Veterinary Internal Medicine Consensus Statement Research Articles

Comparison of Doppler ultrasonic sphygmomanometry, oscillometry and high-definition oscillometry for non-invasive blood pressure measurement in conscious cats.

Systemic arterial hypertension is a common occurrence and can have serious adverse consequences in cats. Therefore, measuring blood pressure is very important. There are many indirect blood pressure measurement devices available. This study compared Doppler, oscillometric (petMAP Graphic II, SunTech Vet20, the Cardell Insight-X0000) and high-definition oscillometry devices for the non-invasive measurement of blood pressure in conscious cats. In this prospective study, blood pressure was measured in 32 cats using the different devices according to the recommendations of the American College of Veterinary Internal Medicine Consensus Statement. Blood pressures (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), time to complete measurements, number of attempts needed, coefficient of variation (CV) between the blood pressure measurements of the different devices, ease of completing measurements and apparent stress level of the cat were assessed. There was a significant difference between devices in the time taken to obtain blood pressure readings and the number of attempts necessary to obtain six reliable measurements. The CV of the Doppler device was significantly smaller than that of the rest of the devices, but there were no other differences between the devices. The mean SBP, DBP and MAP measured by the petMAP device were significantly higher than the measurements from the other devices. The perceived ease of measurement was not significantly different between the various machines. The perceived level of stress of measurement with the Doppler device was significantly higher compared with the other devices but did not lead to an increased SBP. Using a Doppler device to measure blood pressure in conscious cats is fast, relatively easy and gives reliable results. A disadvantage is that the Doppler device can only measure SBP, while oscillometric devices also provide DBP and MAP. However, in veterinary medicine, systolic hypertension is considered the most relevant.

Evaluation of gastroprotectant administration in hospitalized cats in a tertiary referral hospital.

The primary objective of this study was to evaluate the prescription patterns and appropriateness of the use of gastroprotectant medication in cats. Pharmacy dispensation logs from an academic tertiary referral center were reviewed between 1 January 2018 and 31 December 2018. Cats that were administered proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, misoprostol, antacids or a combination were included. Data regarding medication, dosage, formulation, duration of administration, completeness of discharge instructions and clinical rationales for administration were obtained from medical records. The appropriateness of gastroprotectant use was assessed according to the American College of Veterinary Internal Medicine consensus statement guidelines. Of the 110 cases, 67 (60.9%) were prescribed a gastroprotectant medication without an appropriate indication. The most common reason for prescription was acute kidney injury in 26/67 (38.8%). PPIs were the most common gastroprotectant medication administered in 95/110 (86.3%) cats, followed by sucralfate in 18/110 (16.4%) and H2RAs in 11/110 (10%). Of the 35 cases in which gastroprotectant therapy was indicated, the medication chosen or dosage administered was considered suboptimal in 16 (45.7%). Instructions regarding the duration of administration, potential adverse effects and timing of administration in relation to meals or other medications were inconsistently provided in discharge instructions to pet owners. Of the 29 cases discharged with omeprazole, only 13 (44.8%) instructions included a duration of administration, while 6 (20.7%) recommended continuing gastroprotectants indefinitely until further notice, 16 (55.2%) discussed the timing of the administration in relation to a meal and six (20.7%) mentioned potential adverse effects; none advised tapering of omeprazole before discontinuation. When prescribed, gastroprotectant medications were frequently prescribed injudiciously to cats in this referral population over a 12-month period. Discharge instructions to pet owners also often lacked information and recommendations regarding optimal administration, potential adverse effects, and tapering or discontinuation of the medications.

Correlation between the Leaflet-Annulus Index and Echocardiographic Indices in Maltese Dogs with Myxomatous Mitral Valve Disease.

