembolism Common in myocardial disease in cats (10-20% of HCM) Forms in L side of heart Lodge at femoral trifurcation

Thromboembolism Signs Dx Rx Client info
Acute onset of rear leg pain/paresis Cold, bluish foot pads Lack of femoral pulse Hx of myocardial disease Dx Clinical signs Angiography (if available) Rx Dissolve clot TPA (Activase [Genentech]) Heparin Aspirin for prophylaxis Aspirin is slowly metabolized in cats; must be monitored Client info Painful, cold, or paralyzed rear legs in cats is an emergency Px is guarded to poor Surgical removal of thrombus is difficult/expensive

Fetal Heart Right atrium Vena cava

Congenital Heart Disorders
Patent Ductus Arteriosus (PDA)—failure of ductus arteriosus to close after birth Blood shunts from systemic circulation to pulmonary artery Normally, prostagladins are released at birth to cause ductus arteriosus to close Ductus arteriosus To lungs To lungs To lungs

PDA Clinical signs Dx Rx—surgical correction Client info
Usually female Predisposed breeds: chi, collie, maltese, poodle, poms, E Spring, kees, bichons frises, Shetlands Presence of a loud heart murmur over L thorax Some puppies are asymptomatic Dx ECG L vent dilation X-ray L atrial and L vent enlargement Rx—surgical correction Client info Px is excellent following surgery 64% of PDA will die within 1 y without surgery Dog should not be used for breeding

Congenital Disorder: Atrial Septal Defects
An abnormal opening in the atrial wall Foramen ovale—a hole in fetal atrial septum to allow oxygenated blood from the placenta to by-pass lungs (like ductus arteriosus) -should seal at birth Signs Soft, systolic murmur CHF before 8 wk old C After birth, blood is shunted from L to R atria (high press to low)

Atrial Septal Defect

Congenital Disorder: Ventricular Septal Defects
An abnormal opening in the ventricular wall Signs Harsh, holosystolic murmur, R sternal border CHF before 8 wk old Rx (ASD, VSD) open heart surgery unusual in animals Management of CHF Client info (ASD, VSD) Most will develop CHF C

Congenital Disorder: Tetralogy of Fallot
Polygenic malformation of heart (4 abnormalities) Pulmonic stenosis 2° R ventricular hypertrophy Ventricular septal defect Overriding aorta Breeds (Keeshond, E bulldog, cat) Signs Failure to grow Cyanosis Exercise intolerance Weakness Seizures Syncope, sudden death Dx X-ray—normal size heart ECG R vent hypertrophy R outflow obstruction

Tetralogy of Fallot Rx Client info
Surgical procedures can improve condition (cardiology specialty practice) Medical treatment includes phlebotomy to keep PCV between 62-68% Client info Genetic disease; don’t breed Sudden death is common; may live for years CHF is rare Limit stress/exercise Tranquilizers/sedatives may have adverse effects Regular phlebotomies will be required

Acquired Valvular Diseases
Mitral Valve Insufficiency (most common acquired heart disease in dogs (progressive); rare in cats) Caused by proliferation of fibroblastic tissue within valve leaflets causing thickening of valvular free edges, causing valves to roll up Thickened leaflets fail to close sufficiently during systole → regurgitation into L atrium → CHF A main cause is periodontal disease → endocarditis from bacteria in dental tartar Upper leaflet normal Lower leaflet thickened Mitral valves What are white bands?

Mitral Valve Insufficiency
Signs (L CHF) Small breed dog >10 y Cough: deep, productive; worse at night or with exercise Dyspnea, tachypnea Decreased appetite Systolic murmur, L apex Dx X-ray Pulmonary edema may be present; cotton-like alveolar disease L atrial, vent enlargment (Elevation of trachea, loss of cardiac waist)

Mitral Valve Insufficiency
Rx—there is no cure; goal is to improve quality of life Diuretics—furosemide to reduce fluid volume of heart Digoxin—to increase efficiency of heart and ↓HR Client info MVI is a progressive disease; periodic evaluation/readjustment of Rx No cure Low salt diet helps prevent fluid accumulation Eventually medication will not control the condition Mitral valve (L A-V)

