– 9 year old FS Collie X wt. 30kg present about 3 weeks ago for cough, exercise intolerence, decreased appetite
– grade 4/6 systolic murmur detected, elevated resp rate with abdominal effort
– chest rads mild patchy alveolar pattern VHS 11.25
– bloodwork mild elevation in CRE only
– echocardiogram consistent with CVD Briefly: FS 45%, LVs 26, TR max vel 29m/s, 2-D LA/Ao 2.7, thickened mitral and tricuspid valves
– 9 year old FS Collie X wt. 30kg present about 3 weeks ago for cough, exercise intolerence, decreased appetite
– grade 4/6 systolic murmur detected, elevated resp rate with abdominal effort
– chest rads mild patchy alveolar pattern VHS 11.25
– bloodwork mild elevation in CRE only
– echocardiogram consistent with CVD Briefly: FS 45%, LVs 26, TR max vel 29m/s, 2-D LA/Ao 2.7, thickened mitral and tricuspid valves
– started with IV furosemide to get resp rate down, then started on 40 mg furosemide BID, 7.5 mg Vetmedin BID and recheck scheduled where ace inhibitor to be added if all going well
– pet did well at home (SRR 21-24) but at the time of recheck pet had a bad night of pacing and was showing signs of weakness, no cough
– repeat chest rads showed slight worsening in lung alveolar pattern but not severe edema; repeat bloodwork showed mild azotemia
– an arryhtmia was detected with pulse deficits – ran ECG below (atrial fibrillation), tachycardia
So, I did increase the furosemide to 60mg, started Diltiazem 45 mg TID – Any other suggestions for this case? Prognosis for patients with atrial fib?
Comments
any chance for a video or
any chance for a video or stills on the echo??? I believe you on the measurements but pairing wiht images would be best
any chance for a video or
any chance for a video or stills on the echo??? I believe you on the measurements but pairing wiht images would be best
Here’s some stills
Here’s some stills
Here’s some stills
Here’s some stills
Can also consider using
Can also consider using digitalis for the tachycardia.
Can also consider using
Can also consider using digitalis for the tachycardia.
Wow that’s ugly JP. End
Wow that’s ugly JP. End stage C-D valvular disease wiht myocardial insufficiency…. She isnt compensating further and with the a-fib thats likely from the la stretch and myocardial hypoxia from chronic volume overload. You are going to need the kitchen sink on this one. Triple Tx for sure Lasix. pimo, ace-i and I would add in spironolactone…. When arrythmias are present in volume overload I walways treat the volume first and often the arrythmia is more manageable or even goes away. I don’t think thats the case here. Diltiazem will likely be needed long term but its a bit of a paradox because with FS% in the 40s in valve disease thats entering into myocardial insufficiency and diltazem is a mild negative inotrope… but the arrythmia will also drop fs% so we always go back and forth what to do here. I am sure peter will have more insight on this but he’s traveling at the moment.
The myocardium looks remodeled as well so we know this has been going on a while.
If you get her 6 months I would be surpirized but with pimobendan anything is possible. technically pimo is contraindicated in a fib or at least it used to be that way but most cardiologists treat pimo anyway when in stage C or D valve disease. Obviously a sudden death risk no matter what you do. If you started plavix I wouldn’t argue wiht you either. But again opinions will be all over the map on this one. Remo and Peter’s input will be interesting as well on this. I would put this dog on cage rest minor easy walks for a few days til the meds kick in.
Monitor BP ecg and renal values. Hycodan for cough.
Wow that’s ugly JP. End
Wow that’s ugly JP. End stage C-D valvular disease wiht myocardial insufficiency…. She isnt compensating further and with the a-fib thats likely from the la stretch and myocardial hypoxia from chronic volume overload. You are going to need the kitchen sink on this one. Triple Tx for sure Lasix. pimo, ace-i and I would add in spironolactone…. When arrythmias are present in volume overload I walways treat the volume first and often the arrythmia is more manageable or even goes away. I don’t think thats the case here. Diltiazem will likely be needed long term but its a bit of a paradox because with FS% in the 40s in valve disease thats entering into myocardial insufficiency and diltazem is a mild negative inotrope… but the arrythmia will also drop fs% so we always go back and forth what to do here. I am sure peter will have more insight on this but he’s traveling at the moment.
The myocardium looks remodeled as well so we know this has been going on a while.
If you get her 6 months I would be surpirized but with pimobendan anything is possible. technically pimo is contraindicated in a fib or at least it used to be that way but most cardiologists treat pimo anyway when in stage C or D valve disease. Obviously a sudden death risk no matter what you do. If you started plavix I wouldn’t argue wiht you either. But again opinions will be all over the map on this one. Remo and Peter’s input will be interesting as well on this. I would put this dog on cage rest minor easy walks for a few days til the meds kick in.
Monitor BP ecg and renal values. Hycodan for cough.
Hi!
The development of
Hi!
The development of tachycard afib in a MMVD dog with severe volume overload and LAE usually leads to marked clinical deterioration and CHF.
As already has been said, I would increase Furosemide to effect (respiratory rate, repeated rads – and decrease to the minimum effective dose once CHF has resolved), add Spironolactone, an ACEI and Digoxine. Blood pressure and potassium should be monitored (BP appears quite normal here based on MI jet). If the afib remains at very high rates, even after CHF has resolved, I would add Diltiazem, starting at 0.5-1mg/kg tid. Usually, it is not really neg. inotrop at this dose. Re targed heart rate: We have to take into consideration that this dog needs some compensatory increase in heart rate. I would probably aim at 120-140 at rest. I would not use Clopidogrel here.
Best regards!
Peter
Hi!
The development of
Hi!
The development of tachycard afib in a MMVD dog with severe volume overload and LAE usually leads to marked clinical deterioration and CHF.
As already has been said, I would increase Furosemide to effect (respiratory rate, repeated rads – and decrease to the minimum effective dose once CHF has resolved), add Spironolactone, an ACEI and Digoxine. Blood pressure and potassium should be monitored (BP appears quite normal here based on MI jet). If the afib remains at very high rates, even after CHF has resolved, I would add Diltiazem, starting at 0.5-1mg/kg tid. Usually, it is not really neg. inotrop at this dose. Re targed heart rate: We have to take into consideration that this dog needs some compensatory increase in heart rate. I would probably aim at 120-140 at rest. I would not use Clopidogrel here.
Best regards!
Peter
Thanks Peter… but you are
Thanks Peter… but you are not supposed to disagree with my plavix rec LOL. Everyone, Peter is fired cuz he disagreed with me LOL.
All joking aside, really nice input thanks Peter and Remo. Great thread. This is how we are folks brutal reality of fact and experienced based opinon and we say it how it is:)
Thanks Peter… but you are
Thanks Peter… but you are not supposed to disagree with my plavix rec LOL. Everyone, Peter is fired cuz he disagreed with me LOL.
All joking aside, really nice input thanks Peter and Remo. Great thread. This is how we are folks brutal reality of fact and experienced based opinon and we say it how it is:)
Thank-you! Especially Peter
Thank-you! Especially Peter if you are away and took the time to respond to this (hope it is somewhere nice!)
Jacquie
Thank-you! Especially Peter
Thank-you! Especially Peter if you are away and took the time to respond to this (hope it is somewhere nice!)
Jacquie