– 9 year old MN Havenese presented for poor appetite
– x-rays showed an enlarged liver, and enlarged left heart; bloodwork mild anemia, mild hypoalbuminemia, other parameters normal
– u/s diffuse hepatomegaly, rounded capsular margins and ascites; hepatic vein and cvc distension
– “quick” echo with abdominal probe ruled-out pericardial effusion however there is severe LAE, mitral valve disease, MPA/Ao normal and subjectively the right heart may be midly enlarged? No pleural effusion seen. (full echo recommended but finances an issue)
– 9 year old MN Havenese presented for poor appetite
– x-rays showed an enlarged liver, and enlarged left heart; bloodwork mild anemia, mild hypoalbuminemia, other parameters normal
– u/s diffuse hepatomegaly, rounded capsular margins and ascites; hepatic vein and cvc distension
– “quick” echo with abdominal probe ruled-out pericardial effusion however there is severe LAE, mitral valve disease, MPA/Ao normal and subjectively the right heart may be midly enlarged? No pleural effusion seen. (full echo recommended but finances an issue)
– no diaphragmatic masses readily seen
– abdominocentsis serosanguineous which may be a little more bloody then it should be as I hit a blood vessel first try
Does this look like right-heart failure? My other concern would be infiltrative disease like lymphoma.
Comments
Hi
This is very likely right
Hi
This is very likely right heart failure secondary to left heart failure. Usually, the reason is severe pulmonary hypertension (DDs include concomitant decompensated pulmonic stenosis, other reasons for pulmonary hypertension like pulmonary thrombemebolism, concomitant congenital shunt´). The right heart appears markedly enlarged on your 4-chamber view, the gall bladder shows a double conture which usually appears before ascites develops.
There is also an arrhythmia visible on your echo clips – an ECG is recommended.
The patient needs quadruple therapy (Pimo, ACEI, Spironolactone and diuretics).
Best regards!
Peter
That’s awesome Peter. Thank’s
That’s awesome Peter. Thank’s for your input.
Take care
Jacquie
I monitor the CVC:AO ratio on
I monitor the CVC:AO ratio on these right chf cases and would love to do a paper on it but Peter would have to do it because he is willing to battle the cardio gods as Im good on the sidelines:) Just as in shunt hunts the cvc and ao in a normal animal should be 1:1 and in right chf the cvc dilates first then the HV then panc edema and splenic edema then ascites or any combination of things in the abdomen. So monitoring the cvc/ao ratio at the d-inlet is a good reliable parameter to monitor level of clinical right CHF because ascites is variable in amount and presence and the other parameters are subjective but the cvc and ao at the d-inlet are pretty precise in right intercostal long axis. So when tx-ing right chf with triple tx (left and right) or sildenafil and spiro or whatever you are using you can add this ratio to your report for reference and refer to it on follow-up us. Most american cardiologists get shivers down their spines when placing the probe caudal to the diaphragm (joking of course and peter is brilliant in the abdomen) so this is not a mainstream published technique but theoretically, and in my dual cavity brain, makes sense and is reliable.
Thanks EL – that does make
Thanks EL – that does make sense. Out of interest sake, do you think the CVC looks dilated on this chest x-ray? This was taken on the patient the day before the scan.
Hi!
Thank you Eric, that’s a
Hi!
Thank you Eric, that’s a very important input!
Yes, the CVC is dilated because is is wider than the vertebral bodies.
Re Sildenafil: Yes, it has an indication here if right sided outflow tract obstruction has been ruled out.
Peter