Tricuspid Insufficiency
Same disease as Mitral Valve Insufficiency except R sided heart failure results instead of L sided failure Signs (R CHF) Pleural effusion (fluid in pleural cavity not lung tissue) Abdominal distension Hepatomegaly Rx—same as MVI Abdominocentesis may be required periodically Tricuspid valve (R A-V)

Cardiac Arrhythmias Abnormal heart rate or rhythm or rhythm arising from abnormal location Abnormal rhythm result from either: 1. abnormal impulse formation (ectopic beats) Ischemia (↓ blood supply) Hypocalcemia Cardiomyopathy Hypercalcemia Excess catecholamines (↑ adrenalin) 2. abnormal impulse conduction

Sinus arrhythmia Normal in dogs; not in cats P wave for each QRS
Irregular ventricular rhythm P waves

Atrial Fibrillation Signs Dx Weakness, syncope Collapse
No organized atrial contraction Easier to occur in larger heart, so more of a problem in lg breed dogs Signs Weakness, syncope Collapse Rapid, irregular HR Dx Auscultation rapid, irregular HR ECG No P waves Many ectopic foci activating small areas of atrium Only ectopic foci close to AV node are able to cause impulse to travel to ventricle Ventricles are activated at a very fast rate and at irregular intervals

Atrial Fibrillation Rx (aim is to slow HR; it will not correct fibrillation) Digitalis (digoxin) to slow HR Ca++ channel blockers (diltiazem HCl) to slow AV node conduction Client info Rx will not cure atrial fibrillation Concurrent heart disease will progress even with treatment CHF will occur eventually

Ventricular Tachycardia
Rapid HR reduces vent filling time, and, therefore decreases CO If untreated, may lead to vent fibrillation (cardiac arrest), a life-threatening situation Causes: Cardiomyopathy, CHF, endocarditis, neoplasia Electrolyte or acid/base imbalance Signs Weakness, collapse, syncope with rapid HR Sudden death not uncommon CHF

Ventricular Tachycardia
Normal beats? Dx Auscultation: rapid, irregular HR ECG: widened, bizarre QRS complexes of vent origin (PVC’s) V fib: no QRS complexes Rx Procainamide and Tocainide decrease myocardial excitability Lidocaine decreases automaticity of heart muscle For v fib, cardiac defibrillation Px—Guarded unless underlying cause can be corrected

Sinus bradycardia May be symptom of disease:
Def: normal P, QRS complexes; HR <70 bpm May be symptom of disease: ↑ Intracranial pressure Hypothyroidism Hypothermia Hyperkalemia Hypoglycemia Also seen in athletic, well-conditioned dogs

Sinus bradycardia Signs Dx Rx Client info
Episodic weakness, syncope, collapse Dx Auscultation: slow HR ECG: slow HR; normal P, QRS complexes Rx Treat underlying disease Atropine increases HR Placement of artificial pacemaker Client info May be normal in athletic dog Correction of underlying problem may correct bradycardia Most dogs can live normal life with this condition

Heartworms (Dirofilaria immitis)
World-wide distribution With 150 mi of Gulf and Atlantic coasts and Mississippi River Males dogs infected more than females (4:1) Outside dogs more likely to be infected than indoor dogs Rare in cats

Heartworm Cases

Heartworms - canine Life cycle (Adult → L1 (microfilaria), L2, L3, L4, L5 [small adult] Mosquito bites infected dog, picks up microfilaria (L1) Microfilaria may live up to 2 y in dog May be passed transplacentally (will not develop into adult) Microfilaria mature in mosquito to L3 stage (2-3 wk) L3 is capable of infecting new dog L3 migrates thru soft tissue to heart 5-7 mo then becomes L5 (small adult) Adults breed and produce L1 Adults can live in heart for 5-7 years

Canine Heartworms

Canine Heartworms Disease severity Dx # adult worms
Inflammation of endothelium R-sided heart failure Dx Knott’s test—filter technique to see microfilaria in blood Antigen tests detect antigen of female heartworms Antibody tests detect antibodies dog has produced against larvae; positive test confirms dog has been exposed to larvae

