Hi there,
Just wanting to ask the experts out there how do we confirm our diagnosis for DCM? My understanding is if we have :
1. Increase LV diastolic and systolic dimensions
2. Left atrial enlargement or biatrial enlargement
3.decreased fractioning shortening
4. atrial fibrillation
5. increased EPSS
Can we say this animal has DCM?
Hi there,
Just wanting to ask the experts out there how do we confirm our diagnosis for DCM? My understanding is if we have :
1. Increase LV diastolic and systolic dimensions
2. Left atrial enlargement or biatrial enlargement
3.decreased fractioning shortening
4. atrial fibrillation
5. increased EPSS
Can we say this animal has DCM?
Based on the european point systemen for diagnosis of subclinical DCM, if an animal has >6 points, this dog has subclinical DCM. But what if the dog is showing clinical signs, does that mean we diagnosed DCM?
In addition, my boss commented based on the M mode, if the LV free wall is still moving, DCM is unlikely. Would you agree?
7y.o MN Rottweiller had an echocardiogram in Oct’15 and again in Mar’16 (5 months) FS% was initially at 38% however, its gone to 28%( M mode). Patient was placed on Pimobenden after the first scan in Oct which owner reported dog to be doing very well. Recently, dog became lethargic with increased respiratory effort. This dog was also diagnosed with idiopathic pericardial effusion in 2013. He had a small amount of pleural effusion in oct 2015 however, the amount has increased greatly when I scanned him again in march 2016. Atrial fibrillation was also diagnosed. no VPCs were observed in ECG.
Cornell Normalized Ref Ranges
24/3/26 15/10/16
LIVSd 0.48 0.52 ( 0.29 – 0.59)
LVIDd 2.15 2.65 (1.27 – 1.85)
LVPWd 0.41 0.70 (0.29 – 0.60)
LIVSs 0.58 0.49 (0.43 – 0.79)
LVIDs 1.68 1.51 (0.71 – 1.26)
LVPWs 0.49 0.51 (0.28 – 0.87)
LA 1.67 1.95 (0.63 – 0.96)
Ao 0.65 0.80 (0.59 – 0.97)
Comments
Clinical DCM usually has a
Clinical DCM usually has a FS% around < 20% in my experience. I can say this dog does not have DCM one one view whcich is your video which shows the apical MV leaflet touching the LV septum which means ts the epss is normal and rules out dcm.
Pathologies that drop FS% and have normal epss and are imposters for dcm are myocarditis (epss may be high here), hypothyroidism, systemic disease, myocardial insuficiency in late stage valular disease, arrythmias (drop FS% dsignificantly).
The LA is big here in your case and arrythmia noted and at the bottom left of the screen I think Im seeing pericardial effusion under the RA annotation… left to right across the bottom : PC effusion, RA, then big chronic LAE. With that big LA on the right and pericardial effusion I would be concerned for LA rupture but would need more views. I don;t see pericardial effusion in your mmode or still short axis.
So IM thinking valvular disease, chronic LAE and myocardial insufficiency (non compensatory contractility) here in your case. In valve disease we want a high FS% in the 40-50% rage showing th eheart is compensating but when there is vlume overload and the FS% is dropping thats a bad sign and means the myocardium is wearing out… this is more consistent in valve breeds and less consistent in bigger breeds that happen to get valve disease.
Ill see if Peter has some input here.
Hi Eric,
Thank you so much
Hi Eric,
Thank you so much for the feedback. It does make sense with what you’re saying about the myocardium wearing out hence FS% dorpping.With regards to the effusion, the dog has bilateral pleural effusion (That could be why you’re seeing fluid next to the heart). This dog is also a large breed-rottweiler and hence I was not expecting a MVD. Great learning case for me!
Yes, the European scoring
Yes, the European scoring system is used to diagnose DCM, and if the dog is showing clinical symptoms, it is overt DCM. And: your points are good. I woudl still add VPCs in Doberman Pinschers, Boxers and Great Danes as a criterion because these breeds can develop a pure electrical form of DCM
Still, I woudl not use the European scoring system for breeds for which newer data are available (e.g. Doberman Pinschers, see Wess et al, JVIM)
As a general rule, a dog with DCM and CHF almost never has a FS >12%. (Means, in a dog with clinical DCM (CHF) the free wall shows only very slight movements – and no systolic thickening). In your dog, the LA appears much larger than the LV. Thus, I woudl consider DMVD or idiopathic afib (atrial myocarditis…) as differential diagnoses.
Pimo is ok, I would also add and ACEI, Furosemide and Digoxine. If the heart rate does not go down, I would add Diltiazem here.
Thanks Pete, appreciate the
Thanks Pete, appreciate the feedback. Heaps to learn with echo!:)
Valve disease in big dogs
Valve disease in big dogs always consider low grade infectious… bartonella and other bugs… I’m not saying its there every time but doxycycline is cheap and may be effective…in NJ we have most the cool bugs but if you have infectious locally and vegetative valves in big breeds keep it in mind.
Note: Peter doesnt subscribe to this because Austria is bug fee… for now… he may change his mind with global warming and migrations trends lately…. someone will bring a big or two to warming Austria just wait:)