Case Studies In Small Animal

Cardiovascular Medicine

Home Up 1    Pleural Fluid 2              Cough 3   Heart Murmur 4           Syncope 5       Tachypnea 6           Cyanosis 7   Heart Murmur 8   Heart Murmur 9              Cough 10    Heart Failure 11              Ascites 12    Pleural Fluid 13           Syncope 14     Bradycardia 15     Tachycardia 16                Blind 17   Heart Murmur 18   Resp. Distress 19        Collapsing 20    Heart Failure 21          Paralysis 22    New Murmur 23              Cough 24          Vomiting 25       Tachypnea 26   Heart Murmur 27      Hemoptysis 28  Limb Swelling 29  Heart Murmur 30 Acute Collapse 31 Enlarged Heart 32               Blind 33             Cough 34         Collapse 35         Collapse 36 Thromboembolus 37  Heart Murmur 38  Heart Murmur

.    Radiographs ECG 2D Echo M-Mode Color Flow Doppler Diagnosis

Case 10

Primary clinician: Brad Gavaghan, DVM

Supervising clinician: Mark D. Kittleson, DVM, PhD, DipACVIM (Cardiology)

Signalment

bullet10-year-old FS Dalmatian weighing 32 kg ("Manny")

Presenting Complaints

bulletCongestive Heart Failure

Pertinent History

bullet"Manny" presented with exercise intolerance, weakness and a moist cough.
bulletHer referring veterinarian, based on a recent physical exam and chest and abdominal radiographs, diagnosed congestive heart failure.
bulletShe reportedly has had a heart murmur since the owner obtained her at four years of age.
bulletApproximately 2.5months ago she was treated by the referring DVM for coughing with 2 weeks of prednisone 20mg BID. The coughing returned post therapy and she was then treated with 2 weeks of prednisone, 20mg BID and Lasix 25mg BID. The cough returned again upon completion of the prednisone therapy.
bulletShe remains on Lasix.
bulletReferral radiographs show pulmonary edema, an enlarged cardiac silhouette, and hepatomegaly.
bulletShe is referred to the VMTH for further cardiac evaluation.

Physical Examination

bulletT=101.8, P=90, R=60
bulletG: Quiet and BARH, CRT<1.5sec, MM=pink and moist, WT=32Kg,
bulletI: Full coat, no lesions and abrasions, 1cm dermal nodules on right sternum and left flank
bulletEENT: PLR bilateral, ears clean, tonsils in crypts
bulletMS: full fleshed, 7/9 body condition score
bulletCV: Muffled heart sounds, left apical systolic V/VI murmur, right apical III/VI systolic murmur. Brisk femoral pulses. Positive hepatojugular reflux test. Irregular rhythm.
bulletR: Occasional deep wet cough, enhanced bronchovesicular sounds and crackles all areas. Eupneic to shallow breathing
bulletGI: Enlarged abdomen, ballottement does not suggest ascites, liver approximately 2cm from sternal border, left caudal kidney pole smooth
bulletGU: Vulva pink and moist, bladder smooth and roughly 2cm in size.
bulletN: NE
bulletLN: Submandibular, prescapular and popliteal LN<1.5cm.

Problems

bulletLoud systolic heart murmur/Congestive heart failure (historical)/ Positive hepatojugular reflux test
bulletCoughing/Pulmonary crackles
bulletArrhythmia

 

Mark D. Kittleson, D.V.M., Ph.D. All rights reserved.