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Case 14
Primary clinicians: Brad Gavaghan, DVM and
Darcy Adin, DVM
Supervising clinician: Mark D. Kittleson,
DVM, PhD,
DipACVIM (Cardiology)
Signalment
 | 10-year-old MC black American cocker spaniel weighing 12 kg
("Houdi") |
Initial Visit
Presenting Complaints
| Heart Rate Slow & Erratic/Weight Loss |
Pertinent History
| Houdi was diagnosed with bradycardia and a I/VI systolic murmur last month during an
evaluation for weight loss. |
| The referring DVM would like to plan a gastroduodenoscopy and referred
Houdi for cardiac evaluation. |
| The owner reports normal activity and good appetite. |
| He has also begun to put on more weight since this problem started a
few months ago. |
| Houdi was diagnosed with pancreatitis 2 years ago which was treated at
another veterinary clinic. |
Physical Examination
| BAR, T=102.2 P=60 RR=panting.
|
| IV/VI left apical murmur (II/VI on the right). Strong femoral pulses,
pink mm with 1 sec CRT. |
| Clear lung sounds bilaterally.
|
| Abdominal palpation unremarkable.
|
| Slight enlargement of the prescapular lymph nodes.
|
Comments
| ECG: Non atropine-responsive sinus bradycardia (heart rate = 55 beats/minute), with
failure of appropriate response from alternate pacemakers. |
| ECHO: Moderate mitral regurgitation with valve thickening and LA enlargement.
Interventricular septal thickness in diastole - 0.8 cm (normal); LV
end-diastolic diameter - 4.0 cm (increased); LV end-systolic diameter - 2.7
cm (increased); SF 39%; LV free wall thickness in diastole - 0.8 cm (normal);
Ao:LA 15:26 (increased). |
Discharge Summary
| Houdi presented for cardiac examination following the diagnosis of bradycardia. He was
diagnosed with moderate mitral regurgitation and sinus bradycardia that was not atropine
responsive. It was recommended that a temporary pacemaker be placed if he is to be placed
under general anesthesia. It was also noted that a permanent pacemaker may be required in
the future. |
Three months later
Presenting Complaints
| Rear Legs Give Out |
Pertinent History
| History of pancreatitis. |
| Shaky rear legs and not jumping up as often. Every 3-4 days his
rear legs will give out. The owner describes it as stumbling. |
| Currently he has protein
losing nephropathy. |
| He is being seen here for either a temporary or permanent pacemaker
in order to undergo anesthesia for a biopsy of the kidney. |
| Behavior has been unchanged.
Eating and drinking well. Feeding K/D mixed with Nutro, but dog refuses to eat K/D.
|
| Has
had watery diarrhea for the past two days. |
| No coughing, wheezing or vomiting. |
| Taking metronidazole 250mg 1/2 tab TID for the past 2 months. |
| Was on Carprofen 20mg BID but taken off 2 days ago. |
| Also was on enalapril 5mg SID but taken off because of kidney problems. |
Physical Examination
| BAR; Wt: 12.0kg, Temp.: 101.4, Pulse: 44 bpm, Resp: panting. Mucous membranes pink.
CRT: 1sec. |
| Integumentary--Papillomas on head, small mass that appears to be a lipoma right
side. Shiny coat, clear skin. Well hydrated. |
| EENT--Small amount of mucous coming from both eyes and there is some opacity to them.
Small amount of wax in ears but no redness. Nose clear. Severe tartar on teeth. No lesions
in throat. |
| Musculoskeletal--Symmetrical, well muscled, no lameness. Body score 5/9.
|
| Cardio.--Very irregular slow heart rate. Grade III/VI left sided systolic heart murmur.
Strong pulse quality. Approximately 2 sec. pauses intermittently between beats.
|
| Resp.--Clear lung sounds, no crackles. |
| G.I.--No masses or organomegaly. |
| Genitourinary--No secretions detected. |
| Neuro.--Not evaluated. |
| Lymph nodes--not enlarged. |
Problems
| Protein losing nephropathy |
| Bradycardia/Stumbling episodes |
Echocardiogram
| Mild mitral regurgitation with mild valve thickening and mild left atrial
enlargement. |
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