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

Radiographs ECG 2D Echoes PA Echoes Doppler Diagnosis

Case 33

Primary clinician: Sarah Miller, DVM

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

Signalment

bulletSeven-year-old MC Husky weighing 29 kg ("Fisher")

Presenting Complaint

bulletCough

Pertinent History

bulletFisher was presented to the VMTH Cardiology Service for evaluation of possible heartworm infection.
bulletAccording to the owner, Fisher started having clinical signs one to two months ago. He has been coughing, retching, and lethargic and has had labored breathing especially in the last three weeks.
bulletFour weeks ago he had an episode of collapse while playing fetch. It took him approximately ten minutes to recover from the collapse, but he was conscious and responsive during the episode.
bulletFisher was taken to his veterinarian 3 days ago where thoracic radiographs, an ECG, CBC, chemistry panel, urinalysis and heartworm test were performed.
bulletThoracic radiographs showed dilated pulmonary arteries and other radiopaque areas in the lungs.
bulletECG did not show an arrhythmia, but there were wide T waves. CBC showed a regenerative anemia (HCT=31%) and eosinophilia of 2,992/uL. His chemistry panel indicated hypoalbuminemia (2.1) and an increased globulin (5.4). Urinalysis showed SG=1.023 and 3+ proteinuria.
bulletFisher's heartworm antigen test was performed by IDEXX and came back as weak positive. He was also positive for microfilariae.
bulletFisher is current on his vaccinations except Bordetella and is not on any current medications.
bulletHe was given IV fluids and IV Cefazolin TID (dose unknown) at the referring veterinarian for three days.
bulletFisher still has a good appetite and is fed Sensible Choice reduced kibble (Lamb and Rice) along with dog biscuits.
bulletHe was tested for heartworm in 2001 and was negative. He was started on Interceptor, but he apparently had an allergic reaction to it and would vomit it up every time it was administered. He has not been on any heartworm preventative since that time.
bulletFisher has not had any vomiting or diarrhea recently but has been having slightly looser stools.
bulletThere are three other dogs in the household that are all relatively healthy and are all on heartworm preventative.
bullet He lives in Shingle Springs, CA in the foothills of the Sierra Nevada mountains, a region known to be endemic for heartworm.

Physical Examination

bulletGEN: QARH, T=101.6, P=140, R=pant; MM pink/moist, CRT<2s.
bulletINTEG: Clean, shiny coat, no areas of alopecia; shaved areas over both cephalic veins; catheter still in place in right cephalic.
bulletEENT: Eyes-cornea clear OU, sclera white OU, no conjunctival hyperemia, no ocular discharge. Ears-clean, no odor. Nose-wet, no discharge. Throat/Teeth-mild dental calculus, no oral ulcers or masses noted.
bulletMS: No obvious abnormalities, coordinated gait, ambulatory.
bulletCV: No heart murmur ausculted; no arrhythmia detected; difficult to auscult; strong, synchronous femoral pulses.
bulletRESP: No harsh lung sounds, panting heavily.
bulletGI: Doughy abdomen, hepatomegaly and splenomegaly detected on palpation. Feces appeared dark and tarry on walk.
bulletGU: No discharge from prepuce; smooth bladder palpated.
bulletNS: No obvious abnormalities; complete neurological examination not performed.
bulletLN: Submandibular, prescapular and popliteal all <1.5cm.

Problems

bulletHeartworm infection
bulletProteinuria presumed secondary glomerulonephritis
bulletRegenerative anemia
bulletEosinophilia
bulletMelena

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