Myxomatous mitral valve disease (MMVD) is the most common chronic heart valve disease, leading to left-sided cardiomegaly in dogs. The leaflet-annulus index (LAI) was originally used in humans as a predictor of mitral regurgitation (MR) after mitral valve repair surgery. This index represents the quantity and severity of MR since it is affected by annular dilation. Recently, LAI was adapted to veterinary medicine, and its usefulness as an indicator of annular dilation on 2D transthoracic echocardiography in MMVD dogs was suggested. For this study, 135 Maltese dogs were selected and divided into groups of control, B1, and B2, according to the American College of Veterinary Internal Medicine consensus statement. The following data were collected: radiographic indices including the vertebral heart score and vertebral left atrial size, echocardiographic indices including the left-atrium-to-aortic-root ratio (LA:Ao), left ventricular internal diameter at diastole, normalized for body weight, and anteroposterior length and LAI measured on right parasternal long-axis view. The results showed a significant difference in LAI between each group, becoming smaller as the disease progressed. Also, there was a significant correlation between LAI and each index, showing the strongest correlation with LA:Ao. LAI could be helpful as a new indicator used for the determination of severity and prognosis in Maltese dogs with MMVD.

Prevalence of persistent hypertension and situational hypertension in a population of elderly cats in The Netherlands.

Systemic arterial hypertension is increasingly recognised and can have serious adverse consequences in cats. Unfortunately, the act of measuring blood pressure itself may cause an increase in blood pressure, known as situational hypertension. It is currently unknown how often this phenomenon occurs. The aim of this study was to evaluate the prevalence of persistent hypertension and situational hypertension in an elderly population of cats in a first-opinion clinic and to assess which factors were associated with systolic hypertension. In this prospective study, systolic blood pressure was measured in 185 cats aged ⩾10 years using the Doppler sphygmomanometry method according to the recommendations of the American College of Veterinary Internal Medicine consensus statement. Age, sex, body weight, body condition score, position during blood pressure measurement and apparent stress level were assessed. If a systolic blood pressure >160 mmHg was found, measurements were repeated to evaluate if persistent hypertension or situational hypertension was present. The first set of blood pressure measurements were used for all the statistical analyses. The median systolic blood pressure for this population was 140 mmHg. The prevalence of persistent hypertension was at least 14.6% and situational hypertension at least 5.4%. Factors significantly associated with hypertension were age, higher apparent stress levels and a sitting position during measurement. Sex, body weight or body condition score did not significantly influence systolic blood pressure. Both persistent hypertension and situational hypertension are common in elderly cats. There are no reliable parameters to distinguish between the two, underlining the importance of a standard protocol and repeating measurements during a follow-up visit when hypertension is found. Age, demeanour and body position during blood pressure measurement influenced blood pressure in this population of elderly cats.

Feline pulmonary hypertension: are we overlooking an important comorbidity?

Pulmonary hypertension (PH) is a potential complication in many disease states, yet it has been largely overlooked in feline medicine. Recently, increased awareness of potential underlying causes has led to a wider understanding of the disease process in humans, with a focus on tailoring therapy to include specific treatment of the underlying etiology. Most of these treatments are not yet available in veterinary medicine, but as they move from the human to the veterinary field, it would be beneficial to better understand the forms of PH encountered in different species. Recently, diagnosis and classification of PH in dogs has been the focus of an American College of Veterinary Internal Medicine consensus statement, yet this condition has received little attention in cats. It is therefore our intention to raise awareness of this condition in cats and to propose a classification system for the types of PH seen in feline patients. As new medications are developed for the treatment of PH, it is important to recognize which forms of PH are seen in feline patients and understand the etiology of the disease. There are many reports of PH (or suspected PH based on echocardiographic assessment) in cats. In this review, we highlight the large number of conditions, and different etiologies, that are associated with PH. Improving understanding of this condition will bring us closer to being able to investigate the benefits of potential new diagnostics and therapies as they become available.

Hepatic lead and copper concentrations in dogs with chronic hepatitis and their relationship with hematology, serum biochemistry, and histopathology.

