Case Studies In Small Animal

Cardiovascular Medicine

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Case 31

Three months after first visit

Pertinent History

bulletBoris is presenting for not doing right over the last week, according to the owner.

Physical Examination

bulletBARH. BCS 3/9. HR= 180 RR=40 MM=pale pink. Grade V/VI right sided systolic murmur. Friction rub-like sound on auscultation, that is associated with heartworm entanglement in the tricuspid valve. No jugular distension but jugular pulses can be seen 2-3cm dorsal to the thoracic inlet. Strong femoral pulses with pulse deficits. Increased bronchovesicular sounds that are generalized. No masses palpated in the abdomen. Remainder of the exam was unremarkable.


bulletHeartworm disease
bulletHemoglobinuria (caval syndrome)


bulletCBC: HCT=29% PP=9.9 Platelets=230,000 WBC=9000
bulletECHOCARDIOGRAPHY: RA and RV dilation. Heartworms were visualized in right atrium, right ventricle, and pulmonary artery. Since there are some present in the right atrium it may be possible to remove them via a jugular venotomy using forceps and ultrasound guidance. It is best to try to remove them immediately before they are pushed back out of the atrium.
bulletBoris was anesthetized. A surgical cutdown on the right jugular vein was performed. Three heartworms were removed from the right atrium by jugular transvenous extraction with a three-pronged bronchoscopy retrieval device using ultrasound guidance. Two females and one male D. immitis worms were recovered. No worms could be identified on echocardiography following the procedure.

Heartworm Extraction

Boris after being anesthetized


Bronchoscopy retrieval device used for heartworm extraction


Removal of the first heartworm


Removal of the other two heartworms

P: Discharge tomorrow if Boris is stable throughout the night. Continue prednisone 10mg PO BID and antibiotic therapy overnight.

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