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What is a Heartworm?

Heartworm (Dirofilaria immitis) is a fairly large worm (up to 14 inches long) that,
in adulthood, lives in the heart and pulmonary arteries of an infected dog. Dogs
aquire this infection through mosquito bites as mosquitoes readily pick up larval
heartworms from infected dogs and carry them to new dogs. Some geographic
areas have severe heartworm problems while other areas have virtually none. In
order for the parasite to establish its presence in an area, the following conditions
must be met:

• Types of mosquitoes capable of carrying larval heartworms must be
present.

• The weather must be warm enough to allow heartworm larval
development within the mosquito.

• There must be infected dogs (or coyotes) in the area.

• There must be vulnerable host dogs in the area.

When these conditions come together, an area becomes "endemic" for
heartworm disease.

THE DETAILED VERSION OF THE HEARTWORM STORY:
LET'S FOLLOW THE WORM'S LIFE CYCLE

THE ADULT HEARTWORM

Blood going to the lung to pick up oxygen is received first by the right atrium of
the heart, then sent to the right ventricle (the pumping chamber) and then sent
out to the lung via the pulmonary arteries. This path is outlined in the blue
pathway in the graphic below.

The adult heartworm is fairly large, several
inches in length, and it prefers to live, not in
the heart, but in the pulmonary arteries. It
swims into a cozy tubular artery, where it is
massaged and nourished by the blood coursing
past it. In the pulmonary arteries of an
infected dog, the worm's presence generates a
strong inflammatory response and a tendency
for blood to inappropriately clot. If enough
worms are present, the heart must work extra
hard to pump blood through the plugged up
arteries.

If the worm infection is a heavy one (over 25
worms for a 40 lb dog), the worms begin to
back up into the heart's right ventricle (the chamber which pumps blood through
the lung). The worms actually take up a significant amount of space within the
heart, space that could have been taken up by blood. With less blood going
through the heart, there is less blood being pumped out to the lung.

When over 50 worms are present, the ventricle is completely full and the atrium,
the chamber receiving blood from the rest of the body, begins to fill with worms.

When over 100 worms are present, the entire right side of the heart is filled with
worms and there is very little room for any blood to be pumped. This drastic
phenomenon is called "Caval Syndrome" and most dogs do not survive it.

MICROFILARIAE (First Stage Larvae)

microfilariae in a blood smear

With adult male and female worms present, mating begins to occur. Heartworms
do not lay eggs like other worm parasites; instead they give live birth and the
baby worms are called Microfilariae. Microfilariae are released into the
circulatory system in hope that they will be slurped up by a mosquito taking a
blood meal and carried to a new host. Microfilariae may live up to two years
within the host dog in whom they were born. If, after this period, a mosquito has
not picked them up, they die of “old age.” Microfilariae may also be transmitted
across the placental barrier to unborn puppies if the mother dog is infected with
heartworm. It is important to realize that such puppies will not develop adult
heartworms or heartworm disease from these microfilariae; in order for a
heartworm to reach adulthood, it must be passed through a mosquito.

Parasitic worms have 5 larval stages and are termed "L1," "L2," "L3," etc.
Heartworm microfilariae are first stage larvae: "L1"s.

Note: Ivermectin, and milbemycin based heartworm preventives will kill
microfilariae after prolonged use. Dogs on these heartworm preventive, even if
infected with adult heartworms, will not test positive for microfilariae.
Moxidectin based heartworm preventives (Advantage Multi®) and selamectin
based heartworm preventives (Revolution®) will not reliably wipe out
microfilariae; infected dogs who have received these products may or may not
test positive.

INSIDE THE MOSQUITO

So, let us continue to follow the young heartworm's
development inside the mosquito who has taken it in with a

approximately 5-7 months after first entering the new host. the stage capable of infecting a new dog. Note: All commercially available heartworm preventives act by wiping out the freshly delivered L3’s and the L4’s living in the skin. In general. The process goes faster in warmer weather. they will not detect infection with immature worms. The L5. the L3 is not deposited directly into the dog's bloodstream. The L4 will live in the skin for three months or so until it develops to the L5 stage and is ready to enter the host's circulatory system. The ivermectin products are also able to kill the younger L5’s.blood meal. there must be adequate humidity to prevent evaporation of this fluid droplet before the L3’s can swim through the mosquito bite and into the new host. This is why it takes 5-7 months from the time of exposure to get a valid heartworm test and this is also why there is no point in testing puppies under 5-7 months of age. INFECTING A NEW DOG When a dog is bitten by an infected mosquito. . For transmission to occur. it takes a few weeks. the L3 will spend the next week or two developing into an L4 within the host's skin. How long this takes depends on the environmental conditions. migrates to the heart and out into the pulmonary arteries (if there is room) where it will mate. the microfilariae will develop to L2’s and finally to L3’s. which is actually a young adult. Also note: because the heartworm tests on the market either look for microfilariae or for adult worm proteins. it is deposited in a tiny drop of mosquito "spit" adjacent to the mosquito bite. Instead. Once safely inside the new host. A minimum environmental temperature of 57 degrees F is required throughout this period. Within the mosquito's body.

