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 20

Primary Clinician: Darcy Adin, DVM

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

Signalment

bulletTen-week-old M Labrador retriever weighing 4.6 kg ("Stubs")

Presenting Complaint

bulletCongestive heart failure

Pertinent History

bulletStubs was born 10 weeks ago. He was the last of twelve puppies and was discovered still in the amniotic sac. The sac was cleared and he breathed and nursed normally.
bulletThree weeks ago the owners noticed that Stubs was having trouble breathing and was lethargic and weak. He was taken to the referring DVM where radiographs were taken and pulmonary abnormalities were identified.
bulletThe referring DVM started a 5 day course of amoxicillin and another antibiotic BID. Stubs seemed to respond to antibiotics.
bulletHowever, ten days ago he had another episode of respiratory distress and a temperature of 96 degrees. He was rewarmed, given a little maple syrup and admitted to the referring hospital.
bulletStubs was placed on injectable antibiotics (type unknown by owner) and radiographs were retaken. These radiographs revealed a markedly enlarged heart and the dog was given an injection of a diuretic (type unknown) and referred to the VMTH emergency service.
bulletStubs has a good appetite but is not gaining as much weight as the other litter mates.
bulletNo vomiting/sneezing/diarrhea.
bulletOwner noted "moist" sounds during the episodes of respiratory distress but no coughing.
bulletNo PU/PD or polyphagia noted; no stranguria, hematuria noted.
bulletNo history of trauma. Stubs lives with his mother and 7 litter mates who are healthy. He was given a diuretic at the referring DVM but is on no other medications. He was dewormed at 3 and 6 weeks. He has had no immunizations. His diet consists of lamb and rice kibble.

Physical Examination

bulletT: 101 P: 204 bpm R: 72 BAR 2. Full soft coat, no dermatologic lesions noted.  
bulletEyes, ears, nose: clean, no discharge or odor noted.
bulletThroat: no masses detected, no cough on tracheal palpation.
bulletThin, 2/9 BCS
bulletGrade 5/6 left apical systolic murmur, gallop rhythm, weak femoral pulses. MM: pink, CRT 2 s. A soft diastolic murmur was potentially present, however was difficult to discern with certainty due to the high heart rate and 3rd heart sound present. No jugular pulses present.
bulletTachypneic, harsh lung sounds, no crackles or wheezes detected. Moderate inspiratory effort.
bulletSmooth gut loops, no masses palpated.
bulletSmall smooth bladder
bulletCranial nerve function intact.
bulletPLRs normal bilaterally.
bulletLymph nodes: WNL

Problems

bulletRespiratory Distress
bulletGrade V/VI left apical systolic murmur with gallop rhythm and possible soft diastolic murmur
 

 

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