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

Radiogaphs Neurology Consult ECG

Case 30

Primary Clinician: Darcy Adin, DVM

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

Signalment

bulletSix-year-old male neutered Boxer dog ("Max")

Presenting Complaints

bulletAcute collapse

Pertinent History

bulletMax first presented to the referring veterinarian three days ago after an acute collapse. The owner describes the collapse as a seizure accompanied by tremors, paddling, urination, and loss of consciousness. The owner began mouth to nose breathing when the dog became limp and his tongue turned white after the seizure. The owner continued breathing for the dog for approximately three minutes before the dog regained consciousness.
bulletECG findings at that time were consistent with sinus tachycardia. Max was prescribed propranolol 10 mg TID by the referring veterinarian.
bulletMax was slightly lethargic following this visit and had another similar seizure/collapse episode this morning. Max once again responded after a couple of minutes of mouth to nose resuscitation.
bulletPropranolol and monthly heartworm prevention are the only current medications. There is no history of trauma.
bullet A melanoma was removed from the right caudal thigh five months ago.
bullet Indoor/outdoor dog. Two other healthy dogs in house. Current diet is chicken and rice kibble.
bulletMax coughs occasionally. The cough is dry and not associated with any specific time of day. Max vomited once after visiting the referring veterinarian's office.

Physical Examination

bulletT-101.8 P-78 R-60
bulletMax is quiet, alert, and responsive. There is a surgical scar on the right flank. Ectropion is present OU. Anterior chambers, sclera, conjunctiva, and lens clear OU. Epiphora OU. Ears are clean with no discharge. Bilateral serous discharge from nostrils. 
bulletNo atrophy or ataxia noted. No pain on palpation of spine.
bulletThoracic auscultation reveals a soft II/VI systolic murmur with PMI over left apex. Femoral pulses are strong with no deficits. Marked sinus arrhythmia is noted. MM pink. CRT 1 sec.
bulletLungs clear bilaterally.
bulletAbdominal palpation is unremarkable.
bulletAll peripheral nodes are within normal limits.

Problems

bulletTwo episodes of acute collapse in a Boxer dog

Echocardiogram

bulletInterventricular septal thickness - 1.0 cm (normal)
bulletLeft Ventricular Free Wall Thickness in Diastole - 1.0 cm (normal)
bullet Left Ventricular Diameter in Diastole - 4.0 cm (normal)
bullet Left Ventricular Diameter in Systole - 2.9 cm (normal)
bulletFractional Shortening - 27% (normal)
bullet Left Atrial Diameter - 2.6 cm (normal)
bullet Aortic Diameter - 2.0 cm (normal)
bulletTrivial tricuspid insufficiency

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