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

Radiographs 2D Echo Doppler TEE

Case 26

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

Signalment

bulletSix-month-old female Chow Chow weighing 17 kg and named "Tiffany"

Presenting Complaints

bulletHeart Murmur

Pertinent History

bulletTiffany is presented to the VMTH Cardiology Service today for a second opinion of a previously diagnosed ventricular septal defect.
bulletTiffany was discovered to have a grade III-IV/VI systolic heart murmur at 12 weeks of age by the referring veterinarian, who recommended further evaluation with echocardiography. On 4/21/00, a veterinary internist on consultation found Tiffany to have grade IV/VI left- and right-sided systolic heart murmurs. By echocardiography, the internist diagnosed a ventricular septal defect with an overriding aorta. Tiffany's owners were told that there was no cure and that Tiffany may live 2-3 years before she developed severe heart failure. Tiffany's owners were told to watch for signs of coughing and abdominal distension indicating that Tiffany's heart was failing. Recently they were concerned that Tiffany's abdomen was enlarged. Abdominal ultrasound by the referring veterinarian revealed enlarged hepatic vessels, but no ascites.
bulletTiffany comes from a litter of 6 pups. She and one of her brothers live together. She is current on her vaccinations (DA2PPL, rabies, Bordetella). She has not begun to receive heartworm preventative. She is kept outdoors in a run in the day and indoors at night. She is fed Iams moist 1/3 can + Iams kibble 1 cup in the morning, then allowed free choice Iams kibble throughout the day. Currently she is not receiving any medications.
bulletTiffany tires easily on walks. She also sneezes often and has consistent mild epiphora OU, as does her brother. Tiffany developed moderate diarrhea 2 weeks ago when her owners changed her food. They gave her 2-3 teaspoons of Pepto Bismol and the diarrhea resolved within 2 days. Her owners report no coughing, anorexia, vomiting, or PU/PD.

Physical Examination

bulletGeneral: BAR, playful and excited. T=103.2 P=140 R=panting BCS 5/9.
bulletIntegument: Full, healthy hair coat.
bulletEENT: Mild epiphora and staining of medial canthi OU, sclera and conjunctiva clear OU. Ears clean AU. Mild serous nasal discharge bilaterally. Moderate mandibular brachygnathism with mild palatal defects due to malposition of mandibular canines.
bulletMS: No gait abnormalities, no palpable asymmetry.
bulletCV: Grade IV/VI left-sided and III/VI right-sided systolic murmurs. No arrhythmias or pulse deficits. CRT=1 sec, mm pink and moist.
bulletRespiratory: Intermittent stertor, eupneic, quiet inspiratory breath sounds ausculted diffusely.
bulletGI: Smooth gut loops palpated, no pain elicited on palpation.
bulletGU: Smooth and symmetric kidneys palpable, no vulvar discharge or erythema.
bulletNervous System: No gross deficits noted on physical examination.
bulletLymph Nodes: Mandibular and popliteal lymph nodes < 1.5cm diameter. Prescapular, axillary, inguinal lymph nodes not palpable.

Problems

bulletHeart murmur previously diagnosed as ventricular septal defect
bulletMandibular brachygnathism
 

 

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