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 2D Echo Color Flow Contrast Echo Doppler Diagnosis

Case 7

Primary clinician: Darcy Adin, DVM

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

cindyred.jpg (22687 bytes)

bulletFour-month-old female toy poodle weighing 2.2 kg ("Cindy")

Presenting Complaint

bulletHeart murmur/Congenital Heart Disease

Pertinent History

bulletCindy was diagnosed two months ago with severe congenital heart disease but she was too small to intervene at that time. She has grown a little since that time.
bulletThe owner reports significant worsening of clinical signs.  She reports that Cindy is more active (attempts to play with new puppy) but her shortness of breath is gradually getting worse such that any activity precipitates dyspneic episodes.
bulletShe gags when she drinks water.
bulletShe has no persistent vomiting, diarrhea, coughing or sneezing.
bulletHer appetite is very good, her urination and drinking are normal in volume/frequency.
bulletHer diet is still Pedigree Puppy and Nutromax kibble.

Physical Examination

bulletTemperature 101.3, pulse 148, respiration 52.
bulletThe general physical examination was unremarkable.
bulletCardiovascular/Respiratory examination: Lung sounds unremarkable bilaterally, though difficult to auscult due to the loudness of the heart murmur. Femoral pulses moderately strong bilaterally. No jugular pulse noted. Grade V-VI/VI systolic murmur heard loudest and palpated strongest on the right, but prominent at the left base as well. Possible split S2. Mucous membranes are slightly darker than normal, however this is difficult to evaluate in light of the slight membrane pigmentation. Mucous membranes moist, with a 1 second capillary refill time.    


bulletHeart rate - 100 beats/minute. Normal sinus rhythm. Deep S waves in the left and caudal limb leads (I, II, III, and aVF) producing a terminal right axis deviation. The QRS complex duration is normal (0.04 seconds).

Lab Work

bulletPCV = 68%; Systemic arterial oxygen tension when breathing 100% oxygen soon after being anesthetized was 55 mm Hg (normal is greater than 90 mm Hg on room air [21% oxygen] and is greater than 400 mm Hg when breathing 100% oxygen).



Correct Quiz


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