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 Diagnosis

Case 14

Primary clinicians: Brad Gavaghan, DVM and Darcy Adin, DVM

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

Signalment

bullet10-year-old MC black American cocker spaniel weighing 12 kg ("Houdi")

Initial Visit

Presenting Complaints

bulletHeart Rate Slow & Erratic/Weight Loss

Pertinent History

bulletHoudi was diagnosed with bradycardia and a I/VI systolic murmur last month during an evaluation for weight loss.
bulletThe referring DVM would like to plan a gastroduodenoscopy and referred Houdi for cardiac evaluation.
bulletThe owner reports normal activity and good appetite.
bulletHe has also begun to put on more weight since this problem started a few months ago.
bulletHoudi was diagnosed with pancreatitis 2 years ago which was treated at another veterinary clinic.

Physical Examination

bulletBAR, T=102.2 P=60 RR=panting.
bulletIV/VI left apical murmur (II/VI on the right). Strong femoral pulses, pink mm with 1 sec CRT.
bulletClear lung sounds bilaterally.
bulletAbdominal palpation unremarkable.
bulletSlight enlargement of the prescapular lymph nodes.

Comments

bulletECG: Non atropine-responsive sinus bradycardia (heart rate = 55 beats/minute), with failure of appropriate response from alternate pacemakers.
bulletECHO: Moderate mitral regurgitation with valve thickening and LA enlargement.
Interventricular septal thickness in diastole - 0.8 cm (normal); LV end-diastolic diameter - 4.0 cm (increased); LV end-systolic diameter - 2.7 cm (increased); SF 39%; LV free wall thickness in diastole - 0.8 cm (normal);  Ao:LA 15:26 (increased).

Discharge Summary

bulletHoudi presented for cardiac examination following the diagnosis of bradycardia. He was diagnosed with moderate mitral regurgitation and sinus bradycardia that was not atropine responsive. It was recommended that a temporary pacemaker be placed if he is to be placed under general anesthesia. It was also noted that a permanent pacemaker may be required in the future.

Three months later

Presenting Complaints

bulletRear Legs Give Out

Pertinent History

bulletHistory of pancreatitis.
bulletShaky rear legs and not jumping up as often. Every 3-4 days his rear legs will give out. The owner describes it as stumbling.
bulletCurrently he has protein losing nephropathy.
bulletHe is being seen here for either a temporary or permanent pacemaker in order to undergo anesthesia for a biopsy of the kidney.
bulletBehavior has been unchanged. Eating and drinking well. Feeding K/D mixed with Nutro, but dog refuses to eat K/D.
bulletHas had watery diarrhea for the past two days.
bulletNo coughing, wheezing or vomiting.
bulletTaking metronidazole 250mg 1/2 tab TID for the past 2 months.
bulletWas on Carprofen 20mg BID but taken off 2 days ago.
bulletAlso was on enalapril 5mg SID but taken off because of kidney problems.

Physical Examination

bulletBAR; Wt: 12.0kg, Temp.: 101.4, Pulse: 44 bpm, Resp: panting. Mucous membranes pink. CRT: 1sec.  
bulletIntegumentary--Papillomas on head, small mass that appears to be a lipoma right side. Shiny coat, clear skin. Well hydrated.
bulletEENT--Small amount of mucous coming from both eyes and there is some opacity to them. Small amount of wax in ears but no redness. Nose clear. Severe tartar on teeth. No lesions in throat.
bulletMusculoskeletal--Symmetrical, well muscled, no lameness. Body score 5/9.
bulletCardio.--Very irregular slow heart rate. Grade III/VI left sided systolic heart murmur. Strong pulse quality. Approximately 2 sec. pauses intermittently between beats.
bulletResp.--Clear lung sounds, no crackles.
bulletG.I.--No masses or organomegaly.
bulletGenitourinary--No secretions detected.
bulletNeuro.--Not evaluated.
bulletLymph nodes--not enlarged.

Problems

bulletProtein losing nephropathy
bulletBradycardia/Stumbling episodes

Echocardiogram

bulletMild mitral regurgitation with mild valve thickening and mild left atrial enlargement.

 

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