Many dogs are asymptomatic when the disease is diagnosed by a positive routine screening test result. Dogs with occult disease or those that have not been routinely tested are more likely to have advanced pulmonary arterial disease and clinical signs. Symptomatic dogs often have a history that includes exertional dyspnea, fatigue, syncope, cough, hemoptysis, shortness of breath, weight loss, or signs of right-sided congestive heart failure.
A change in or the loss of a dog’s bark has sometimes been reported. The physical examination findings may be normal in early or mild disease. Severe disease is frequently associated with poor body condition, tachypnea, dyspnea, jugular vein distention or pulsations, ascites, or other evidence of right-sided heart failure. Increased or abnormal lung sounds (wheezes, crackles), a loud and often split second heart sound, an ejection click or murmur at the left base, a murmur of tricuspid insufficiency, or cardiac arrhythmias are variably heard on auscultation.
Severe pulmonary arterial disease and thromboembolism can be associated with epistaxis, disseminated intravascular coagulation, thrombocytopenia, and possibly hemoglobinuria; the latter is also a sign of the caval syndrome.
Occasionally, aberrant worm migration to the central nervous system, eye, femoral arteries, subcutis, peritoneal cavity, and other sites occurs and causes related signs. Several cases of systemic arterial migration causing hindlimb lameness, paresthesia, and ischemic necrosis have been described. Worm and thrombus extraction via femoral arteriotomies, along with adulticide therapy, has been successful in some cases, but limb amputation may be necessary.
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