Dogs with only larvae of one stage or another are not sick and it is controversial how dangerous it is for a dog to have only one or two adult heartworms. Heartworm infection by definition means the host animal (generally a dog) is parasitized by at least one life stage of the heartworm (Dirofilaria immitis). dogs with heartworm disease are sick. They not only have the infection but they have any of the problems listed below because of it. they may have larval heartworms in their skin only. Dogs with heartworms in their bodies are not necessarily sick. an important distinction must be made between heartworm disease and heartworm infection. WHAT HAPPENS IN HEARTWORM DISEASE HEARTWORM DISEASE vs. On the other hand. HEARTWORM INFECTION Before reviewing the clinical signs seen in heartworm disease. Dogs with heartworms in their bodies do not necessarily have adult worms in their hearts. Fortunately. These dogs are certainly infected but they do not have heartworm disease. either. .

continues to damage the artery. Cells of the immune system are called into the area but the worm is far too big for these tiny cells to destroy. The lining of the artery becomes damaged within days of the worm's arrival. however. we will now discuss the damage heartworms can do to a dog's body.heartworm disease is both treatable and preventable. The resulting inflammation. Blood is shunted to other arteries which are not plugged up by worms and fluid begins to accumulate in the lung around the worm- filled arteries. The arteries dilate and become tortuous (which may be visible on a radiograph). Further sections of this web area explain both treatment and prevention. . Aneurysms and abnormal blood clotting (embolism) results. Blood being sent to the lung is not efficiently oxygenated and areas of lung become consolidated and unable to participate in providing oxygen to the blood. DAMAGE TO THE PULMONARY ARTERIES Arteries do not do well having worms living inside them.

SO IS SUDDEN DEATH. CHRONIC IMMUNE STIMULATION When a dog goes without treatment for heartworm disease. Antibodies. • If the right side of the heart becomes too weak to keep up. ARRHYTHMIA IS A POSSIBILITY. blood vessels. the heart must pump faster and stronger still. If worms begin backing up into the heart. This means that the pumping/filling rhythm can be disrupted and an "ARRHYTHMIA" may result. In order to meet the body's oxygen demand. it may not conduct electrical impulses normally. • A form of non-infectious pneumonia ("pulmonary eosinophilic granulomatosis") can result from excessive infiltration of inflammatory cells into the lung in response to the parasite. IN ANY HEART DISEASE. kidney. the heart must pump harder against the pressure of the plugged arteries. These antibodies can cause a lot of trouble by precipitating in the delicate membranes of the eye. which are not only important tools of the immune system but are inflammatory proteins. WHEN ARRHYTHMIA IS A POSSIBILITY. With the arteries plugged with worms. It may be strong enough and it may not. The heart must pump through the high pressure system of the plugged arteries using less blood then normal. there will be less space in the pumping chamber for blood to be pumped. and joints. • When the heart muscle begins to thicken (as any over-worked muscle will). leading to a pot-bellied appearance and/or difficulty breathing. This condition is called "PULMONARY HYPERTENSION " and the right side of the heart must drastically increase its ability to work. There may come a point when the heart simply is not strong enough. its immune system becomes chronically stimulated. HEART FAILURE Blood normally is pumped with ease through the arteries of the lung. • Coughing and exercise intolerance result as areas of the lung are unable to participate in the blood oxygenation process. fluid may accumulate in the chest cavity and abdominal cavity. are produced in high amounts all the time. Antibodies stuck in these . • Nose bleeds may occur due to abnormal blood clotting in the lung.

disease.areas. shock. there are so many worms present (around 100) that the entire right side of the heart is filled with worms and they are backing out into the large veins that feed the right side of the heart. For details on heartworm infection. Heartworm disease is a highly significant problem and must be managed both by dealing with the worms and by dealing with the heart disease. the dog may survive. Cats are so small that only one adult worm could be enough to cause heart failure plus there is much more inflammation involved with the immature worms in the cat. and red blood cell destruction associated with this syndrome. HEARTWORM IN THE CAT Heartworm disease is the cat is quite a bit different from heartworm disease in the dog. Death usually occurs within 1 to 2 days and the only effective treatment is to open the dog's jugular vein and physically remove the worms with a special clamp. call in inflammatory cells and damage these delicate membranes thus setting up tremendous tissue damage and pain. and prevention in the cat click here. Here. . If enough worms can be removed to re-establish blood flow. treatment. Usually there have been no signs of heart disease prior to the collapse. CAVAL SYNDROME Caval syndrome represents an especially disastrous form of heartworm disease.

