Case Studies In Small Animal

Cardiovascular Medicine

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Third Visit

Case 33

Presenting Complaints

bulletHeartworm Therapy

Pertinent History

bulletFisher was presented to the Cardiology Service at the VMTH for Immiticide treatment for stage III heartworm disease. One week ago he had 8 heartworms physically removed (2 from the left pulmonary artery and 6 from the right pulmonary artery). He recovered well from that procedure and is now here to receive the first of three Immiticide (melarsomine) injections to kill any remaining adult worms.

Physical Examination

bulletGEN: BARH, BCS 4/9.
bulletINT: Full hair coat.
bulletEENT: Mild wearing of all incisors, all other WNL.
bulletMS: Symmetric gait, adequate muscle tone.
bulletCV: Mucous membranes pink. CRT 2.0 sec. HR: 92. Rhythm regular. Split second heart sound. Femoral pulses strong.
bulletRESP: Harsh lung sounds in all lung fields. Panting. No crackles or wheezes ausculted. Cough elicited on pulling on the leash.
bulletGI: WNL
bulletGU: WNL
bulletLN: All peripheral nodes less than 1.5cm.
bulletNS: Mentation appropriate. PLR and menace intact OU.

Problems

bulletStage III heartworm disease
bulletSevere pulmonary hypertension

Medical/Surgical Procedures

bulletImmiticide, 84.5mg (3.4cc) IM.

Clinical Diagnoses

bulletClass III heartworm infestation
bulletSevere pulmonary hypertension
bulletImmiticide treatment (first injection of alternate dosing regimen)

Plans and Progress Notes

bulletDay 1: Heartworm disease: S/O: 3.4cc Immiticide given left paralumbar musculature 3:00 pm. A: Successful injection. P: Monitor throughout the day and overnight for respiratory distress or vomiting. Discharge with instructions for strict cage rest tomorrow.
bulletDay 2: Heartworm disease: S/O: am: QARH. Walks slowly and appears sore around the injection site. Lungs still slightly harsh on auscultation. Eupneic, no evidence of respiratory distress. A: Pain likely associated with injection. Consider analgesia. NSAIDS contraindicated because of history of prednisone administration.

Discharge Instructions

bulletThank you for bringing Fisher to the Cardiology service at the VMTH.
bulletWhile Fisher was here, we gave him an intramuscular injection of the drug Immiticide to treat heartworm disease. The injection was given in the musculature at the shaved site on his back. This area is likely to be very sore for several days.
bulletThis drug causes the death of worms within the blood vessels. It is extremely important that Fisher be crated at all times except when led outside on a leash to go to the bathroom. This strict cage rest must be maintained for at least 4 weeks. If Fisher begins to have trouble breathing within the next 4 weeks, please bring him directly to your local veterinarian.
bulletPlease begin giving Fisher Heartgard plus when you return home. This medication should be given every month to kill the younger stages of the worms and prevent re-infection with the parasite.
bulletYou may continue to give Fisher the prednisone if he appears very sore. This medication will help to decrease the inflammation associated with the injection. Common side effects of short-term prednisone administration are increased water drinking and urination and increased appetite. If Fisher is doing well, please refrain from giving him the prednisone.
bulletPlease make an appointment to bring Fisher back to the VMTH for his next two injections in one month.
bulletFisher is a friendly and handsome dog. We enjoyed working with him.

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