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Case 33
Primary clinician:
Sarah Miller, DVM
Supervising clinician: Mark D. Kittleson,
DVM, PhD,
DipACVIM (Cardiology)
 | Seven-year-old MC
Husky weighing 29 kg
("Fisher") |
| Cough |
| Fisher was presented to the VMTH Cardiology Service
for evaluation of possible heartworm infection. |
| According to the owner, Fisher
started having clinical signs one to two months ago.
He has been coughing, retching, and lethargic and
has had labored breathing especially in the last three weeks. |
| Four weeks ago
he had an episode of collapse while playing fetch. It took him approximately
ten minutes to recover from the collapse, but he was conscious and responsive
during the episode. |
| Fisher was taken to his veterinarian 3
days ago where thoracic radiographs, an ECG, CBC,
chemistry panel, urinalysis and heartworm test were performed.
|
| Thoracic
radiographs showed dilated pulmonary arteries and other radiopaque areas in
the lungs. |
| ECG did not show an arrhythmia, but there were wide T waves. CBC
showed a regenerative anemia (HCT=31%) and eosinophilia of 2,992/uL. His
chemistry panel indicated hypoalbuminemia (2.1) and an increased globulin
(5.4). Urinalysis showed SG=1.023 and 3+ proteinuria. |
| Fisher's heartworm
antigen test was performed
by IDEXX and came back as weak positive. He was also
positive for microfilariae. |
| Fisher is current on his vaccinations
except Bordetella and is not on any current medications. |
| He was given IV
fluids and IV Cefazolin TID (dose unknown) at the referring
veterinarian for three days. |
| Fisher still has a good appetite and is
fed Sensible Choice reduced kibble (Lamb and Rice) along with dog biscuits.
|
| He
was tested for heartworm in 2001 and was negative. He was started on
Interceptor, but he apparently had an allergic reaction to it and would vomit
it up every time it was administered. He has not
been on any heartworm preventative since that time.
|
| Fisher has not had any vomiting or diarrhea recently but has been having
slightly looser stools. |
| There are three other dogs in the household that are
all relatively healthy and are all on heartworm
preventative. |
| He lives in Shingle Springs, CA in the
foothills of the Sierra Nevada mountains, a region known to be endemic for
heartworm. |
| GEN: QARH, T=101.6, P=140, R=pant; MM pink/moist, CRT<2s. |
| INTEG: Clean, shiny coat, no areas of alopecia; shaved areas over both
cephalic veins; catheter still in place in right cephalic. |
| EENT: Eyes-cornea clear OU, sclera white OU, no conjunctival hyperemia,
no ocular discharge. Ears-clean, no odor. Nose-wet, no discharge.
Throat/Teeth-mild dental calculus, no oral ulcers or masses noted. |
| MS: No obvious abnormalities, coordinated gait, ambulatory. |
| CV: No heart murmur ausculted;
no arrhythmia detected; difficult to auscult;
strong, synchronous femoral pulses. |
| RESP: No harsh lung sounds, panting heavily. |
| GI: Doughy abdomen, hepatomegaly and splenomegaly detected on
palpation. Feces appeared dark and tarry on walk. |
| GU: No discharge from prepuce; smooth bladder palpated. |
| NS: No obvious abnormalities; complete neurological examination not
performed. |
| LN: Submandibular, prescapular and popliteal all <1.5cm. |
| Heartworm infection |
| Proteinuria presumed secondary glomerulonephritis |
| Regenerative anemia |
| Eosinophilia |
| Melena |
|