The chief issue in the diagnosis of heartworm disease centers around detecting heartworm infection. The following are a list of diagnostic methods that have been and are used in the detection of heartworms within the pet dog's body. BECAUSE OF THE 5-MONTH MINIMUM MIGRATION TIME OF THE LARVAL HEARTWORM AFTER INFECTION. IT IS OF NO USE TO HEARTWORM TEST DOGS YOUNGER THAN 5 MONTHS OF AGE. THESE PUPPIES ARE TOO YOUNG TO HAVE ADULT HEARTWORMS AND ARE TOO YOUNG TO TEST POSITIVE UNDER ANY CIRCUMSTANCES. .

In these tests. it is not recommended as a regular test method. In this test. heartworm microfilaria under the microscope DIRECT BLOOD SMEAR While this method is a simple screening test. detection of heartworm larvae in this way require large numbers of larvae for detection (less than 20-50 microfilariae per ml of blood will not be detected). More subtle infections will be missed. Of course. DIFIL TEST AND KNOTT’S TEST heartworm microfilaria as seen via a Knott's test These tests represent "concentration" methods for the detection of microfilariae so that more subtle infections can be detected. microfilaria testing is usually done in conjunction with antigen testing (see below). Nowadays. chances are at least one will be seen seen swimming by. a larger amount of blood is either centrifuged or filtered to concentrate any microfilariae present. If a large number of microfilariae are present. either of these would be appropriate. a single drop of blood is examined under the microscope for the presence of live microfilariae. In . When a microfilaria test is to be done.

an example of an ELISA test for in house use. IDEXX snap test for heartworm.areas where heartworm infection is not common. it has become possible to create extremely sensitive tests capable of detecting tiny pieces of adult heartworm skin circulating in the blood. Subtle differences in the swimming characteristics. which is transmitted by fleas. and tail structure can be used to distinguish this harmless larva from the more serious heartworm microfilaria. nose structure. there was an element of diagnostic challenge when microfilaria were detected in the blood (was the nose the shape that would justify a harsh and possibly life-threatening treatment for heartworm infection or was it a harmless creature for which no treatment was needed?) The advent of antigen testing has made this distinction much easier to make. more than one type of test should be performed for the sake of accuracy. which may be picked up by the microfilaria tests. In . Before immunotechnology. DIPETALONEMA RECONDITUM: THE OTHER MICROFILARIA Heartworm is not the only species of worm that has circulating microfilariae as a first stage larva. There is another parasite called Dipetalonema reconditum. ANTIGEN TESTING Using genetic engineering.

If for some reason. This kind of testing has made it possible to detect infections in which no microfilariae are present: the so-called "Occult infections. One problem is that the antigens detected by antigen tests are unique to female worms. moxidectin. even single worm infections. one could be misled into thinking that the infection had been completely cleared. Animals infected with only male worms will test antigen negative. it is felt by many specialists that no microfilaria positive dog should be treated for heartworm without a positive antigen test. antibody tests have been developed to detect the host's immune response against the parasite. There are many important reasons why a dog might be infected with adult heartworms yet no microfilariae can be detected: • Single sex infections or single worm infections Younger female worms tend to be resistant to the drugs used to clear adult worms.this way." Most of these immunological tests are available as test kits which can be performed in the veterinarian's office while you wait. at least three female worms are needed for the test to show a positive result. ivermectin. This means that after the first treatment with anti-heartworm medication. This kind of breakthrough has been . it is possible for an infection to establish yet no microfilariae will be detected. very small numbers of adult worms can be detected. ANTIBODY TESTING Antigen tests have limited usefulness when it comes to infections involving only a few worms. • Immunologic destruction of microfilariae In the cat. a dog is not properly tested and has missed a dose of medication. • The dog is taking heartworm prevention medication Milbemycin. this is one reason. If antigen testing is not performed. To get around these limitations. People commonly ask why they must continue annual testing in animals that are on preventive medication. Since Dipetalonema microfilariae can be mistaken for heartworm larvae and since microfilariae can be transferred to unborn puppies (but adult heartworms cannot). For most tests. a group of young female worms will be left. the period in which microfilariae can be detected in the blood stream is extremely short as the immune system rapidly groups and clears these larval worms. and selamectin are able to kill circulating microfilariae (but not adult heartworms).

it becomes difficult to figure out in what month heartworm preventive medication should be initiated.). With differences in weather patterns every year (i.especially important in testing for cats in whom infection with one or two worms is the usual situation. late freeze another year etc. antigen tests are performed for dogs with or without a microfilaria test and cats get antibody tests sometimes with antigen tests as well. then the dog should be tested before beginning prevention the next season. If a dog lives in an area considered not to have heartworm and travels to an area that IS considered to have heartworm. As a general rule. HOW OFTEN SHOULD A DOG BE TESTED? This is a hard question to answer.e. If the dog consistently takes monthly heartworm preventive medication all year round. see heartworm prevention. RADIOGRAPHS AND ULTRASOUND . both microfilaria and antigen testing should performed at least seven months after the last day the dog was present in the heartworm endemic area. it is probably a good idea to simply test the dog annually. If there is any question about the dog spitting out any preventive tablets last season . If there is any question about when the last possible transmission date was in the previous season. then testing can probably be performed every 2 to 3 years (though an annual physical exam is needed to legally obtain a prescription for medication). early spring one year. Antibody testing may be able to detect infection sooner than can antigen testing and infections involving only male worms can be readily detected. For more information on the different medications used in the prevention of heartworm infection.

