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 Radiographs 2D Echo Color Flow Doppler Diagnosis

Case 23

Primary Clinician: Kris MacDonald, DVM

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

Signalment

bulletTwo-year-old neutered male Labrador retriever weighing 31 kg ("Max")

Presenting Complaint

bulletCough

 Pertinent History

bulletMax was brought to the referring DVM one week ago for a dry nonproductive cough.
bulletThe referring DVM on physical exam found an irregular heart rhythm and pulse deficits. An ECG revealed tachycardia.
bulletRadiographs revealed severe cardiomegaly.
bulletThere was apparently an echocardiogram performed, but the owner was not informed of those results.
bulletMax 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.
bulletA 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.
bulletMax 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.
bulletHe is not receiving any medications at this time. 

Physical Examination

bulletGENERAL: BARH, acts like a healthy 2 year old lab, T=102, P=140, R=panting, Wt=31.2kg
bulletINTEGUMENT: Coat clean, salivary staining on all four paws. 
bulletEARS, EYES, NOSE, THROAT: Eyes - cornea and anterior chamber clear, no discharge. Ears - clean. Nose - clean and moist, no discharge. Mouth - no tartar or gingivitis
bulletMUSCULOSKELETAL: Thin, BCS=4/9 
bulletCARDIOVASCULAR: 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 deficits.
bulletRESPIRATORY: No crackles or wheezes. Decreased lung sounds ventrally. 
bulletGASTROINTESTINAL: Moderate hepatomegaly, all other organs within normal limits; no ascites, no masses, gut loops smooth.
bulletGENITOURINARY: Intact male; both testicles descended.
bulletNERVOUS: Not examined 
bulletLYMPH NODES: Within normal limits

Problems

bulletSystolic heart murmur heard best over right apex
bulletArrhythmia (auscultatory)
bulletJugular pulses
 

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