ACVIM cheat sheet

Normal canine vertebral heart score (VHS) is 8.5–10.5 on a lateral radiograph (left lateral preferred); measure from T4 to the cardiac apex and sum with the cardiac short axis.

Stage B2 mitral valve disease (ACVIM consensus): murmur plus cardiomegaly (VHS >10.5 or LA/Ao >1.6) warrants pimobendan; stage C begins at first congestive heart failure event.

Echocardiographic LA/Ao ratio >1.6 and normalized left ventricular end-diastolic dimension >1.7 support congestive heart failure in dogs with mitral disease.

Feline cardiomyopathy phenotypes: hypertrophic (LV wall >6 mm), restrictive, dilated, arrhythmogenic right ventricular; hypertrophic cardiomyopathy is most common.

Feline arterial thromboembolism most often occludes the distal aorta at the trifurcation; hallmark signs are cold painful pelvic limbs, absent femoral pulses, and cyanotic nail beds.

Doberman Pinscher occult dilated cardiomyopathy: 24-hour Holter ventricular premature complex count >100 and/or fractional shortening <20% indicates increased risk and treatment consideration.

Pericardiocentesis: approach at the right 4th–5th intercostal space just lateral to the sternum, directed dorsally toward the opposite shoulder; remove fluid slowly to avoid cardiac tamponade decompensation.

Sotalol and amiodarone are used for ventricular arrhythmias; diltiazem controls rate in atrial fibrillation, while digoxin is used for positive inotropy and rate control in selected cases.

Pulmonary hypertension is suggested when tricuspid regurgitant jet velocity >2.8 m/s (estimated systolic pulmonary pressure >36 mmHg) plus supportive echocardiographic findings.

Equine metabolic syndrome diagnosis: basal insulin >20 µIU/mL (or post-thyrotropin-releasing hormone insulin >90 µIU/mL) plus generalized/regional adiposity and laminitis risk.

Equine Cushing's disease (PPID): diagnosis by basal ACTH (seasonally adjusted) or overnight dexamethasone suppression test; pergolide is the standard treatment.

Equine gastric ulcer syndrome: squamous ulcers treated with omeprazole 4 mg/kg PO q24h; glandular disease may require misoprostol or sucralfate and responds less predictably.

Bovine ketosis: blood beta-hydroxybutyrate >1.2 mmol/L is diagnostic; treat with IV dextrose followed by oral propylene glycol.

Bovine respiratory disease: Mannheimia haemolytica, Pasteurella multocida, and Histophilus somni are primary bacterial pathogens; Mycoplasma bovis causes chronic unresponsive cases.

Equine colic: reflux volume >20 L on nasogastric intubation, abdominal distension, and pain unresponsive to analgesia suggest surgical small intestinal lesion.

Equine laminitis: Obel grading and radiographic rotation of the distal phalanx guide prognosis; hoof wall temperature and digital pulse are key clinical signs.

Bovine milk fever (hypocalcemia): recumbency with cold extremities, tachycardia, and decreased rumen motility; treat with IV calcium borogluconate with monitoring for cardiac arrhythmia.

Equine strangles: Streptococcus equi subsp. equi; diagnose by culture or PCR of guttural pouch or nasal swab; quarantine and screen for carriers with guttural pouch lavage.

Lesion localization: forebrain signs include seizures, altered mentation, and contralateral postural reactions; brainstem signs include cranial nerve deficits and ipsilateral paresis.

Modified Glasgow Coma Scale (MGCS) scores motor activity, brainstem reflexes, and level of consciousness; total ≤8 indicates poor prognosis.

Cerebrospinal fluid: normal protein <50 mg/dL and nucleated cells <5/µL in dogs; elevated protein with normal cells suggests blood-brain barrier disruption.

Myasthenia gravis: acetylcholine receptor antibody titer is definitive; megaesophagus and focal weakness are common; edrophonium response is supportive but not diagnostic.

Intervertebral disc disease: Hansen type I (extrusion, chondrodystrophic breeds) vs type II (protrusion, older large breeds); myelography or MRI localizes the lesion.

Status epilepticus: first-line benzodiazepines (diazepam, midazolam), then levetiracetam or phenobarbital; refractory cases may require propofol or pentobarbital coma.

Canine distemper and feline infectious peritonitis can cause encephalitis; cerebrospinal fluid may show elevated protein and pleocytosis, but definitive diagnosis often requires PCR or histopathology.

Idiopathic vestibular disease vs central: peripheral disease has horizontal or rotary nystagmus that does not change with head position and no proprioceptive deficits.