Some hospitals use computerized formulas to categorize heartworm infected patients. Ultrasound not only can measure thickening of the right side of the heart but can actually show the live worms wiggling. In these cases. TREATMENT OF INFECTION It has been said that the treatment of heartworm infection is somewhat of an art. When imaging tests are consistent with heartworm disease. PATIENT EVALUATION Prior to therapy. The categories into which patients are grouped are as follows: . antigen and/or microfilaria testing would be the obvious next step. the infection is picked up during the work-up for heart disease. routine testing is not performed and infection is unlikely to be detected until the dog is sick. The important concept to realize is that very harsh arsenic based drugs are necessary to kill adult heartworms and that treating for heartworm infection is neither simple nor safe in itself. Important factors include: how many worms are thought to be present based upon the tests performed. the heartworm patient is assessed and rated for risk into one of four categories. and the degree to which exercise can be restricted in the recovery period. Radiographs can be strongly indicative of heartworm infection if they show blunted tortuous pulmonary arteries and enlargement of the right side of the heart (the side doing all the extra work to pump blood past the worms). the size of the dog. Let us review some of the dangers and options in clearing the body of this parasite. concurrent health factors. There are several strategies that can be used depending on the dog's medical condition including the option of not treating at all. the age of the dog. severity of the heart disease.In areas where heartworm infection is not common.

Healthy dogs with minimal signs as above. normal blood work. and no symptoms of illness. lab work reveals a more severe anemia and marked urinary protein loss. Lab testing shows mild anemia. urine dipsticks show some protein present but not severe urinary protein loss. difficulty breathing. Chest radiograph from a mildly affected dog • Class I: Lowest Risk. blatant damage to the vasculature is apparent on radiographs. fatigue only with exercise but with radiographs that show definite evidence of heart disease. Young healthy dogs with minimal disease evident on radiographs. they only fatigue with exercise. • Class II: Moderately Affected. Chest radiograph from a severely affected dog • • Class III: Severely Affected. and their chest radiographs are normal. They may cough only occasionally if ever. cough. Dog is suffering from weight loss. occasional coughing. .

This group requires the arsenic compounds for destruction while the other two groups can be killed with less toxic products. Heartgard®. L3. click here: www. These will continue their maturation and repopulate the heart and pulmonary arteries if they are not killed before the adult worms. further heartworm infection treatment cannot be contemplated until the dog is stable enough to fit into one of the other categories above. If such a dog can be saved from this crisis. and L4 larvae can all be killed by monthly ivermectin based heartworm preventive products (i. Fewer adult worms dying at once means less risk. The microfilariae are swimming freely in the bloodstream possibly in large numbers and it is the microfilariae which can (through a mosquito) spread to other dogs. • The new arrival heartworm larvae.com/watch?v=VOLzFsNOJ-4 After knowing what Class the patient fits in. These are L3 & L4 larvae living in the skin (having arrived within the last 3 months). • The L5 larvae and adult worms living inside the heart and pulmonary arteries. we minimize the number of adult worms we must kill in the second step. very abnormal bloodwork. The milbemycin . treatment can be determined. Triheart® etc. To view the physical removal of adult heartworms from the jugular vein of a dog with caval syndrome.).e. KILLING THE MICROFILARIA AND MIGRATING WORMS The first step in treatment is clearing the migrating immature worms. These dogs are dying and can only be saved by the physical removal of adult heartworms via an incision through the jugular vein. The microfilaria are killed so as to keep the dog from spreading his or her infection.youtube. • Class IV: Caval Syndrome. If we were to jump directly to killing the adult worms first. The dog has three groups of heartworms in his or her body: • The microfilariae which are the newborn children of the adult worms living in the heart and pulmonary arteries. the adult worms we remove could be readily replaced shortly afterwards by those that were in the process of migration at the time of treatment. Heartworms visible by ultrasound in the AV valve of the right side of the heart. delivered from mosquito bites in the last 6-7 months. Dog is collapsing in shock with dark brown urine evident. By addressing the migrating immature worms first. Happily the microfilariae.

