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Charles : The Heart Of A King

Mayer, who is Editor at Large on Time magazine, does not provide a chronological narrative of Charles's life. She covers it discursively, even diffusely, with detours into related subjects such as the phone-hacking saga and the Parliamentary expenses scandal. An oft-told tale certainly emerges: the unhappy childhood, the Goon-ish adolescence, the flings with Charlie's angels, the search for a purpose, the disastrous marriage, the Camillagate tapes, the controversial causes, and the settling into uxorious middle age. But Mayer, who followed the Prince round, observing him on tour in Wales and Canada, concentrates on his work and his opinions.

Charles : the heart of a king

Charles divides where his mother unites and he intervenes in politics in a way that many see as unconstitutional. Republicans regard him as their king of trumps, reckoning that Queen Elizabeth's death will provide the best opportunity for promoting an elected head of state. Mayer endorses this assessment, which is highly dubious given the surge of royalist emotions that will inevitably be generated by the funeral and the coronation. However, as a monarchist herself, she concludes by advising Charles about how to keep the throne: embrace transparency, especially in financial matters; renounce special privileges, such as the Prince of Wales's extraordinary right to veto proposed legislation affecting his own interests; and find cheaper ways to project majesty.

MVD is a degeneration of the heart's mitral valve, one of four sets of valves in a dog's heart. A dog's heart valves' leaflets must open and close tens of thousands of times a day to maintain uni-directional blood flow through the heart. When the valves open, they direct blood flow forward to where it is supposed to go, and when they close, they prevent blood from going backward to where it is not supposed to go. The mitral valve is located between the left atrium and ventricle.

Heart failure (HF) is a condition where the heart is still working, but it can't pump enough blood to fully meet the dog's body's needs. HF is determined by its symptoms, which include high rates of breathing (respiratory rates), exercise intolerance, shortness of breath (dyspnea), increase in respiratory effort, and/or fainting. The term "congestive heart failure " (CHF) refers to the heart's dysfunction causing fluid buildups in the lungs (pulmonary edema) or elsewhere (effusions). Congestive heart failure (CHF) is the next step in the progression of MVD, following heart failure (HF).

About 10% of all dogs suffer from some form of heart disease. Mitral valve disease is the most common heart disorder in older dogs of all breeds. However, in the cavalier King Charles spaniel, the prevalence of MVD is about 20 times that of other breeds. Also in cavaliers, the onset of the disease typically is much earlier in the life of the dog. It has been reported that, once diagnosed, mitral valve disease is much more rapid in cavaliers than in other breeds, possibly reaching a life-threatening stage within as little as 1 to 3 years, rather than the average 3 to 5 years. To a lesser extent, cavaliers also suffer from deterioration of their tricuspid valves. More...

All cavaliers should be screened for the sounds of tubulent blood flow, called heart murmurs, once a year beginning at age 1 year. Once MVD is detected, its progression can be monitored with stethoscopic examinations (auscultations), x-rays, echocardiograms, and color Doppler echocardiograms. If a heart murmur is detected, it should be confirmed in 3 to 6 months. If it still is detected, the dog is considered probable for MVD. More...

The progression of mitral valve disease can be rapid or slow. In most cavaliers, the disease shows a gradual progression in the loudness of the murmur and to more serious symptoms, in as little as 2 years after first detecting the murmur. Drugs may help to minimize the symptoms, but eventually the drugs may be unable to control them. The drugs prescribed for cavaliers with MVD can sometimes have severe adverse side effects, and blood chemistry should be done routinely to monitor their effects upon the kidneys, liver, and other internal organs. Severe symptoms of MVD in some cavaliers will appear more quickly, although previously having been stable. The ultimate consequence of the disease is heart failure. More...

Degenerative mitral valve disease (MVD)* is the leading cause of death of cavaliers. It is a highly-heritable, polygenetic acquired heart disease which, statistics show, afflicts over half of all cavalier King Charles spaniels by age 5 years (by stethoscopic examination) and greater than 90% by age 10+ years, should they survive that long. It is estimated to affect 10% of the entire dog population, but at a much older age of onset than for CKCSs.