BackgroundAlthough the influence of copper ([Cu]) on chronic hepatitis (CH) has been widely studied in dogs, little information is available about the accumulation of other metals.Hypothesis/ObjectivesWe assessed the concentration of lead ([Pb]) in the livers of dogs with CH with or without abnormal hepatic [Cu] to establish if any association existed between [Pb] and either hematologic or biochemical variables, fibrosis, necrosis and inflammation of the liver on histology.AnimalsThirty‐four dogs with CH that had hepatic [Cu] and [Pb] determined.MethodsRetrospective review of medical records of dogs with CH and hepatic [Cu] and [Pb]. Chronic hepatitis was defined using current American College of Veterinary Internal Medicine consensus statement guidelines. Hepatic [Cu] and [Pb] were determined using square wave anodic stripping voltammetry. Dogs were divided into 2 groups based on [Cu]: <400 ppm (LoCu) and ≥400 ppm (HiCu).ResultsThe median [Cu] and [Pb] were 357 ppm (range, 100‐7743 ppm) and 58.7 (range, 6.89‐224.4 ppm), respectively. Nineteen dogs had LoCu and 15 dogs had HiCu. Median [Pb] was significantly higher in HiCu compared to LoCu dogs (P < .001). Hepatic [Pb] and [Cu] were significantly correlated (rho = 0.7; P < .001). Dogs with microcytosis had higher [Pb] than did dogs with normal red cell volume (P = .02). Hepatic [Pb] was not correlated with either necroinflammatory or fibrosis scores.Conclusions and Clinical ImportanceAlthough additional studies are needed to better understand the clinical role of hepatic [Pb], dogs with abnormal hepatic [Cu] may also have higher hepatic [Pb]. In addition, in dogs with high hepatic [Pb], microcytosis may be present.

Assessing knowledge, attitudes, and practices of Canadian veterinarians with regard to Lyme disease in dogs.

BackgroundThe blacklegged tick (BLT) is a vector for the bacterium Borrelia burgdorferi (Bb), which causes Lyme disease. Range expansion of the BLT in Canada is related to an increased risk of Lyme disease in many regions. Current literature, such as the 2018 American College of Veterinary Internal Medicine consensus statement, suggests that there may be differences in the approaches of veterinarians who encounter dogs exposed to Bb and dogs with Lyme disease.ObjectivesTo determine current knowledge, attitudes, and practices of Canadian veterinarians regarding Lyme disease in dogs.AnimalsNone.MethodsAn online survey was distributed to Canadian veterinarians through veterinary associations and industries. Survey responses were analyzed using descriptive statistics, spatial analysis, Fisher's exact tests, and univariable logistic regression.ResultsAt the completion of the survey, 192 responses were received from veterinarians practicing in all 10 Canadian provinces. Answers to short scenario and treatment questions reflected a wide variety of clinical approaches taken by veterinarians. Regional differences were seen in reported tick distribution and clinical approaches.Conclusions and Clinical ImportanceRegional differences and generalized differences were found in approaches used by responding Canadian veterinarians with regard to managing Bb exposure and Lyme disease in dogs. We identified areas for future research and knowledge mobilization for veterinarians.

Bovine viral diarrhea virus: An updated American College of Veterinary Internal Medicine consensus statement with focus on virus biology, hosts, immunosuppression, and vaccination.

Control of bovine viral diarrhea virus (BVDV) in cattle populations across most of the world has remained elusive in spite of advances in knowledge about this viral pathogen. A central feature of virus perseverance in cattle herds is the unique mechanism of persistent infection. Managing BVDV infection in herds involves controlling persistently infected carrier animals using a multidimensional approach of vaccination, biosecurity, and identification of BVDV reservoirs. A decade has passed since the original American College of Veterinary Internal Medicine consensus statement on BVDV. While much has remained the same with respect to clinical signs of disease, pathogenesis of infection including persistent infection, and diagnosis, scientific articles published since 2010 have led to a greater understanding of difficulties associated with control of BVDV. This consensus statement update on BVDV presents greater focus on topics currently relevant to the biology and control of this viral pathogen of cattle, including changes in virus subpopulations, infection in heterologous hosts, immunosuppression, and vaccination.