treatment can be done in 2 doses or 3 doses depending on the Class of heartworm infection. it is the adult worms that cause heartworm disease. Be very careful of the injection site as the pet may bite. Pain medication may be needed. The American Heartworm Society recommends 1-3 months of a preventive prior to treating the adult worms. The dog must live the indoor life. Some dogs develop a permanent firm lump at the site of the injection.based products (Sentinel® and Interceptor®) will also do the same job but will kill the microfilariae much faster which can create circulatory shock if there are large numbers of microfilariae dying all at one time. How long one chooses to wait depends on how urgent the dog’s need is to remove the adult worms. Approximately 30% of dogs experience some sort of injection site reaction which resolves in 1-4 weeks. the patient must be strictly confined for one month following the final treatment. no running around. the dog comes back for a second injection the next day on the opposite side of the lower back. Most universities. In the 2 dose protocol. The patient receives an intramuscular injection deeply in the epaxial (lower back) muscles as shown above. After treatment. In the 3 dose protocol. KILLING THE ADULT WORMS The only product currently available for the treatment of adult heartworms is melarsomine dihydrochloride (immiticide® made by Merial). No walks. If one goes by the manufacturer's recommendations. opt to treat all patient with the 3 dose protocol as it creates a more gradual kill of the adult worms (which is safer in terms of embolism and shock). however. The newer products such as the selamectin and moxidectin products do not clear microfilaria well enough to be used in the treatment of an active infection so right now the ivermectin based products seem to be the best for this use. The reason . After all.) Keep in mind. too many worms dying at once creates circulatory shock. the dog comes back one month later for 2 doses 24 hours apart (the first dose representing an introductory treatment to kill some of the more sensitive worms. This is a painful injection with a painful substance and it is common for the patient to be very sore at home afterwards. not the immature worms addressed by the preventives. The site may actually form an abscess which requires warm compresses.

If the dog is stable (Class I) one option is to simply leave the dog on an ivermectin based preventive. • Ivermectin does shorten the lifespan of adult heartworms. • Ivermectin does sterilize adult heartworms. This means that if one opts to treat a heartworm positive dog with an ivermectin heartworm preventive only. IVERMECTIN ONLY Melarsomine treatment is expensive and often out of reach for rescue groups. Exercise increases heart rate and oxygen demand and we need the heart to rest during this recovery period. . one can expect the dog to remain heartworm positive for a good 2 years and the heartworm disease will be progressing during that 2 years. This option has led to a great deal of misconception about the ability of ivermectin to kill adult heartworms.for this is that embolism to some degree is inevitable and it is important to minimize embolism-related problems. • Ivermectin does kill microfilaria (keeping the dog from being a source of contagion) • Ivermectin does kill L3 and L4 larvae (preventing new infections). shelters. and many individuals. report them to the vet as soon as possible. This approach should only be considered for patients who are Class I and may be able to withstand 2 years of heartworm infection. Let us lay the rumors to rest now: • Ivermectin does not kill adult heartworms. The most critical time is 7-10 days following a melarsomine treatment but they can occur anytime in the following month. Watch for: • Coughing • Fever • Nose bleeds If any of these occur. This is not good for the dog but certainly beats getting no treatment of any kind.

larval heartworms. The role of this organism is still being investigated. . Page last updated: 6/20/09 FELINE HEARTWORM DISEASE Section of normal cat lung. As new information emerges. we will post here. which kills Micrograph of a Wolbachia organism. If your veterinarian wants to pre-treat your heartworm positive dog with doxycycline. seems to sterilize female heartworms (meaning they cannot reproduce). They live inside the adult heartworm. it may be because of concerns regarding this organism. theWolbachia. The cells of inflammation have thickened the tissues so that oxygen absorption is challenged and there is far less room for air. These organisms seem to be protective or beneficial to the heartworms and treating the dog with the antibiotic doxycycline. Wolbachia is also thought to be involved in the embolism and shock that results when heartworms die.WHAT IS WOLBACHIA Wolbachia is a genus of rickettsial organisms (sort of like bacteria but not exactly). Section of a lung from a cat with circulating White areas would be full of air.

a common statistic presented was that within a given geographic area. Recent research indicates this is not so. In the past. Auburn University College of Veterinary Medicine DO CATS GET HEARTWORM? The answer to this question is an unequivocal "yes" but the feline situation is vastly different from the canine situation. the feline infection has recently been found to be a much more widespread problem than previously believed. Images courtesy of Dr. Byron L. Blagburn. the feline heartworm infection rate was approximately 10% of the of the canine infection rate. in heartworm endemic areas the incidence of feline heartworm infection rivals or surpasses that of feline leukemia virus or feline immunodeficiency virus. While it is true that the feline infection is not as common as the canine infection. Ray Dillon and Dr. An incidence of 2-14% of all cats has been reported for endemic areas making heartworm a concern for any cat living where there are mosquitoes. Thanks to The American Heartworm Society for these pictures. THE PARASITE AND ITS MIGRATION .

infected cats typically have less than six adult worms. six worms or fewer might not be considered worth treating. Because the feline heart and blood vessels are so small. • Whereas worms found in the canine heart can reach lengths up to 14 inches.• The cat is not a natural host for the heartworm which means the migrating larval heartworm is not likely to complete its life cycle. The migrating worm uses molecular sign posts to tell it how to get to its host’s pulmonary arteries. In the cat. a single worm could easily represent a lethal infection. . • Whereas a moderate heartworm infection in a dog would involve 25-50 adult heartworms. Most of the larvae that actually make it to the pulmonary artery die soon afterwards due to the massive immune attack from the feline body. In a dog. the average length of worms found in feline hearts is only 5-8 inches. Very few larval heartworms survive to adulthood in the cat. The worm is prepared to read CANINE directions and may get lost in the feline body ending up who knows where. these few worms can wreak havoc.