Phenobarbital therapeutic range is 15–45 µg/mL; monitor liver enzymes and consider levetiracetam as adjunct for refractory seizures.

Resting energy requirement (RER) = 70 × (body weight in kg)^0.75 kcal/day; maintenance energy requirement is roughly 1.2–1.6 × RER for adult dogs and 1.1–1.4 × RER for cats.

Weight loss plans: target 1–2% body weight loss per week in dogs and 0.5–1% per week in cats; cats should never lose >2% per week to avoid hepatic lipidosis.

Feline obligate carnivore requirements: taurine, arachidonic acid, and preformed vitamin A are essential; taurine deficiency causes dilated cardiomyopathy and retinal degeneration.

Dogs require 10 essential amino acids (including arginine and taurine) and linoleic acid; cats also require arginine and taurine.

Grain-free and boutique diets are associated with canine dilated cardiomyopathy; consider diet history in any dog with unexplained DCM.

Hepatic lipidosis in cats: initiate enteral feeding at 25–50% RER and advance over several days; avoid rapid refeeding syndrome.

Pancreatitis: low-fat diet is recommended during recovery; severe cases may require parenteral nutrition or jejunal feeding.

Chronic kidney disease: protein restriction is not routine; phosphate restriction and adequate calorie intake are priorities; monitor for proteinuria and hypertension.

Food allergy diagnosis requires elimination diet trial (hydrolyzed or novel protein) for 8–12 weeks; serologic testing is unreliable.

Lymphoma: multicentric is most common in dogs; immunophenotype (B vs T) and stage affect prognosis; CHOP-based chemotherapy is standard for B-cell.

Feline lymphoma: gastrointestinal form is most common; FeLV and FIV status should be assessed; feline injection-site sarcoma is associated with adjuvant vaccines.

Osteosarcoma: most common primary bone tumor in dogs, often appendicular; treatment includes amputation plus chemotherapy (carboplatin or doxorubicin); pulmonary metastases common.

Mast cell tumors: grade with Patnaik or Kiupel systems; c-kit mutation testing guides use of toceranib or masitinib; H2 blockers and omeprazole used for GI signs.

Hemangiosarcoma: splenic or cardiac (right atrial) mass; often presents with hemoabdomen; surgery plus doxorubicin-based chemotherapy improves survival modestly.

Transitional cell carcinoma (urothelial carcinoma): most common bladder tumor in dogs; BRAF mutation testing aids diagnosis; piroxicam plus mitoxantrone or vinblastine is used.

Canine melanoma: oral and digital forms are aggressive; vaccine (Oncept) available for oral melanoma; staging includes lymph node and thoracic imaging.

Mammary tumors: spaying before first heat markedly reduces risk; approximately 50% of canine mammary tumors are malignant; cats have higher malignancy rate.

Paraneoplastic hypercalcemia: most common with lymphoma and anal sac adenocarcinoma; measure ionized calcium and PTHrP to differentiate from primary hyperparathyroidism.

Canine Cushing's disease: low-dose dexamethasone suppression test (0.01 mg/kg IV, cortisol at 4 and 8 h) and ACTH stimulation test; urine cortisol:creatinine ratio is a screening test only.

Hypothyroidism: total T4 and free T4 with TSH; TSH is elevated in primary hypothyroidism but can be normal in 20–40% of cases.

Diabetes mellitus in dogs: diagnosis based on persistent hyperglycemia and glucosuria; insulin therapy with porcine lente or NPH; monitor with glucose curves.

Feline diabetes: remission possible with early insulin and weight management; acromegaly and hyperadrenocorticism are differentials for poorly controlled cases.

Acute kidney injury: International Renal Interest Society (IRIS) grading uses creatinine and urine output; fluid therapy and avoidance of nephrotoxins are mainstays.

Protein-losing enteropathy: measure fecal alpha1-proteinase inhibitor; differentials include inflammatory bowel disease, lymphangiectasia, and intestinal lymphoma.

Pancreatitis: canine pancreatic lipase immunoreactivity (cPLI) is sensitive and specific; feline pancreatic lipase immunoreactivity (fPLI) used in cats; treatment is supportive.

Immune-mediated hemolytic anemia: spherocytes, positive Coombs test, and regenerative anemia; rule out Babesia and Mycoplasma; prednisone plus azathioprine or cyclosporine.

Feline hyperthyroidism: elevated total T4; treat with methimazole, radioiodine, or thyroidectomy; monitor for renal disease after treatment.