Big Left Atrial Appendage

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Big Left Atrial Appendage

Hi,

13yo female mix small breed with persistent cough that worsens with activity

Echo showed big LA with huge LA Appendage, mixomatous mitral valve degeneration assotiated with severe regurgitation. Thoracix X ray reveals huge LA with mainstem bronchus compression, with no obvious pulmonary edema and/or pulmonary parenquimal disease (maybe bronchomalacia?). This dog never has had signs of ICC, but it really seems to me like a borderline stage C.

Hi,

13yo female mix small breed with persistent cough that worsens with activity

Echo showed big LA with huge LA Appendage, mixomatous mitral valve degeneration assotiated with severe regurgitation. Thoracix X ray reveals huge LA with mainstem bronchus compression, with no obvious pulmonary edema and/or pulmonary parenquimal disease (maybe bronchomalacia?). This dog never has had signs of ICC, but it really seems to me like a borderline stage C.

Dog was already on furosemide 1mg/kg TID, benazepril 0,3 mg/kg SID, pimobendam 0,3 mg/kg BID and Aminophylline 10 mg/kg PO BID.

What would you do in this case? I’m worried about thrombus generating in the LAA, would you put him on clopidogrel? And what about the cough? Continue aminophylline (does it have any effect at all on the big bronchi?)? Start an opioid cough supressant?

 

 

Comments

randyhermandvm

I am not a cardiologist but I

I am not a cardiologist but I would consider the following modifications:

1. Stop the Aminophylline (contraindicated with severe cardiac disease)

2. Increase the Furosemide. You could easily double or triple the dose short term

3. Increase the Benazapril to q12h

4. Increase the Pimobendan up to 0.3 mg q8h.

Monitor RRR

Adjust medication based on response to therapy.

This is the world “according to GARP”

Maybe Peter or EL can offer suggestions

 

EL

There is LVE and LAE that LA

There is LVE and LAE that LA max eyeball measures about 4.5-5cm and the AS is deviated. This is surely Pimo territory but with that level of volume overload and eminent chf I would add lasix +/- acei to triple tx if you are an acei person.

Hycodan for cough

Then rescan in a couple of weeks hopefully the heart is happier then.

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