Heartworm disease in the cat is caused by the inflammatory reaction generated by the worm’s presence. it will only live 2-3 years in a cat probably due to the cat's especially strong immune reaction. heartworm disease is mostly about the obstruction of blood flow from the physical size of the worms. Click here to see an animated depiction of how heartworm infection causes disease in the cat courtesy of Pfizer Animal Health . In the dog.• While an adult heartworm can expect to live 5 years in a dog.

In the cat. There may be only a few adult worms present. it is virtually impossible to detect microfilariae in an infected cat. The second phase where problems can occur is when the worm dies. in cats heartworm disease in cats stems at least in . For this reason. in the cat microfilaria testing is virtually worthless. (The cat's immune system removes them too quickly). symptoms of infection tend to be more immune-related than heart failure related. disease is not dependent on the presence of adult worms so this kind of testing has limited applications. testing for microfilariae (off-spring of adult heartworms born in the host’s body) are also commonly performed. Also. Feline heartworm disease is often misdiagnosed as feline asthma. Since the cat is not the natural host for this parasite. Cats develop more of a lung disease. Cells of inflammation infiltrate the lung and interfere with the cat’s ability to breathe. Further there may be too few adult worms present to generate a positive antigen test. and coughing or vomiting chronically. single sex infection is common. HEARTWORM DISEASE IS PRIMARILY A LUNG DISEASE IN THE CAT. most immature worms that make it to the lung are killed. First of all. The first is when immature worms reach the lung and pulmonary arteries. In cats there are two phases where the disease can exert symptoms. Sudden death may occur just as it may occur in infected dogs. if any. diagnosis is usually not complicated. In the dog. (Imagine your body trying to remove/digest the dead body of another animal inside your lung and circulation!) The effects of this kind of widespread inflammation can reach far beyond the lung and circulatory system. are simply cleared too quickly to be found reliably. complete with respiratory distress. The presence of the dead worm is extremely inflammatory. as early as 75-90 days after infection. The presence of even small worms is very inflammatory and disruptive to the circulation. microfilariae. The kidney can be affected as well as the gastrointestinal tract and even the nervous system. infected cats usually do not have enough adult worms for the production of off-spring. A blood sample is tested for proteins that can only be found in the body of the adult female heartworm.SYMPTOMS OF DISEASE The cat's immune system is extremely reactive against heartworms. Further. NOT A HEART DISEASE DIAGNOSTIC TESTING In the dog. As mentioned. Unfortunately.

if the cat does not appear sick. the American Heartworm Society recommends attempting to wait out the worm's 2-3 year life span and simply monitor chest radiographs every 6 months or so. So if no single test is reliable. It could indicate the presence of immature worms in the body. Approximately one third of cats receiving heartworm adulticide therapy will experience life-threatening embolic complications when the worms die suddenly (generally an unacceptable statistic). however. however. A negative antibody test is good evidence that the cat is not infected. The dose of ivermectin (active ingredient of Heartgard) needed to prevent heartworm infection in the cat is about 4 .) This means that a positive antibody test should be accompanied by some kind of signs of heart disease (either symptoms or radiographic or ultrasonographic evidence) or with a positive antigen test before making a diagnosis of active heartworm infection in a cat. both these tests are recommended plus chest radiographs and/or echocardiography to assess heart and lung disease. If a cat is sick and heartworm disease is suspected. PREVENTION The good news is that feline heartworm infection is 100% preventable and there are currently four products on the market that are reliably effective. TREATMENT Since the major signs of disease in the cat are due to inflammation and immune stimulation. Antibody testing may be more sensitive but is not adequate alone. No adult worms (and thus no off-spring) are necessary for disease so microfilariae testing is not worthwhile in the cat. a positive antibody test may indicate several things. a medication such asprednisone can be used to control symptoms. It could also indicate a past infection. depending on the degree of illness from the heartworm disease. (Antibody levels will remain somewhat elevated after the heartworms have long since died of old age. In general. The same heartworm adulticide therapy used in dogs is best not used in cats as it is extremely dangerous to do so and is considered a last resort. There may not be a choice. what are we supposed to do for testing? The American Heartworm Society currently recommends using both an antigen test and an antibody test for screening apparently healthy cats. One month of cage confinement is typically recommended to control circulatory effort after adulticide treatment.part from migrating immature larvae. It could indicate a mature infection.

