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 PA Echo M-Mode Color Flow Doppler Liver Diagnosis

Case 12

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

lucky.jpg (23211 bytes)

Signalment

bullet10-year-old FS German shepherd cross weighing 17 kg ("Lucky")

Presenting Complaints

bulletFluid in the Chest/Possible Tumor

Pertinent History

bulletLucky was adopted at the age of 6 months by the owner. She has lived all her life in Fresno, CA and every summer goes to Fish Camp near Yosemite (alt=5000'). She also occasionally spends time in the foot hills, but is mostly inside there. This summer she did not go to Fish Camp because the owner was advised not to by the referring DVM.
bulletApproximately, 6 months ago, the owner began to notice that she was not eating as well as she usually does, was becoming lethargic, and was panting more frequently. She is fed ProPlan kibble, boiled chicken, zucchini, and rice. Three weeks ago, Lucky began refusing to eat the kibble.
bulletNine days ago she was taken to the emergency hospital in Fresno because the owner noticed that she was making "gurgling" sounds. Radiographs were taken which revealed severe pleural effusion and possibly pulmonary edema as well as some loss of serosal detail in the abdomen. The ECG showed a tachycardia (HR=270bpm). 1500ml of serosanguinous fluid was drained from her chest. She also had a fever (105.0) and was mildly dehydrated. The S.G. of the fluid was 1.015 and the protein was 1.0g/dl. This cytology is most consistent with a transudate although the presence of RBCs and neutrophils may indicate a modified transudate. Lucky was sent home on Lasix 12.5mg tablets (1 1/2 tablets SID), enalapril 20mg tablets (1/4 tablet every 12 hours), and digoxin 0.125mg (1 1/2 tablets SID).
bulletYesterday she returned to the same emergency hospital for "gurgling" sounds with respiration. 1500ml of clear-straw colored fluid was removed from her thorax. She was found to be 5% dehydrated at this time. The emergency veterinarian wanted to take repeat radiographs and the owner declined opting for a referral to UC Davis (he went to school here). Her digoxin dose was reduced to 1 tablet SID (0.125mg). The owner spoke with a resident here last night and was advised not to give her any digoxin this morning.

Physical Examination

bulletT=101.5, HR=240, RR=52
bulletQAR, Mild dehydration, emaciated. 
bulletInteg: Full, dry and coarse coat. No alopecia. Two ticks were seen and removed. Lucky tends to chew on her skin.
bulletEyes: Clear corneas and anterior chambers. Small amount of clear-greenish discharge OU. Ears: Clean with no odor or discharge.
bulletNose: Moist with no discharge. No sneezing. Mouth: 4+ tartar with moderate gingivitis.
bulletMS: Emaciated with general muscular atrophy. No gait abnormalities.
bulletGI: Palpated a 2cm, soft, mass in the ventral abdomen (may be fat or intestine). No vomiting or diarrhea. Hepatomegaly, small spleen.
bulletGU: No vaginal discharge, empty bladder. Nervous: Not evaluated. L.N.: All within normal limits.
bulletCV: Tachycardia which fluctuates in rate and rhythm. No murmur ausculted. MM=pink,
CRT=2sec. Weak to fair pulses. Pulse deficits were noted. The hepatojugular reflux test was positive.
bulletResp: Dyspnea (panting and increased chest movements). She prefers to remain standing or sternal (orthopnea).

Problems

bulletDyspnea with historical pleural effusion
bulletPositive hepatojugular reflux test
bulletEmaciation
bulletTachycardia/Arrhythmia

Laboratory Work

bulletDifil test for microfilariae - negative
bulletHeartworm antigen test - negative
 

 

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