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 17

Primary clinician: Darcy Adin, DVM

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

Signalment

bulletOne-year-old MC Chihuahua weighing 4.4 kg ("Chico")

Presenting Complaints

bulletHeart Murmur

Pertinent History

bulletChico presented to the referring DVM 7 weeks ago to be neutered. This was postponed due to coughing.
bulletPhysical exam and auscultation were unremarkable at that time so the dog was placed on Clavamox 62.5 mg. BID for 14 days.
bulletTwo weeks later Chico was neutered without complication. The cough had subsided.
bulletChico represented to the referring DVM four weeks ago for mucoid nasal discharge and cough. Thoracic auscultation was reported as unremarkable and the dog was again placed on Clavamox.
bulletChico was placed on Tussigon 5 mg. BID two weeks ago for coughing.
bulletTen days ago Chico was placed on Torbutrol 1 mg. TID for continued coughing.
bulletOne week ago a IV/VI systolic murmur was ausculted at the referring DVM and thoracic radiographs revealed cardiomegaly and pulmonary edema.
bulletChico was then placed on 10 mg Lasix BID with no response in the cough.
bulletThe owner has had Chico for 8 weeks (obtained from a friend); the owner recently obtained a second dog from the pound. She has not noticed any change in activity level or appetite.
bulletHe is very active.
bulletHe coughs throughout the day and possibly coughs up saliva/fluid.
bulletThe owner has been treating with Lasix once a day instead of BID (she misunderstood the instructions).
bulletThere has been no vomiting or diarrhea.
bulletThe owner has recently noticed some odd respiratory motions where he lurches when he breathes. This lasts about a minute. This does not occur in conjunction with the coughing.
bullet Additionally, she has heard him yelp/squeal for a moment while eating. 
bulletChico has had one incident of trauma: strangulation/choking episode on choke collar while tied up at previous owner's house.

Physical Examination

bulletGeneral: BARH. Very active
bulletIntegument: no abnormalities
bulletEENT: No abnormalities
bulletMS: No masses palpated.
bulletGI/GU: No abnormalities. Slightly tender upon abdominal palpation. Small smooth bladder palpable. No abnormalities noted on prepuce/penis.
bulletNS: Not evaluated.
bulletLN: No abnormalities.
bulletCV: HR 140. Grade V/VI continuous murmur heard best over the left cranial - ventral thorax (left axillary region). Regular rhythm. Very strong/bounding femoral pulses. No jugular pulses. No pulse deficits.
bulletR: RR 40; Eupneic. Clear lung sounds all fields. Tracheal palpation elicited a cough.

 

Femoral artery pressure recording (note the pressure measures on the left side)

 

Problems

bulletGrade V/VI left basilar continuous murmur with bounding pulses
bulletCough

 

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