Interceptor for cats also protects against hookworms and roundworms. The American Heartworm Society recommends testing prior to adminstrtion. It is a monthly flavored chewable available by prescription.times higher than that in the dog. PREVENTION OF HEARTWORM INFECTION IN DOGS (also called “Chemoprophylaxis” . Heartgard was the first FDA approved heartworm prevention medication available for cats. Interceptor® also makes a monthly chewable for cats with the same active ingredient (milbemycin oxime) as Interceptor for dogs.

IVERHART MAX® made by Virbac TRI-HEART PLUS® made by Schering Plough The approval of ivermectin in 1987 represented a huge breakthrough in heartworm prevention. both topical and oral. Tri-Heart Plus) MILBEMYCIN Based Products (Interceptor.IVERMECTIN Based Products (Heartgard. Preventive medication for the first time could be given once a month instead of daily. HEARTGARD PLUS® made by Merial PRODUCTS: IVERHART PLUS®. At this point. These medications utilize an extremely low dose of ivermectin which is adequate to kill any L3 and L4 larval stages which are inhabiting the pet’s skin tissues at the time the medication is given. the products available are intended for monthly use. There are presently many choices. Iverhart Max. giving an ivermectin-based heartworm preventive to an infected dog is the first step in heartworm infection treatment. In fact. all the products discussed have feline formulations. Proheart6) Heartworm preventive medications are used to periodically kill larval heartworms that have managed to gain access to the dog’s body. while the subject of this page is canine heartworm prevention. plus. Sentinel) SELAMECTIN Based Products (Revolution) MOXIDECTIN Based Products (Advantage Multi. Some products offer the ability to kill older larvae which helps keep the pet protected in case someone is late giving the heartworm preventive medication at some point. If given to a heartworm positive dog by accident In most cases no reaction of any kind occurs when an ivermectin-based heartworm preventive is given to a heartworm positive dog. Iverhart Plus. In other words. Ivermectin kills the developing larval worms and clears the circulating microfilariae thus rendering the dog unable to spread . This means that they kill all the heartworm larvae (stage “L3” and “L4”) that have accumulated in the past month each time they are given. IVERMECTIN BASED HEARTGARD®. infection takes place but is halted every month when the medication is administered. Heartgard Plus.

In the 1988 experiment by Atwell. pyrantel pamoate. it is still worth picking up where one left off. re-starting preventive could still preclude adult heartworm infection in the heart and pulmonary arteries. a dewormer. That said. Other Parasites Covered Ivermectin at the heartworm preventive dose is not strong enough to kill common intestinal parasites. (ELISA test kits should still be accurate. This allows the dog to be observed for several hours following the oral dose in case of trouble. in most cases no reaction of any kind occurs and the larval worms are cleared without event. Iverhart Max®includes both pyrantel pamoate and praziquantel so as to cover tapeworms as well. As other ivermectin-based products have entered the market.) In addition to killing microfilariae. a shock-like circulatory reaction can occur so for this reason the American Heartworm Society recommends that the first dose of ivermectin be given under veterinary supervision. ivermectin will also suppress reproduction in the adult female worms and shorten the overall life span of adult worms. it cuts their life expectancy. This does mean. however. Because of this fact. Breed Sensitivity . Iverhart Plus®. that giving this product to a dog with heartworm will kill all circulating microfilariae and the dog will test erroneously heartworm negative by Difil or Knott’s testing. these have also added pyrantel pamoate to extend the spectrum of protection.its infection and minimizing the number of adult worms to be killed in the second phase of treatment when the adult worms are specifically addressed. dogs who went off heartworm preventive for four months and then restarted with ivermectin had 95% fewer adult heartworms than dogs who went without ivermectin (though it should be noted that some heartworms were still able to establish infection). was added to cover hookworms and roundworms in the original Heartgard product. Whipworms are not covered by any of the ivermectin containing products at this time but. manufacturers may pay for treatment for whipworm infections acquired while their product is administered. If the larval worms die too quickly. Ivermectin does not kill adult heartworms (just the immature ones) though. as said. The Reach Back Effect There is also a phenomenon called the “Reach back effect. and Tri-Heart Plus®. The products containing both ivermectin and pyrantel pamoate are Heartgard Plus®. This means that if one skips several doses of ivermectin accidentally. in order to remain competitive in the market.” This means that if a dog goes off heartworm preventive medication for a prolonged period (four months was the time tested).

