Supervising Clinician: Mark D.
Kittleson, DVM, PhD,
|Five-year-old female spayed
|Sarah was presented to the UC Davis VMTH Cardiology Service for further evaluation
and possible treatment of congenital heart disease.
Her owner had been in a car accident last summer and his sister took over
Sarah's care shortly thereafter. She reports that Sarah would exercise
normally and had a normal activity level at that time. After her OVH
3 months ago, Sarah's owner noticed that she began
coughing and had some abdominal distension. The abdominal distension has
gotten progressively worse since that time. She has also had a progressive
reduction in activity level and appetite, and is now exercise intolerant.
About twice a month, Sarah has collapsing episodes during which time she
seems dazed and confused for about 5 seconds; these are usually brought on
by exercise or excitement. The owner has noted collapsing episodes
for 6 months but did not know the etiology. The owner has also noticed that Sarah
has been having respiratory difficulty for the past month. A heart murmur
has not previously been diagnosed. |
|No pertinent medical history prior to new ownership
starting 6 months ago. |
|6 months ago: Presented to
first veterinary clinic for walking strangely
and possible collapse with activity. No diagnostic workup at that time.
|4 months ago: Presented
because she had two episodes where she fell on her
side and staggered. CBC/blood chemistry panel was normal. Ddx - possible epilepsy.
|3 months ago: OVH
|3 months ago: Presented to
check incision (bruising) and for cough/gag. Owner to monitor.
|3 months ago: Recheck
- still coughing. Rx: Amoxicillin 750mg BID x 14 days. Possible
abdominal distention which was not worked up further. |
|1 month ago: Presented to
a different veterinary clinic for abdominal
distension. Pale mm with prolonged CRT. Low output signs. Ddx:
congestive heart failure |
|4 weeks ago: CBC/ chemistry panel
|3 weeks ago: Abdominal
ultrasound revealed a large amount of abdominal fluid, moderate
hepatomegaly with mottled texture, severe hepatic vein and
caudal vena caval distension. Brief cardiac exam
revealed severe right atrial enlargement.
Recommended evaluation by cardiology specialist. |
|3 weeks ago: Furosemide
80mg BID started by referring DVM.
Abdominocentesis attempted but not accomplished.
|2 weeks ago: Furosemide
increased to 80mg TID due to progressive abdominal distention. Benazepril
15mg daily started. |
|Furosemide 80mg q8 hours|
|Benazepril 15 mg q24 hours
|Sarah has not had a successful abdominocentesis performed.
|GEN: QAR, 5-8% dehydrated based on decreased skin
turgor and pale, tacky mm; very weak and
lethargic. P=140-150 R=32. Ambulatory x 4 with assistance. Cold extremities.
|INT: Smooth, full hair coat. Salivary staining
interdigitally of all paws. 5cmx2cm area of alopecia with raised, thickened
dermis over right metatarsals (presumed acral lick
granuloma). No evidence of ectoparasites seen.
|EENT: Symmetric face with no muscle atrophy. Clear
conjunctiva, anterior chambers, corneas, and scleras OU. PLRs intact, direct
and consensual. No ocular discharge noted. Moderate ceruminous debris and
erythema AU. Clean dry nose. Pale, tacky mucous membranes. Clean teeth with
no dental calculus or plaque. No oral masses or foreign bodies seen.
|MS: BCS 6/9. No lameness noted; strong symmetric gait.
|CV: Muffled heart sounds;
difficult to auscult, particularly over right hemithorax. Soft diastolic
murmur possibly ausculted over left hemithorax. No systolic murmur
ausculted. Extra heart sound ausculted during early diastole. Pulses weak and symmetric. CRT 2.5
seconds. No obvious jugular pulsation, but subcutaneous
edema of the neck noted.
|RESP: Mildly tachypneic, no
crackles, wheezes, or stridor ausculted. Referred upper airway noises.
Short, shallow breathing pattern. |
|GI: Abdomen soft and distended, with fluid wave
palpable. Non-painful. Hepatomegaly palpated. |
|LN: Mandibular, prescapular, and popliteal lymph nodes
less than 1 cm. |
|Ascites most likely due to right heart failure|
|Clinical signs suggestive of low cardiac output|
|Abnormal heart sounds|
|Abdominocentesis: 4.25 L serosanguinous fluid
removed on presentation to Cardiology Service. Fluid
was consistent with a modified