Examined a 9 YO, 53# (24Kg) German Shepherd currently receiving Immiticide therapy for HW. Has been treated before as well. Discovered Grade 2-3/6 systolic murmur that has recently been detected.
- Rads reveal normal to mild increase LA and mild interstitial markings probably from old HW disease
Echo findings: Most consistent with MV Disease
Examined a 9 YO, 53# (24Kg) German Shepherd currently receiving Immiticide therapy for HW. Has been treated before as well. Discovered Grade 2-3/6 systolic murmur that has recently been detected.
- Rads reveal normal to mild increase LA and mild interstitial markings probably from old HW disease
Echo findings: Most consistent with MV Disease
- LVEDDd – Increased (51mm)
- LVEDDs – Normal to mild increase (29.9mm)
- FS% = 41%
- EPSS Normal (2mm)
- Mild to moderate LA enlargement LAmax4chamber (51mm)
- Large, eccentric trans Mitral Flow on CFM (5.8 m/s on CW)
- TransMitral E-wave velocity increased (1.6 m/s)
- Mild Aortic Insufficiency and increased Aortic Velocity (2.6 m/s)
- Mild Pulmonic Insufficiency
- ECG reveals what looks to me as a sinus arrhythmia with periods of sinus bradycardia and sinus arrest
Questions:
1: Start Pimobendan? Seems to be a good candidate, but with the HW and arrhythmia I want to make sure.
2: Do you agree with the rhythm analysis that it is most likely from high vagal tone, and that it may improve post Immiticide therapy.
Comments
Additional media
Additional media inserted.
Jeff
Ill let Peter jump in on tghe
Ill let Peter jump in on tghe ecg results but Im seeing a stage B2 case at least sonographically so triple therapy warranted in my book. The atrial septum is deviated and there’s la and lv volume overload. Not seeing anything HW related but a GSD with valve disease have to consider hx of endocarditis possible since this isnt a typical valve breed.
Thanks Eric, I agree on the
Thanks Eric, I agree on the HW too. Not too much evidence of HW disease, May just be old changes from previous with incoplete kill of a few worms? Still I would expect some PA and Lobar artery changes in most cases if there are enough worms to cause a positive test.
I will wait and see what Peter says about the ECG. I have convinced myself that it is just a pronounced sinus arrhythmia, but we shall see. Might need a more diagnostic ECG if there is suspicious of a serious arrhythmia.
jjp
Hi!
1. Yes, I would start
Hi!
1. Yes, I would start with Pimobendan
2. Could you post an ECG? If this is significant bradycardia (possibly high vagal tone) then we should help the patient to compensate a bit (maybe Theophylline or Ipratropriumbromide). It would likely be advisable to administer atropine (0.04 mg/kg) and see if the bradyarrhythmia resolves to confirm a high vagal tone.
Peter
I don’t have an ecg strip
I don’t have an ecg strip other than what was done at the time of the echo. I will talk to the primary vet and see if she can get a more diagnostic strip. Most of the exam the HR was in the 50-60 bpm, but at times it was a normal sinus rhythm at about 120 bpm i believe.
I didn’t think about an atropine response test, will do that…Thanks for the input on this one.
jjp