merial. and will suppress female worm’s ability to reproduce.com www. acts by killing all L3’s and L4’s accumulated in the month prior to administration. If given to a heartworm positive dog by accident If milbemycin is inadvertantly given to a dog with active heartworm infection.us.There are breed-related sensitivities with ivermectin (i.com/home/ www. Large animal ivermectin products are vastly more concentrated than those meant for dogs and it becomes problematic to dilute them properly.e. Use of Large Animal Products It is neither safe nor legal to obtain large animal ivermectin products for use in dogs for heartworm prevention.triheartplus. also clears microfilariae. collie-related breeds have some difficulties) though at the very low doses used in the prevention of heartworm disease are not a problem for any breed. For information on these products from their manufacturers visit: http://heartgard. Even small doses of these products are unnecessarily high and if they are inadvertently given to a sensitive individual death can result. There are a few important differences to note between this product and the ivermectin-based products. In a dog with a light infection this might not be . though.com MILBEMYCIN OXIME BASED (INTERCEPTOR® & SENTINEL® made by PRODUCTS: Novartis) This product is also given monthly. the microfilariae are killed much faster than with the ivermectin products. An assortment of doses have circulated around on the internet and in other sources advocating the use of highly concentrated ivermectin formulas for heartworm prevention in dogs. This might sound like a good thing but in fact it increases the likelihood of the previously mentioned shock-like reaction when all the first stage larvae die all at once. These doses are not comparable to the miniscule doses in licensed heartworm preventive products and using them represents an element of gambling.iverhart.

There are no breed-related sensitivities for milbemycin. the dog can be expected to have 41% fewer heartworms than if heartworm prevention was not resumed. Milbemycin is also available combined withlufenuron for the control of fleas in the form of Sentinel®. Milbemycin can also be used in the treatment of demodectic mange. Novartis Animal Health has a Heartworm section on their web site at: www. This was not as good a result as with the ivermectin products because ivermectin is better at killing older heartworm larvae. The Reach Back Effect When milbemycin is given to a dog after a prolonged period without heartworm preventive (the Atwood experiment). A special dosing schedule is needed to accomplish this. If one finds oneself in the situation of having skipped several months of heartworm prevention in the middle of heartworm season. Lufenuron is an oral flea sterilizer which prevents any fleas feeding on the dog from laying viable eggs.shtml .com/health_topics/en/dog_heartworms. Milbemycin-based preventives are safe and highly effective in preventing heartworms in dogs that are heartworm negative to begin with. one might do better to restart an ivermectin-based product rather than a milbemycin-based product. Other Parasites Covered Milbemycin. For more information on Interceptor® or Sentinel®. hookworms. Click here for more information. and whipworms without the addition of a second parasiticide. Of course. however. heartworm preventive doses are not adequate but milbemycin does offer a convenient treatment option for collie-type breeds. this issue should never arise. If these products are used according to their labeled instructions.petwellness.important but in a heavily infected dog it is safer not to use milbemycin to clear the microfilariae. heartworm preventives are meant to be used in heartworm negative dogs. does not require the addition of other dewormers in order to provide a broad spectrum of parasite control The milbemycin products control roundworms.

it can be given to heartworm positive dogs and it will decrease the number of circulating microfilariae but it is not a good choice in the treatment of active heartworm disease.com MOXIDECTIN BASED ADVANTAGE MULTI® made by Bayer PRODUCTS: PROHEART6® made by Fort Dodge Moxidectin is another relative of ivermectin. the flea-killing ingredient in Advantage®. The product is topical. The imidocloprid present will kill the pet’s fleas. ticks. . fleas. applied monthly and is fully approved for safe use in heartworm infected animals. roundworms. Selamectin is not as effective at clearing microfilariae as other products and thus is not generally used in the treatment of active heartworm infections. andhookworms. It is designed for broad coverage of small animal parasites and will protect dogs not only against heartworm but also against ear mites. ear mites. There are presently two products that use moxidectin to prevent heartworm infection: Advantage Multi® which is available for both dogs and cats as a topical and Proheart6® which is available only for dogs as a injection. Selamectin is a closely related cousin of ivermectin. Advantage Multi® represents the combination of moxidectin with imidocloprid. Advantage Multi® prevents heartworm infection. and fleas. visit: www. Obviously both Advantage® and Advantage Multi® are made by the same manufacturer (Bayer). andwhipworms. kills roundworms. For more information on Revolution (from the manufacturer). hookworms. sarcoptic mange mites.SELAMECTIN BASED PRODUCTS: (REVOLUTION® made by Pfizer) Ivermectin’s entrance onto the anti-parasite warfront represented a culmination in the trend for broader and broader spectrum parasite control.revolutionpet. As with selamectin. to create a broad spectrum anti-parasite product for both dogs and cats. Cats are protected against heartworm.

S. In other countries. it was voluntarily withdrawn from the market in 2004 after a number of adverse reactions were reported.S.Proheart6® is an injection given once every six months. click here. The present restrictions are up for review in one year. Proheart6® returned to the U. Proheart6 rapidly captured 40-50% of the entire heartworm prevention market but in this country. There has been great deal of controversy regarding these adverse reaction reports. especially since similar reactions have not been reported in the international market using the identical product made in the same manufacturing plant as the U. a larger volume is given and it lasts 12 months). v . In June of 2008. market with some restrictions as the FDA studies the situation. product. To review the restrictions. obviating the need for the owner to remember to use a monthly product. The moxidectin is contained in special "microspheres" enabling the drug to last a full six months (or in the case of the Australian version of the same product.