Agreement between invasive and oscillometric arterial blood pressure measurements using the LifeWindow multiparameter monitor and two cuff sizes in anesthetized adult horses

ObjectiveTo assess agreement between oscillometric noninvasive blood pressure (NIBP) measurements using LifeWindow monitors (LW9xVet and LW6000V) and invasive blood pressure (IBP). To assess the agreement of NIBP readings using a ratio of cuff width to mid-cannon circumference of 25% and 40%. Study designProspective, randomized clinical study. AnimalsA total of 43 adult horses undergoing general anesthesia in dorsal recumbency for different procedures. MethodsAnesthetic protocols varied according to clinician preference. IBP measurement was achieved after cannulation of the facial artery and connection to an appropriately positioned transducer connected to one of two LifeWindow multiparameter monitors (models: LW6000V and LW9xVet). Accuracy of monitors was checked daily using a mercury manometer. For each horse, NIBP was measured with two cuff widths (corresponding to 25% or 40% of mid-cannon bone circumference), both connected to the same monitor, and six paired IBP/NIBP readings were recorded (at least 3 minutes between readings). NIBP values were corrected to the relative level of the xiphoid process. A Bland–Altman analysis for repeated measures was used to assess bias (NIBP–IBP) and limits of agreement (LOAs). ResultsThe 40% cuff width systolic arterial pressure [SAP; bias 7.9 mmHg, LOA –26.6 to 42.3; mean arterial pressure (MAP): bias 4.9 mmHg, LOA –28.2 to 38.0; diastolic arterial pressure (DAP): bias 4.2 mmHg, LOA –31.4 to 39.7)] performed better than the 25% cuff width (SAP: bias 26.4 mmHg, LOA –21.0 to 73.9; MAP: bias 15.7 mmHg, LOA –23.8 to 55.2; DAP: bias 10.9 mmHg, LOA –33.2 to 54.9). Conclusions and clinical relevanceUsing the LifeWindow multiparameter monitor in anesthetized horses, the 40% cuff width provided better agreement with IBP; however, both cuff sizes and both monitor models failed to meet American College of Veterinary Internal Medicine Consensus Statement Guidelines.

Exercise induced pulmonary hemorrhage in horses: American College of Veterinary Internal Medicine consensus statement.

BackgroundPublished studies of exercise‐induced pulmonary hemorrhage (EIPH), when assessed individually, often provide equivocal or conflicting results. Systematic reviews aggregate evidence from individual studies to provide a global assessment of the quality of evidence and to inform recommendations.ObjectivesEvaluate evidence to determine: if EIPH adversely affects the health, welfare or both of horses; if EIPH affects the athletic capacity of horses; the efficacy of prophylactic interventions for EIPH; and if furosemide affects the athletic capacity of horses.AnimalsNone.Materials and Methods Systematic review. A panel of 7 experts was formed to assess evidence in the peer reviewed literature addressing each of the 4 objectives. Methodology followed that of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Publications were assessed for quality of evidence by working groups of the panel, and a summary of findings was presented in tables. Recommendations were based on quality of evidence and were determined by a vote of the panel.ResultsMuch of the evidence was of low to very low quality. Experimental studies frequently lacked adequate statistical power. There was moderate to high quality evidence that EIPH is progressive, is associated with lung lesions, that it adversely affects racing performance, that severe EIPH (Grade 4) is associated with a shorter career duration, that furosemide is efficacious in decreasing the incidence and severity of EIPH, and that administration of furosemide is associated with superior race performance.Conclusions and clinical significanceStrong recommendation that EIPH be considered a disease and a weak recommendation for use of furosemide in management of racehorses with EIPH.

