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 17

Primary clinician: Darcy Adin, DVM

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

Signalment

bulletOne-year-old MC Chihuahua weighing 4.4 kg ("Chico")

Presenting Complaints

bulletHeart Murmur

Pertinent History

bulletChico presented to the referring DVM 7 weeks ago to be neutered. This was postponed due to coughing.
bulletPhysical exam and auscultation were unremarkable at that time so the dog was placed on Clavamox 62.5 mg. BID for 14 days.
bulletTwo weeks later Chico was neutered without complication. The cough had subsided.
bulletChico represented to the referring DVM four weeks ago for mucoid nasal discharge and cough. Thoracic auscultation was reported as unremarkable and the dog was again placed on Clavamox.
bulletChico was placed on Tussigon 5 mg. BID two weeks ago for coughing.
bulletTen days ago Chico was placed on Torbutrol 1 mg. TID for continued coughing.
bulletOne week ago a IV/VI systolic murmur was ausculted at the referring DVM and thoracic radiographs revealed cardiomegaly and pulmonary edema.
bulletChico was then placed on 10 mg Lasix BID with no response in the cough.
bulletThe owner has had Chico for 8 weeks (obtained from a friend); the owner recently obtained a second dog from the pound. She has not noticed any change in activity level or appetite.
bulletHe is very active.
bulletHe coughs throughout the day and possibly coughs up saliva/fluid.
bulletThe owner has been treating with Lasix once a day instead of BID (she misunderstood the instructions).
bulletThere has been no vomiting or diarrhea.
bulletThe owner has recently noticed some odd respiratory motions where he lurches when he breathes. This lasts about a minute. This does not occur in conjunction with the coughing.
bullet Additionally, she has heard him yelp/squeal for a moment while eating. 
bulletChico has had one incident of trauma: strangulation/choking episode on choke collar while tied up at previous owner's house.

Physical Examination

bulletGeneral: BARH. Very active
bulletIntegument: no abnormalities
bulletEENT: No abnormalities
bulletMS: No masses palpated.
bulletGI/GU: No abnormalities. Slightly tender upon abdominal palpation. Small smooth bladder palpable. No abnormalities noted on prepuce/penis.
bulletNS: Not evaluated.
bulletLN: No abnormalities.
bulletCV: HR 140. Grade V/VI continuous murmur heard best over the left cranial - ventral thorax (left axillary region). Regular rhythm. Very strong/bounding femoral pulses. No jugular pulses. No pulse deficits.
bulletR: RR 40; Eupneic. Clear lung sounds all fields. Tracheal palpation elicited a cough.

 

Femoral artery pressure recording (note the pressure measures on the left side)

 

Problems

bulletGrade V/VI left basilar continuous murmur with bounding pulses
bulletCough

 

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