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A 12 year old FS Irish Terrier was presented. A mitral regurgitation was noted on previous echo. The patient is coughing and is administered Lasix 20 mg bid.
A 12 year old FS Irish Terrier was presented. A mitral regurgitation was noted on previous echo. The patient is coughing and is administered Lasix 20 mg bid.
All findings are consistent with clinical (overt) dilated cardiomyopathy. Pulmonary edema is very likely in this case. Prognosis is very guarded. I would use triple therapy (Lasix (at least 2mg/kg tid), Pimobendan and ACEI) for treatment. If pulmonary edema doesnВґt resolve with that lasix dosage or if it reoccurs, an increase up to 3 mg/kg tid is recommended. If that isnВґt enough you can switch to torasemide (dosage is usually 1/10 of lasix dosage). Spironolactone can be added, but there is evidence of a benefit anyway. Please be aware of possible arrhythmias that could occur (especially afib or ventricular beats/tachycardia) In this case antiarrhythmics have to be administered.
The left ventricle is massively enlarged and shows increased sphericity and high grade systolic dysfunction (FS 9.88%, EPSS 1.49 cm). The mitral valve leaflets are only very mildly thickened with no sign of prolapse. Mild mitral insufficiency is noted but the left atrium is severely enlarged. Pressure gradients of the regurgitant jet are indicative of increased LA pressures. The left ventricular outflow tract looks normal but flows display small velocity time integrals with is consistent with decreased stroke volume. The right ventricle and atrium are normal, the tricuspid valve is unchanged. No alterations of the right ventricular outflow tract are noted. Flow profiles across the RVOT show similar changes as profiles across the LVOT mentioned above.
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