ISSN 2398-2985      

Heart disease

Jreptile
Contributor(s):

Agata Witkowska

Sarah Brown

Synonym(s): Cardiomyopathy, Congestive heart failure (CHF), Acquired heart disease, Congenital heart disease, Cardiovascular disease


Introduction

  • Cause: cardiac disease in reptiles appears to be rare and few reports exist. This is possibly due to high tolerance of low oxygen levels, low metabolic rate, and behavioral inactivity. Congenital disease is likely more common than thought and most animals will either die or complete development of minor anatomical abnormalities post-hatching.
  • Signs: non-specific, ranging from respiratory signs such as dyspnea, cyanosis and edema to lethargy, weight loss and anorexia.
  • Diagnosis: husbandry review, clinical examination and palpation findings (cardiomegaly is often obvious), radiography, echocardiography, electrocardiography, doppler blood flow, MRI, post-mortem.
  • Treatment: supportive care, diuretics, non-steroidal anti-inflammatory medication, antibiotics. Largely dependent on cause of cardiac disease.
  • Prognosis: guarded to poor; patients often presented late in disease process.

Pathogenesis

Etiology

Congestive heart failure (CHF)

  • Report of cardiomyopathy in a mole king snake (Lampropeltis calligaster rhombomaculata) presented with lesions of primary collage proliferation and replacement of myocardial fibrils by fibrocollagen.
  • Report of myocardial degeneration in a Russian rat snake (Elaphe schrenckii) diagnosed post-mortem.
  • Report of heart failure associated with hepatic inclusions in a Deckert’s rat snake (Elaphe obsoleta deckerti) presented for cardiomegaly. Focal mineralized lesions were found in the tunica media of the right aorta and the right atrioventricular valve.
  • Endocarditis and CHF have been described in a geriatric, female Burmese python (Python Molurus Bivittatus). The animal presented with pitting edema at the cardiac level and cardiomegaly. The animal suffered an infection of Salmonella arizona and Corynebacterium spp isolated from a caseous mass filling the sinus venosus and right atrium.

Atherosclerosis and pericardial effusion

  • Atherosclerosis and pericardial effusion were described in a 2-year-old, male, captive-born central bearded dragon (Pogona vitticeps) Bearded dragon. The animal had appropriate environmental needs, but a poor diet. The animal presented with anorexia, lethargy, and postural abnormalities. Cardiomegaly was visible on radiography.
  • Arteriosclerosis has been documented in green iguanas (Iguana iguana) Green iguana.
  • Aortic stenosis with associated dilatation of the right chambers of the heart have been described in an iguana.

Cardiomyopathy

  • Granulomatous myocarditis with coelomic effusion due to Salmonella enterica arizonae has been described in a Madagascar Dumeril’s boa Dumeril’s boa. The 8-year-old animal presented in good condition with progressive lethargy and anorexia.
  • Infective endocarditis of the pulmonic valve caused by septicemia with Salmonella enterica spp in a Burmese python (Python molurus bivittatus) with pneumonia Pneumonia has been described. The animal was 11-years old and presented with respiratory symptoms.
  • Granulomatous peri- and myocarditis has been described in six captive-born puff adders (Bitis Arietans) due to Chlamydia spp infection.
  • Myocardial abscess causing coronary artery rupture and fatal hemopericardium has been described in a green iguana (Iguana iguana).

Valvular insufficiency

  • Double valvular insufficiency has been described in a 5-year old, captive born female, albino Burmese Python (Python Molurus Bivittatus) suffering from bacterial pneumonia Pneumonia.

Congenital

  • Interventricular septal defect in an American Alligator has been described (Alligator mississipiensis Daudin).
  • A case of a hatchling Brazilian rainbow boa (Epicrates cenchria) Rainbow boa presenting with incomplete migration and development of viscera, including the heart, has been described. Surgical repair was attempted, the animal never thrived and was subsequently euthanized.
  • Incomplete closure of the atrioventricular valves has been described in a neonatal boa constrictor (Boa constrictor) presented for a swelling at the level of the heart.
  • Two cases of bifid ventricles and cardiomegaly have been described in juvenile ball pythons (Python regius). Both patients were able to feed and reach normal adult bodyweights.
  • Secundum atrial septal defect has been described in a Komodo dragon (Varanus komodoensis). Cardiomegaly was discovered at routine radiographic screening.

Mineralization

  • Dystrophic mineralization of the great vessels is a common finding in captive reptiles.
  • A case of a ruptured aorta associated with mineralization of the aorta has been reported in a Chinese water dragon (Physignathus concincinus) Chinese water dragon. The animal died acutely, and diagnosis was reached post-mortem.

Thromboembolism

  • Parasites such as filarid nematodes and trematodes are common in wild-caught reptiles and may be an incidental finding at necropsy. Where treated with anthelmintics such as ivermectin Ivermectin, the clinician should be aware of the risk of thromboemboli formation that may occur with the death of the parasites.
  • Spirorchid fluke infestation leading to cardiovascular changes have been described in green turtles (Chelonia mydas). Cardiac changes included endocarditis, arteritis, thrombosis and aneurysm formation.
  • Death due to a ruptured aortic aneurysm found on post-mortem examination of a healthy Burmese python (Python molurus bivittatus) Burmese python has been described.
  • Other potential cardiac disease processes include visceral gout causing thickening of the pericardium, traumatic hemopericardium due to hematoma formation after cardiac blood sampling in snakes, and primary and secondary cardiac neoplasms. Bacterial, viral and parasitic infections may also be implicated in cardiac disease. Indeed, bacterial endocarditis secondary to systemic infections such as Salmonellosis is not uncommon in reptiles.

