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 Doppler TEE

Case 26

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

Signalment

bulletSix-month-old female Chow Chow weighing 17 kg ("Tiffany")

Presenting Complaints

bulletHeart Murmur

Pertinent History

bulletTiffany is presented to the VMTH Cardiology Service today for a second opinion of a previously diagnosed ventricular septal defect.
bulletTiffany was discovered to have a grade III-IV/VI systolic heart murmur at 12 weeks of age by the referring veterinarian, who recommended further evaluation with echocardiography.
bulletSeveral weeks ago, a veterinary internist on consultation found Tiffany to have grade IV/VI left- and right-sided systolic heart murmurs. By echocardiography, the internist diagnosed a ventricular septal defect with an overriding aorta. Tiffany's owners were told that there was no cure and that Tiffany may live 2-3 years before she developed severe heart failure.
bulletTiffany's owners were told to watch for signs of coughing and abdominal distension indicating that Tiffany's heart was failing.
bulletRecently they were concerned that Tiffany's abdomen was enlarged. Abdominal ultrasound by the referring veterinarian revealed enlarged hepatic vessels, but no ascites.
bulletTiffany comes from a litter of 6 pups. She and one of her brothers live together.
bulletShe is current on her vaccinations (DA2PPL, rabies, Bordetella). She has not begun to receive heartworm preventative.
bulletShe is kept outdoors in a run in the day and indoors at night.
bulletShe is fed Iams moist 1/3 can + Iams kibble 1 cup in the morning, then allowed free choice Iams kibble throughout the day.
bulletCurrently she is not receiving any medications.
bulletTiffany tires easily on walks. She also sneezes often and has consistent mild epiphora OU, as does her brother.
bulletTiffany developed moderate diarrhea 2 weeks ago when her owners changed her food. They gave her 2-3 teaspoons of Pepto Bismol and the diarrhea resolved within 2 days.
bulletHer owners report no coughing, anorexia, vomiting, or PU/PD.

Physical Examination

bulletGeneral: BAR, playful and excited. T=103.2 P=140 R=panting BCS 5/9.
bulletIntegument: Full, healthy hair coat.
bulletEENT: Mild epiphora and staining of medial canthi OU, sclera and conjunctiva clear OU. Ears clean AU. Mild serous nasal discharge bilaterally. Moderate mandibular brachygnathism with mild palatal defects due to malposition of mandibular canines.
bulletMS: No gait abnormalities, no palpable asymmetry.
bulletCV: Grade IV/VI left-sided and III/VI right-sided systolic murmurs. No arrhythmias or pulse deficits. CRT=1 sec, mm pink and moist.
bulletRespiratory: Intermittent stertor, eupneic, quiet inspiratory breath sounds ausculted diffusely.
bulletGI: Smooth gut loops palpated, no pain elicited on palpation.
bulletGU: Smooth and symmetric kidneys palpable, no vulvar discharge or erythema.
bulletNervous System: No gross deficits noted on physical examination.
bulletLymph Nodes: Mandibular and popliteal lymph nodes < 1.5cm diameter. Prescapular, axillary, inguinal lymph nodes not palpable.

Problems

bulletHeart murmur previously diagnosed as ventricular septal defect
bulletMandibular brachygnathism
 

 

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