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

ECG 2D Echo Doppler Diagnosis

Case 19

Primary Clinician: Aaron Wey, DVM

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

Signalment

bulletEight-year-old MC Labrador retriever cross weighing 35 kg ("Axel")

Presenting Complaint

bulletCollapsing Episodes

Pertinent History

bulletTwo weeks ago the owner noted Axel had a cough.
bulletHe was taken to the referring DVM, thoracic radiographs were taken, and kennel cough was diagnosed. Ciprofloxacin 250mg PO q12 hours was prescribed. The cough responded to treatment.
bulletOne week ago the owner heard Axel fall and found him in lateral recumbency and unresponsive. He urinated and defecated during the episode which lasted approximately 30 sec. Immediately after the episode Axel seemed disoriented and went outside and urinated and defecated. Later in the day Axel collapsed while playing ball. This time the episode was short and he remained responsive during the event. No urination or defecation was noted.
bulletFour days ago he had another short collapse episode and a longer episode during which he urinated and defecated and was unresponsive. He was taken to the referring DVM. CBC and serum chemistry were within normal limits.
bulletA cardiac ultrasound was performed with SF=10% LVFW=0.5 cm, RVFW=0.9 cm, right ventricular lumen was noted to be increased.
bulletDigoxin 0.125mg PO q12 hours was started.
bulletThe episodes continued with about 2 episodes daily for the last three days.
bulletThe owner reported that Axel was lethargic and drinking lots of water during this time.

Physical Examination

bulletPresented to ICU after acute collapse in parking lot.
bulletUpon presentation to ICU he was responsive and standing.
bulletT=101.8, RR=pant, HR=120, pulses adequate, mucous membranes pale.
bulletWell-fleshed, body score 6/9.
bulletEyes-clear, no discharge. Mouth- CRT=2sec. 
bullet3/6 left basilar murmur ausculted. No pulse deficits, femoral pulses fair.
bulletBronchovesicular sounds in all lung fields.
bulletNo masses on abdominal palpation. Smooth bowel loops, liver margin not palpable.
bulletLymph nodes- no peripheral lymphadenopathy noted.

Problems

bulletCollapsing Episodes
bullet Heart Murmur
bullet Polydipsia

Plans and Progress Notes

S/O  Axel was admitted to ICU. On presentation PCV=45%; TP=6.5; Blood Glucose=62; Lactate=3.6 mmol/L (normal is < 1); Na=150; K=3.4; Ca=1.04. When walked from ICU to cardiology Axel had an episode of collapse. He began to collapse then fell to lateral recumbency. He was unresponsive, urinated and defecated. Mucous membranes were pale and pulses were fair. Heart rate was approximately 80 beats/minute increasing to 150 beats/minute over the course of the 30 seconds the episode lasted. Axel became responsive but remained lateral and vocalized. He recovered within 5 minutes.

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