Case Study

15_00092 Barney G Mod-severe DVD, MI, LAE, and Left heart failure

A 9-year-old MN Maltese presented for evaluation of a heart murmur. Systolic blood pressure was 160, and survey radiographs showed possibly enlarged calcified hilar lymph nodes.

A 9-year-old MN Maltese presented for evaluation of a heart murmur. Systolic blood pressure was 160, and survey radiographs showed possibly enlarged calcified hilar lymph nodes.

Sonographic Differential Diagnosis

Moderate to severe degenerative valve disease (DVD) with moderate to severe mitral insufficiency, left atrial enlargement and beginning left heart failure. Based on the ACVIM consensus statement this is stage C2 (heart failure).

Image Interpretation

A volume overloaded left ventricle and a markedly enlarged left atrium (interatrial septum bulging towards the right atrium in systole) were noted. The mitral valve leaflets are moderately to severely degenerated and mildly prolapsing and there is mild systolic dysfunction. Color Doppler shows moderate to severe mitral insufficiency. The right ventricle and atrium are normal even though the tricuspid valve is mildly affected too. Flows across the LVOT and RVOT are normal indicating that there is no stenosis or significant pulmonary hypertension present.

Outcome

It is recommended to start with triple therapy (Pimobendan, ACEI, furosemide) and spironolactone. High salt food should be avoided. Another radiograph is recommended along with rescanning the dog about 2-3 weeks after initiation of therapy.

Comments

No further outcome provided.

Clinical Differential Diagnosis

Cardiac – mitral/tricuspid endocardiosis, vegetative endocarditis, myocardial weakness Tracheo-bronchial – tracheal collapse, chronic bronchitis, tracheitis (viral, bacterial, allergic), environmental (dust, tobacco smoke, chemicals), obesity, neoplasia (tracheal, pulmonary) Lymph nodes – neoplasia, abscessation, fungal disease, granulomatous disease.