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Case 29
Follow-Up
Three Months Later
 | Nimbus has been doing reasonably well at
home. She has good energy and is very active, but she tires easily and will
lay on her side and pant until she catches her breath again. She has not had
any syncope. Her appetite
and water consumption are unchanged. |
| Gen: BARH T = 101.0 |
| Integ: Normal |
| EENT: Normal |
| MS: BCS =5/9. |
| CV: IV/VI left parasternal systolic murmur. Strong synchronous femoral
pulses. HR=200. MMs pink and moist, becoming cyanotic when stressed by
restraint. CRT < 2 sec. No jugular pulses. |
| Resp: Bronchovesicular sounds ausculted in all lung fields. RR=40-60
|
| GI: Normal |
| GU: Normal |
| NS: Normal |
| LN: Normal |
| Echocardiogram: Marked
right ventricular concentric hypertrophy with right
ventricular free wall thickness of 6mm and a left
ventricular free wall thickness of 4mm. Large
ventricular septal defect with laminar flow from
right ventricle into the overriding aorta;
narrowed RVOT with malpositioning of pulmonic valve and pulmonic stenosis
- highest velocity recorded across pulmonic valve 5.4 m/s
(pressure gradient of 117;
therefore approximate RV and LV pressure of 140 mmHg). |
| Thoracic rads: Static cardiomegaly and pulmonary hypoperfusion. |
| PCV:51% TP=7.4 gm/dl |
| Conclusions: Echocardiography findings again
document tetralogy of Fallot with pulmonic stenosis, overriding aorta, VSD,
and RV concentric hypertrophy. Right-to-left
shunting of blood flow is present with laminar flow
evident from the right ventricle through
the large ventricular septal
defect into the aorta. The
PCV of 51% is elevated. If she becomes more polycythemic
and exhibits clinical signs we will consider hydroxyurea therapy
or phlebotomy. Clinically Nimbus is not cyanotic at rest. When severely
stressed by restraint, she did progress to open-mouth
breathing with increased abdominal effort and cyanosis which resolved within
minutes with rest. The owner is interested in providing a good quality of life
for Nimbus, but declines invasive treatments. |
One Year Later
| Nimbus was diagnosed with tetralogy of Fallot
here in 1/02. She has been doing reasonably well at
home since then. She has good energy and is very active, but she tires easily
and will lay on her side and pant until she catches her breath again. The
owner is concerned that Nimbus is obese. She is also
worried about Nimbus's strange habit of drinking contact lens solution due to
the high sodium concentration. |
| Gen: BARH P-186, RR-60 |
| Integ: Full hair coat. shedding. No masses or lesions noted. |
| EENT: Normal |
| MS: BCS = 6/9. |
| CV: III/VI left parasternal systolic murmur. Strong synchronous femoral
pulses. HR=186. MMs pink and moist. CRT < 2 sec. No jugular pulses.
|
| Resp: Bronchovesicular sounds ausculted in all lung fields. RR=40-60
|
| GI: Normal |
| GU: Normal |
| NS: Normal |
| LN: Normal |
| Tetralogy of Fallot |
| Echocardiogram: No change from last echocardiogram.
|
| PCV-50% |
| Conclusions: Echocardiography findings again
document tetralogy of Fallot. The PCV of 50% is
static, which is a good prognostic sign. The owner
was instructed to come back in one year for a
recheck unless Nimbus has any problems. |
Six Years Later
| Telephone Conversation - In a conversation with
Nimbus' owner, he indicated that she is alive and doing well. She will still
play a bit hard and then get winded and have to lie on her side for while and
breathe heavily. Other than that he feels that she is quite normal clinically.
She is the only pet in the household since the owners feel that another pet
would put too much stress on Nimbus. Besides, he feels that Nimbus enjoys
being an only child. |
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