Evaluation of oscillometric and Doppler ultrasonic devices for blood pressure measurements in anesthetized and conscious dogs

Two non-invasive blood pressure (NIBP) devices (oscillometry and Doppler) were compared to invasive blood pressure using a Bland–Altman analysis, in anesthetized and conscious dogs. When considering the systolic arterial pressure only during general anesthesia, both NIBP devices slightly underestimated the systolic arterial blood pressure however the precision and the limits of agreement for the Doppler were of a greater magnitude. This indicates a worse clinical performance by the Doppler. The performance of both NIBP devices deteriorated as measured in conscious animals. In general, for the oscillometric device, determination of invasive diastolic and mean arterial pressures was better than the invasive systolic arterial pressure. Overall, the oscillometric device satisfied more of the criteria set by the American College of Veterinary Internal Medicine consensus statement. Based upon these results, the oscillometric device is more reliable than the Doppler in the determination of blood pressure in healthy medium to large breed dogs.

Pimobendan: its place in managing feline heart failure

Pimobendan, a positive inodilator, has proven to bring an added benefit when used in combination with other routine medications in the treatment of canine heart failure. In 2009, the American College of Veterinary Internal Medicine Consensus Statement recommended the use of pimobendan for treatment of dogs with congestive heart failure secondary to degenerative mitral valve disease, while in 2012 the PROTECT (Pimobendan Randomised Occult DCM Trial to Evaluate Clinical symptoms and Time to heart failure) study advocated the use of pimobendan in asymptomatic Doberman Pinscher dogs with dilated cardiomyopathy. With pimobendan being the only canine approved positive inotrope in the UK, and with its success in increasing survival times in our canine patients with heart failure, use of pimobendan in cases of feline heart failure is now being investigated as a viable option when positive inotropic effects are required.

Could we eradicate strangles in equids?

Views: Commentary 377 S (Streptococcus equi subsp equi infection) is a globally distributed and highly contagious equine scourge first described by veterinarians of ancient Rome. Outbreaks are associated with loss of condition, disruption of training and riding activities, cost of veterinary care, and lethal sequelae including disseminated (bastard) strangles and purpura hemorrhagica. The overall complication rate can be as high as 20% of affected animals, with a case fatality rate of up to 8%. Control of strangles is based on various approaches, including screening, quarantine, and immunization. Fully effective and safe vaccines providing long duration of immunity are not available, and the task of developing such vaccines, even with complete genome sequence data for S equi and Streptococcus zooepidemicus, is recognized to be considerable. A recent American College of Veterinary Internal Medicine consensus statement from the United States and United Kingdom on guidelines for treatment, control, and prevention was 12 pages, a length that emphasizes the complexity of control measures. In the United Kingdom, the Codes of Practice Guidelines on Strangles published by the Horserace Betting Levy Board is shorter and, like the consensus statement, focused on dealing with outbreaks. It notes the advisability of informing the relevant breeders’ associations of infection, but acknowledges that there is no legal requirement for this, even for purposes of export. There are no guidelines in Canada agreed to by the horse industry. Strangles has all the hallmarks of an infection that should and could be eradicated (Appendix 1). The causative agent replicates only in equids and survives only briefly in the environment. It causes serious loss through morbidity and death, as well as through cost and implementation of control measures in outbreaks. Because it is not reportable, its presence may fail to be disclosed for economic or other reasons, and therefore, the disease may be introduced unknowingly causing demoralization and conflict. Recent work has shown that the organism is a unique biovar or genovar of an ancestral S zooepidemicus. It appears to be genetically frozen, and unlike most pyogenic streptococcal species, antigenic variation of surface virulence-associated proteins including SeM is slight or absent. In many ways, S equi is an archaeologic relic that could be consigned to history. Could we eradicate strangles in equids?