Canine Heartworms

HW Life Cycle

Heartworms Signs Rx—pretreatment lab workup (CBC, Chem Panel)
Usually asymptomatic; diagnoses on routine screening Exercise intolerance Coughing, dyspnea R-sided heart failure Rx—pretreatment lab workup (CBC, Chem Panel) Melarsomine (Immiticide; Merial)—kills adult worms Ivermectin—kills microfilaria and migrating worms (L3, L4) +/- Doxycycline Prevention—many products Diethylcarbamazine (daily) Ivermectin (monthly) Milbemycin (monthly)

Feline Heartworms Prevalence – 1997 necropsy survey in SE Texas
10% of shelter cats had adult HW Greater infection rate than FeLV or FIV

Feline Heartworms Epidemiology
Female mosquito feeds on infected dog; picks up mf Become L1 to L3 in mosquito Deposited on skin of cat or dog in saliva L3 enter thru bite, molt to L4, migrate through tissues for 2 months Final molt to immature adult (previously L5); enter peripheral vein Immature worms carried to heart – days PI By day 100 – worms 2 inches long Matures to adult over 2-3 months Most juvenile worms die shortly after arriving in pulmonary arteries Initiates an inflammatory reaction A few worms live 2-4 years in small percentage of cats

Feline Heartworms- Heartworm Asocciated Respiratory Disease (HARD)
3 stages 1st Acute inflammatory reaction to presence and death of worms Coughing, dyspnea Intermittent vomiting 28% asymptomatic X-rays – inflammatory infiltrates around R caudal lobar artery Similar to allergic bronchitis or asthma Responds to steroids

Feline HARD 2nd stage 3rd stage
Adult HW (if survives) suppresses immune system => decreased signs Worm dies – no more immune suppression Intense inflammatory reaction occurs Thromboembolism => acute lung injury and sudden death 3rd stage If cat lives => permanent injury and chronic resp disease

Feline Heartworms Diagnosis
Filtration for mf useless – usually single sex infections (1-2 worms only) X-rays as above – 55% have radiographic signs US – % accurate Serology Ag tests – do not detect early or male only infections Negative result does not r/o HW dz Ab test – confirms recent infection with L4 or older but not disease Ag test in process of being added to FeLV/FIV test.

Feline Heartworm Testing

Feline Heartworm X-rays

Feline Heartworms Rx— Acute respiratory distress
Steroids (Dex SP 1-2 mg/kg IM/IV, PredSS mg/kg/cat IV Bronchodilator Supportive – IV fluids, etc If not demonstrating clinical signs, supportive care until heartworm dies Prednisolone to reduce pulmonary effects +/- doxycycline

Feline Heartworms Prevention
Safe for all cats because mf infection rare or minimal Heartgard® for Cats (Ivermectin, orally) from Merial Interceptor® (Milbemycin oxime, orally) from Novartis Revolution® (Selemectin, topically) from Pfizer Advantage Multi™ for Cats (Moxidectin / imidacloprid, topically) from Bayer

Respiratory Diseases

Upper Respiratory Diseases
Upper Respiratory Tract is any resp structure above the trachea Rhinitis—inflammation/infection of nasal passages Usually occurs with other resp diseases Signs Nasal discharge; crusty nares Pawing at nose Staphylococcus spp Rx Clean nares Antibiotics if necessary

Sinusitis Usually due to abscess of 4th premolar (Carnassial tooth) Largest tooth; roots extend into frontal/maxillary sinus Signs Swelling under eye on infected side Unilateral nasal discharge Rx Remove infected tooth Antibiotics Flush fistula with iodine solution

Tonsillitis (Tonsils provide lymphoid protection to lower resp tract) Signs Anorexia Increased salivation Pain on opening mouth It is more common in small dog breeds Dx Visualized inflamed, swollen tonsils Tonsils may be coated with mucus/pus Sx Antibiotics Surgical removal of chronic cases

Tonsillitis

Laryngitis Most common cause is excessive barking **Rabies can also change vocal quality Signs Loss of voice or alteration of voice Increased mucus production in back of throat Rx Restrict barking Anti-inflammatory medication (glucocorticoids) Client info Most Upper Respiratory Infections are self-limiting