Since then, cardiologists have examined the hearts of many thousands of cavalier King Charles spaniels at health clinics held by CKCS breed clubs in the UK, Canada, the USA, and elsewhere. From the data they have compiled, they have found that the percentage of CKCSs which develop MVD murmurs increases at a rate of about 10% per year. So, roughly 10% of cavaliers by age one year have MVD murmurs, and 20% aged between one and two years have murmurs, and so on for each age level. Specifically, the statistics show that more than half of all cavaliers aged five years have murmurs, and it is the very rare cavalier at age ten years which does not have, at the very least, a low grade MVD murmur.

In the United States, out of 300,000 dogs, 5% died from MVD while 50% of the cavaliers died from MVD. In a2006 study comparing the severity of MVD in cavaliers with six other breeds (Bichon, Dachshund, Lhassa Apso, poodle, Shi Tzu, and Yorkshire terrier), the researchers reported that in those other breeds, the age of onset of MVD is much later, and MVD is a well-tolerated disease with a long and slow progression, with most of the dogs not reaching heart failure. In aJuly 2017 article, the authors described MVD as a "relatively benign condition" in most breeds of dogs, with the exception of cavaliers.

Mitral valve disease is a uniquely serious, life-shortening problem for cavalier King Charles spaniels and is their leading cause of death. About 10% of all dogs suffer from some form of heart disease. MVD is the most common heart disorder in older dogs of all breeds. Several smaller breeds of dogs typically are predisposed to suffer from MVD. However, in most all breeds, MVD does not result in heart failure (HF), causing death, because MVD does not develop early in a dog's life, and does not progress rapidly. See thisJanuary 2008 article, in which, of 302 MVD-affected dogs of various breeds with mild heart enlargement, over 60% were alive 70 months after initial diagnosis, and over 70% never reached the stage of heart failure.

For nearly all other breeds, MVD is an old-age disease, and the age of onset is between 10 and 15 years of age. In most dogs affected with MVD, the disease seldom progresses to heart failure. The estimates have varied from 20% to 30% of all dogs diagnosed with MVD eventually going from heart enlargement into heart failure. However, MVD usually results in heart failure in the CKCS.

MVD is a degeneration and fibrosis of the heart's mitral valve, one of four sets of valves in a canine's (and a human's) heart. It is the valve which is designed to prevent the backflow of blood from the left ventricle into the left atrium (called mitral regurgitation -- MR). The normal mitral valve has a saddle shape. It consists of a set of double flaps, called "leaflets", that open and close like a set of one-way doors at appropriate times during each heart beat. Normal mitral valve leaflets (see diagram of a leaflet cross-section, at right) consist of four layers of tissue (atrialis, fibrosa, spongiosa, and ventricularis), most of which are comprised of collagen and elastin fibers, and are very thin and nearly transparent. The two leaflets are the "anterior" leaflet and the "posterior" leaflet. They are connected by tendons (chordae tendineae) to the muscles of the left ventricle. An average of 24 chordae are attached to the anterior leaflet and 18 to the posterior leaflet.

Blood flows through the pulmonary veins from the lungs into the left atrium, one of the chambers of the heart. The mitral valve is located between the left atrium and the left ventricle, another chamber in the heart. The valve's action is governed by the movement of blood as it is pumped from the atrium and into the ventricle. The two leaflets of the mitral valve are controlled by the tendons -- the chordae tendineae -- which serve as thin "struts" shaped much like the chords of a parachute. Normal healthy chordae are smooth and symmetrical.

The mitral valve's two leaflets are surrounded by a ring called the annulus (MVA). (See image at right.) The dog's MVA contracts (systolic phase -- when the heart is pumping blood the arteries) and expands (diastoic phase -- when the heart refills with blood). This is called the cardiac cycle. In most healthy dogs without MVD, their MVA is saddle-shaped or elliptical but during the diastolic phase, the annulus becomes rounder.

The echocardiograph examination shows the dimensions of the heart chambers, wall thickness and movement, valve movement and lesions, fractional shortening, among other characteristics. The echo screen shows the amount of wall contraction, which enables the operator to determine contractility, preload, and afterload. These factors are used to calculate "fractional shortening" (FS%) which is used as an indication of ventricular performance and of myocardial contractility.

The initial effect of MVD upon the affected dog's body is a very mild reduction in the heart's output of blood (cariac output) along with reductions in blood pressure and dissolved oxygen (oxygen tension) in the blood stream. These signals prompt other regions of the dog's body to initiate compensatory mechanisms aimed at maintaining normal cardiac output, blood pressure, and oxygen tension levels. These mechanisms include: 041b061a72


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