Case Study

15-00037 Buddy S LV and LA enlargement—NEEDS CDX—NO IMAGES—-

This 8 year old MN canine (breed unspecified) presents with grade 6/6 murmur with palpable thrill. Chronic dry cough, was seen in December at different specialty clinic and diagnosed with chronic valve disease and was also thought to have chronic bronchitis and treated with Theophylline, lasix and Butrophanol. Medications are not being administered on a routine basis as this dog is difficult to medicate.

This 8 year old MN canine (breed unspecified) presents with grade 6/6 murmur with palpable thrill. Chronic dry cough, was seen in December at different specialty clinic and diagnosed with chronic valve disease and was also thought to have chronic bronchitis and treated with Theophylline, lasix and Butrophanol. Medications are not being administered on a routine basis as this dog is difficult to medicate.

Sonographic Differential Diagnosis

Left ventricular enlargement, left atrial enlargement with probable PDA or aorticopulmonary window. The increased left ventricular outflow tract velocities and AI are likely due to volume overload on the left side. COMMENTS: Further workup should include a systemic blood pressure as well as an EKG. Enalapril should be started at 0.5mg/kg po sid. The dose of Lasix should be increased to 2 mg/kg PO BID and can be increased to manage the congestive heart failure as needed. You can also add low dose sprionoloactone at 0.5 mg/kg PO BID. Monitor electrolytes, BUN, creatinine and radiographs in one weeks time. Referral to a local cardiologist is strongly recommended. They can also consider if he is a candidate for catheterization and closure of the PDA. This will improve our medical management of the signs but will not alleviate them completely since this is a middle age dog and remodeling and failure have already occurred. If this is not pursued, we may add pimobendan to the therapeutic regime at 0. 25-0.3 mg/kg PO BID.

Image Interpretation

The left atrium was moderately enlarged and there was no evidence of any thrombi or smoke within the atrium. The left ventricle was eccentrically dilated. The myocardium was homogenous with no focal masses or infarcts. The right atrium and right ventricle appeared normal. The mitral valve was thickened. Moderate to severe mitral regurgitation was noted on both color flow and spectral doppler examination with a velocity of 7.01m/sec. The fractional shortening was increased due to a hyperdynamic effect due to the presence of mitral regurgitation. The left ventricular outflow tract was normal but there was an increased velocity turbulence of the left ventricular outflow tract flows measuring up to 3.75m/sec. Mild to moderate aortic insufficiency was noted as well at a velocity of 2.4m/sec. The right ventricular outflow tract was abnormal in that there was a dilated pulmonary artery with marked increased velocities of 4.35m/sec as well as severe pulmonic insufficiency at 5.7m/sec. the flow in this region of the pulmonic valve appeared more continuous compared to flow in any of the other valves concerning for a PDA or an aortico- pulmonary window. There is no tricuspid regurgitation. There was no evidence of pleural or pericardial effusion nor any masses. PI 570. AI 240. Thoracic radiographs revealed marked left atrial and left ventricular enlargement with a prominent bulge in the region of the aortic arch and pulmonary artery. There is increased pulmonary venous distension and pulmonary infiltrates consistent with pulmonary edema.

Patient Information

Gender : Male, Neutered

Species : Canine

Type of Imaging : Ultrasound

Status : For Review

Clinical Signs

Coughing
Heart Murmur

History

Lasix therapy

Clinical Signs

Coughing
Heart Murmur