Lower Respiratory Diseases
Lower Respiratory Tract includes trachea, bronchi, lungs, pleural cavity Infectious Canine Tracheobronchitis (Kennel Cough) Causes (a collection of several causative agents including viruses, bacteria, mycoplasmas, fungi, parasites Canine parainfluenza virus Canine adenovirus Canine herpesvirus Reovirus Bordetella bronchiseptica mycoplasma Signs Hx of exposure to animals at a kennel, hospital, groomer, show Dry hacking cough in an otherwise healthy animal Rx—antibiotics, glucocorticoids, antitussives Client info Self-limiting (2-3 wks); Rx is to make animal/owner more comfortable Vaccinate 2-3 wk before chance of exposure

Collapsing trachea Failure of proper development of tracheal rings Signs Cough, esp during excitement or exercise Dx Goose-like honk on tracheal palpation r/o other causes of coughing Rx Acepromazine to calm excitement Antitussives (Hycodan, Butorphanol) Glucocorticoids Bronchial dilators Prosthetics have been surgically implanted, but complications have occurred Client info Wt reduction Use shoulder harness rather than neck collar

Feline Bordetella Infection Bordetella bronchiseptica grow in ciliated respiratory mucosa; release toxins Signs (look like respiratory viral infections) Fever Sneezing, nasal discharge, coughing, rales Submandibular lymphadenopathy Rx (usually self-limiting) Antibiotics (oral tetracycline or doxycycline) Prevention Eliminate stress Good hygiene, good nutrition Vaccination Client info Looks like resp infections caused by feline herpes and calicivirus Usually self-limiting Vaccination effective

Feline asthma (bronchoconstriction, inflamed/hyperreactive airways) Signs Coughing, wheezing Labored breathing Dx Clinical signs X-rays show “doughnuts” typical of airway inflammation Rx Long-term corticosteroids (prednisone, DepoMedrol) Bronchodilators (terbutaline [Brethine], cyproheptadine) Client info Prognosis is variable If allergens can be determined and exposure limited, most cats do well A cure is not usually possible

Feline Asthma Same cat Top—normal Bottom—asthma
Airways more prominent because of inflammation and mucus buildup Doughnuts (end-on view) and tramways (lateral view) of airways

Feline Viral Resp Infections
2 viruses responsible for most feline resp diseases Feline Viral Rhinotracheitis (FVR; Feline Herpesvirus) Feline Calicivirus (FCV) Caliciviridae family Highly contagious High mobidity Low mortality Most severe in kittens

Feline Viral Rhinotracheitis
Signs Acute onset of sneezing Conjunctivitis, severe rhinitis Fever, depression, anorexia Ulcerated hard palate, excess salivation Corneal ulcers Rx Supportive Rx IV fluids, broad spectrum antibiotics, decongestants Nursing care: clean nose, eyes; force feed food; decrease stress Antiviral therapy Prevention Vaccination Client info FVR highly contagious; can transmit via clothing, hands, etc; only cats Warming food may improve palatability Vaccinated cats may show mild symptoms Disinfectants kill herpesvirus type I virus

Feline Calicivirus Signs Rx Prevention Client info Fever
Serous ocular/nasal discharge; mild conjunctivitis Oral ulcers, salivation Pneumonia Diarrhea Rx Supportive care Antibiotics Force feed disinfect using bleach Prevention Vaccination Client info Highly contagious Signs last 5-7 d Force-feeding may be necessary (if cats can’t smell, they won’t eat)

What do you see? or What do you not see?

Pleural Effusion Dx—x-ray Types of fluid Causes
Fluid in thorax Types of fluid Causes Transudate R-sided CHF, FIP plasma-like fluid; straw colored Blood trauma, neoplasia Chyle neoplasia, pancreatitis, trauma lymphatic fluid from intestine; high fat content infection, parasites --Empyema Infection, foreign body, trauma pus in thorax All types of fluid cause same signs dyspnea may show cough, fever, pleural pain

Pleural Effusion Thoracentesis
Clip hair, scrub skin, block with local anesthetic Most dependent space (7th-8th intercostal space) Aspirate using 3 way valve Remove as much fluid as possible Do not create pheumothorax Analyze aspirate Rx—depends on pathology causing effusion Client info Owner may need to continue pleural drainage Unless 1° is treated, effusion will return Rx can be long and expensive