Predisposing factors

General

  • Varanid lizards and pythons have a functional separation between the systemic and pulmonary circulation. This leads to different mean arterial pressures. Cardiac disease in these species may present with respiratory signs and often leads to lung edema.

Specific

  • Wild reptiles will be predisposed to parasitic infections.

Pathophysiology

  • Mechanisms involved in cardiomyopathy are likely as in other species.

Timecourse

  • Variable depending on cause of cardiac disease.

Epidemiology

  • Wild reptiles are more commonly affected by parasites.

Diagnosis

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Treatment

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Prevention

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Tiwari S, Aufa S, Park Hyung-Hun et al (2018) Myocardial degeneration in Russian rat snake (Elaphe schrenckii). Korean J Vet Serv 41 (3), 217-220.
  • Schilliger L, Lemberger L, Chai N et al (2010) Atherosclerosis associated with pericardial effusion in a central bearded dragon (Pogona vitticeps). J Vet Diagn Invest 22 (5), 789-792 PubMed.
  • Schillinger L, Trehiou-Sechi E, Petit A M P et al (2010) Double valvular insufficiency in a burmese python (python molurus bivittatus, linnaeus, 1758) suffering from concomitant bacterial pneumonia. J Zoo Wildl Med 41 (4), 742-744 PubMed.
  • Schroff S, Schmidt V, Kiefer I et al (2010) Ultrasonographic diagnosis of an endocarditis valvularis in a Burmese python (Python molurus bivittatus) with pneumonia. J Zoo Wildl Med 41 (4), 721-724 PubMed.
  • Jensen B & Wang T W (2009) Hemodynamic consequences of cardiac malformations in two juvenile ball pythons (Python regius). J Zoo Wildl Med 40 (4), 752–756 PubMed.
  • Mitchell M A (2009) Reptile cardiology. Vet Clin Exot Anim 12 (1), 65-79 PubMed.
  • Pizzi R, Martinez P Y, Feltner R Y et al (2009) Secundum atrial septal defect in a Komodo dragon (Varanus komodoensis). Vet Rec 164 (15), 472-473 PubMed.
  • Kik M J L & Mitchell M A (2005) Reptile cardiology: a review of anatomy and physiology, diagnostic approached and clinical disease. Se Avian Exotic Pet Med 14 (1), 52-60.
  • Andersen J B, Rourke B C, Caiozzo V J et al (2005) Postprandial cardiac hypertrophy in pythons. Nature 434 (7029), 37–38 PubMed.
  • Schilliger L, Vanderstylen D, Pietrain J et al (2003) Granulomatous myocarditis and coelomiceffusion due to Salmonella enterica arizonaein a Madagascar Dumerili’s boa (Acrantophis dumerili, Jan. 1860). J Vet Cardiol 5 (1), 43-45 PubMed.
  • Rush E M, Donnelly T M & Walberg J (2001) Cardiopulmonary arrest in a Burmese python. Lab Animal Europe 1 (3), 15-20.
  • Gordon N, Kelly W R & Cribb T H (1998) Lesions caused by cardiovascular flukes (Dogemea:spirorchidae) in stranded green turtles (Chetonia mydas). Vet Pathol 35 (1), 21-30 PubMed.
  • Jacobson E R, Homer B & Adams W (1991) Endocarditis and congestive heart failure in a Burmese python (Python Molurus Bivittatus). J Zoo Wildl Med 22 (2), 245-248 VetMedResource.
  • Jacobson E R, Gaskin J M & Mansell J (1989) Chlamydial infection in puff adders (Bitis arietans). J Zoo Wildl Med 20 (3), 364-369 VetMedResource.
  • Elliott R J, John C S, Meliton N N & James P D (1980) Heart failure associated with unusual hepatic inclusions in a Deckert’s rat snake. J Wildl Dis 15 (1), 75-81 PubMed.
  • Barten S (1980) Cardiomyopathy in a king snake (Lampropeltis calligaster rhombomaculata). Vet Med Small Anim Clin 75 (1), 125-129 PubMed.
  • Schuchman S M & Taylor D O (1970) Arteriosclerosis in an iguana (Iguana iguana). JAVMA 157 (5), 614-616 PubMed.
  • Brockman H L & Kennedy J P (1962) Inverventricular septal defect in Alligator mississipiensis Daudin. Tex Rep Biol Med 20, 719-20 PubMed.

Other sources of information

  • Hynes B & Girling S J (2019) Cardiovascular and Haemopoietic Systems. In: BSAVA Manual of Reptiles. 3rd edn. Eds: Girling S J & Raiti P. pp 309-322.
  • Schilliger L & Girling S (2019) Cardiology. In: Mader’s Reptile and Amphibian Medicine and Surgery. 3rd edn. Eds: Divers S J & Stahl S J. Elsevier. pp 669-698.
  • Schmidt R & Reavill D (2010) Cardiopulmonary Disease in Reptiles. In: 2010 Proc ARAV. pp 90-98.
  • Innis C J (2000) Myocardial Abscess and Hemopericardium in a Green Iguana (Iguana Iguana). In: Proc ARAV. pp 185-188.
  • Clippinger T L (1993) Aortic Stenosis and Atrio/ventricular Dilatation in a Green Iguana (lguana Iguana). In: Proc AAZV. pp 342-344.

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