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Case 33
Eighteen weeks after first visit
 | Recheck heartworm disease |
| Fisher was presented today to the Cardiology Service for
a recheck of his heartworm disease. He was originally diagnosed with Class
III heartworm infestation with severe pulmonary hypertension
18 weeks ago. At that time, eight worms were
removed from the pulmonary arteries with Ishihara
forceps under fluoroscopic guidance. He was later treated with Immiticide
(melarsomine) on Feb 11, 2003 and March 13, 2003
according to the alternate dosing protocol. |
| Since the last visit on March 13th, Fisher has been still
coughing a little, but the owner feels that the coughing has significantly
decreased. They are still restricting his
activity. |
| Fisher is not currently on any medications. His vaccines
are up to date, and he has been receiving Heartgard as a monthly heartworm
preventative and Frontline for flea and ticks. His diet is Science Diet
maintenance, 2-3 cups PO SID. |
| Fisher is primarily an indoor dog who lives with 3 other
dogs, cats, chickens, and several other farm animals on a large fenced
property. He currently goes on leash walks, but he has also been allowed to
roam the property a couple of times at night. |
| GEN: BARH, T=101.1, P=100, R=panting, CRT < 2 sec.
|
| INTEG: Normal.
|
| EENT: Normal.
|
| MS: BCS=7/9, weight=40kg. Gait is normal, and body
appears symmetrical with no abnormalities noted. |
| CV: No arrhythmia or heart murmur
ausculted. |
| RESP: Normal.
|
| GI: Normal. |
| LNs: Normal.
|
| NEURO: Full neuro examination not performed.
|
| Historical Class III heartworm disease |
| Historical severe pulmonary hypertension
|
| Historical proteinuria (glomerulonephritis)
|
| Heartworm infection - resolved
|
| Pulmonary hypertension
- improved |
| Proteinuria
(glomerulonephritis) - resolved |
| Radiographs: Today's radiographs
are compared to previous radiographs taken at the VMTH. Again, a diffuse
interstitial pattern is appreciated along with severely enlarged, tortuous,
and blunted pulmonary arteries. However, the right main pulmonary artery
appears more prominent than previously noted. |
| Echo: IVSd = 1.2 cm, EDD = 4.33 cm, LVFWd = 0.8 cm, IVSs =
1.4 cm, ESD = 2.8 cm, LVFWs = 1.2 cm, Ao = 2.1 cm, LA = 2.7 cm, FS = 37%,
LA/Ao = 1.3. The previously noted septal flattening is no longer
apparent. The pulmonary arteries are severely enlarged. No pulmonic
insufficiency or tricuspid regurgitation is apparent. No heartworms are
seen. |
| Difil Test -
negative. Synbiotics
DiroCHEK heartworm antigen
test: Negative
|
| URINALYSIS pertinent results:
Turbidity - clear;
Color - yellow;
Specific gravity - 1.037
Refractometer; pH 8.5;
Protein 1+ |
| Urine Protein/Creatinine
- 0.11 |
| Conclusions: The echocardiographic findings today show
that Fisher's severe pulmonary hypertension has improved.
He is now heartworm antigen and Difil tests are
negative and his glomerulonephritis has resolved with the treatment of his
heartworm disease. Given the appearance of the right main pulmonary artery
on his thoracic radiographs, Fisher could still have a male worm occupying
this artery, causing an antigenic response and resulting in a negative
antigen test. This is, however, of low likelihood. He is doing clinically
well, and he will return yearly for rechecks. Fisher's owners were told that
exercise restriction is no longer necessary, and Fisher should live a
normal, healthy life now that his heartworm disease has been addressed and
treated effectively. |
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