Fungal Diseases Commonly seen fungal diseases of animals Blastomycosis
Usually result from inhalation of fungal spores or wound contamination Fungi release enzymes/toxins that damage host’s cells Endemic along east coast, Great Lakes, river valleys of the Miss, Ohio, St Lawrence Commonly seen fungal diseases of animals Blastomycosis Coccidioidomycosis Histoplasmosis Aspergillosis

Blastomycosis (Blastomyces dermatitides)
Signs (non specific) Anorexia, depression, wt loss Fever, cough, dyspnea Enlarged LN Dx X-rays—diffuse, nodular interstitial lung pattern (x-ray) Serology testing is available Most cases are diagnosed in the fall. Rx Amphotericin B Client info Blastomycosis usually not zoonotic disease, however, use caution with animals with draining wounds Owners share same environment and are likely to be exposed Relapses are common Rx is expensive

Coccidioidomycosis (Coccidioides immitis)
Signs Mild, non-productive cough Low-grade fever, anorexia, wt loss Weakness, depression Lameness, pain is bone involvement LN enlargement Dx Parenchymal changes on x-ray Serology Rx Ketoconozole Itraconazole Client info Usually not zoonotic disease, however, use caution with animals with draining wounds Response to Rx is good, but recurrence is common Rx is expensive radius-ulna

Histoplasmosis (Histoplasma capsulatum)
Organism which grows in bird manure, bat dropings or organically enriched soil. Signs Feline (pulmonary signs) Wt loss, anorexia Fever, pale mm, swollen LN Canine (GI signs) Wt loss, diarrhea, low-grade fever Dyspnea, cough, pale mm Dz CBC: anemia X-ray: diffuse pulmonary interstitial pattern Rx Ketoconazole Itraconazole Client info Px fair to good for pulmonary form; guarded to grave for systemic form

Cryptococcosis (Cryptococcus neoformans)
A yeast-like fungus found in soil contaminated with pigeon and other bird droppings. Inhalation major route of infection. Immunocompromised animal more susceptible than normal animal Signs Feline Lesions in nasal and sinus cavities; chronic nasal discharge enlarged LN, wt loss, anorexia, lwo-grade fever Canine Usually CNS lesions (vestibular dysfunction) Dx Cytology of aspirates, impression smears Antigen test available Rx Amphotericin B Ketoconozole Itraconazole Px Fair to good unless CNS involvement No known health hazard to humans

Aspergillosis (Aspergillus fumigatus)
Inhalation major route of infection; nasal cavity is main location of lesions Signs Feline (uncommon) May be immunocompromised (FeLV) Lethargy, fever, wt loss, anorexia Canine (localized) Young to middle age Chronic nasal discharge, sneezing, loud breathing (like snoring) Canine (generalized infection) Primarily seen in G Shep Wt loss, anorexia fever, lameness, paresis/paralysis Dx X-ray—loss of nasal turbinates endoscopy:--yellow-green to black fungal plaques on nasal mucosa Rx—topical clotrimazole Client info Localized dis—poor Px; Generalized dis—grave Px; not zoonotic

Pulmonary Neoplasms Signs Primary neoplasia Metastatic neoplasia
Tumors in lungs are usually metastatic, although primary lung tumors do occur Signs Primary neoplasia Cough, exercise intolerance Wt loss, poor condition Dysphagia, vomiting, anorexia Metastatic neoplasia Evidence of primary tumor at other location Same signs as above for Primary neoplasia

Pulmonary Neoplasms Dx
Chest X-rays—mass occupying lesions; can be mistaken for abscess, parasitic dis, fungal infect, bact infect Biopsy—provides definitive diagnosis

Pulmonary Neoplasms Client Info Rx—surgical removal is TOC
Same dog as x-ray Rx—surgical removal is TOC Lobectomy for solitary tumor Chemotherapy (may reduce tumor size, may not increasse survival time Client Info Px is guarded to grave By the time these tumors are diagnosed, they are usually in advanced stages Chemotherapy may reduce clinical symptoms

Cardiorespiratory Diseases

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