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 Echo M-Mode Color Flow Doppler Diagnosis

Case 10

Primary clinician: Brad Gavaghan, DVM

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

Signalment

bullet10-year-old FS Dalmatian weighing 32 kg ("Manny")

Presenting Complaints

bulletCongestive Heart Failure

Pertinent History

bullet"Manny" presented with exercise intolerance, weakness and a moist cough.
bulletHer referring veterinarian, based on a recent physical exam and chest and abdominal radiographs, diagnosed congestive heart failure.
bulletShe reportedly has had a heart murmur since the owner obtained her at four years of age.
bulletApproximately 2.5months ago she was treated by the referring DVM for coughing with 2 weeks of prednisone 20mg BID. The coughing returned post therapy and she was then treated with 2 weeks of prednisone, 20mg BID and Lasix 25mg BID. The cough returned again upon completion of the prednisone therapy.
bulletShe remains on Lasix.
bulletReferral radiographs show pulmonary edema, an enlarged cardiac silhouette, and hepatomegaly.
bulletShe is referred to the VMTH for further cardiac evaluation.

Physical Examination

bulletT=101.8, P=90, R=60
bulletG: Quiet and BARH, CRT<1.5sec, MM=pink and moist, WT=32Kg,
bulletI: Full coat, no lesions and abrasions, 1cm dermal nodules on right sternum and left flank
bulletEENT: PLR bilateral, ears clean, tonsils in crypts
bulletMS: full fleshed, 7/9 body condition score
bulletCV: Muffled heart sounds, left apical systolic V/VI murmur, right apical III/VI systolic murmur. Brisk femoral pulses. Positive hepatojugular reflux test. Irregular rhythm.
bulletR: Occasional deep wet cough, enhanced bronchovesicular sounds and crackles all areas. Eupneic to shallow breathing
bulletGI: Enlarged abdomen, ballottement does not suggest ascites, liver approximately 2cm from sternal border, left caudal kidney pole smooth
bulletGU: Vulva pink and moist, bladder smooth and roughly 2cm in size.
bulletN: NE
bulletLN: Submandibular, prescapular and popliteal LN<1.5cm.

Problems

bulletLoud systolic heart murmur/Congestive heart failure (historical)/ Positive hepatojugular reflux test
bulletCoughing/Pulmonary crackles
bulletArrhythmia

 

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