Primary Clinician: Kris
Supervising Clinician: Mark D.
Kittleson, DVM, PhD,
|Two-year-old neutered male Labrador retriever weighing 31 kg
|Max was brought to the referring DVM one week ago for a dry nonproductive cough.
referring DVM on physical exam found an irregular heart rhythm and pulse deficits. An ECG revealed tachycardia.
|Radiographs revealed severe cardiomegaly. |
|There was apparently an echocardiogram performed, but the owner was not informed
of those results. |
|Max was placed on enalapril 20mg PO BID. The owner also administered one
aspirin a day since he had heard this was a treatment in human heart failure.
|A second veterinarian
was consulted and on physical exam he found hepatomegaly, weak femoral pulses, and an
arrhythmia. After reviewing the radiographs and ECG he felt that a further work-up should be
performed and sent Max to the VMTH.|
|Max is a narcotics detection dog in training and leads an active life.
He doesn't seem to have any energy loss or exercise intolerance. He has always
been very thin and is a fastidious eater. His only clinical sign is the dry
nonproductive cough. |
|He is not receiving any medications at this time. |
|GENERAL: BARH, acts like a healthy 2 year old lab, T=102, P=140, R=panting, Wt=31.2kg|
|INTEGUMENT: Coat clean, salivary staining on all four paws. |
|EARS, EYES, NOSE, THROAT: Eyes - cornea and anterior chamber clear, no discharge. Ears - clean.
Nose - clean and moist, no discharge. Mouth - no tartar or gingivitis|
|MUSCULOSKELETAL: Thin, BCS=4/9 |
|CARDIOVASCULAR: V/VI systolic murmur heard over the right apex; irregularly irregular
arrhythmia; jugular pulses extend 3 inches above the thoracic inlet; mm=pale pink, CRT=1.5s, peripheral pulses poor with
|RESPIRATORY: No crackles or wheezes. Decreased lung sounds ventrally. |
|GASTROINTESTINAL: Moderate hepatomegaly, all other organs within normal limits; no ascites, no masses, gut loops smooth.|
|GENITOURINARY: Intact male; both testicles descended.|
|NERVOUS: Not examined |
|LYMPH NODES: Within normal limits|
|Systolic heart murmur heard best over right apex|