Case Study

15-00078 Rosie F Severe DVD–>severe MI and moderate TI——NO IMAGES—-

An 8-year-old SF King Charles Cavalier Spaniel with previously diagnosed, degenerative mitral and tricuspid valves with mild to moderate left atrial enlargement was presented for progressive coughing. On auscultation a grade 4/6 systolic murmur was present.

An 8-year-old SF King Charles Cavalier Spaniel with previously diagnosed, degenerative mitral and tricuspid valves with mild to moderate left atrial enlargement was presented for progressive coughing. On auscultation a grade 4/6 systolic murmur was present.

Sonographic Differential Diagnosis

This is a case of severe DVD causing severe mitral and moderate tricuspid insufficiency. The left atrium is severely enlarged, there should be some pulmonary edema present in this case (at least interstitial). Left ventricular systolic function seems to be impaired. ThereВґs no sign of marked pulmonary hypertension. I would start with triple therapy (Furosemide at a dosage at least 2 mg/kg t.i.d, depending on the radiographs). If there marked pulmonary edema present I would hospitalize the patient and administer Furosemide as a CRI at 1mg/kg/h. If the owner compliance is good I would give Spironolactone additionally. If there is pulmonary edema evident on the radiographs (as I suspect) I would take another radiograph 2 days after initiation of therapy. Furosemide dosage can be reduced after resolution of pulmonary edema, but I would not go below 2 mg/kg bid here. Another echo should be done about 1 month later, depending of the clinical signs (look for PHT, measure LA size). If the patient is coughing despite this therapy I would give codeine additionally.

Image Interpretation

I see a severely volume overloaded left ventricle, a severely degenerated mitral valve (the anterior leaflet prolapsing into the left atrium) and a severely enlarged left atrium. The mitral insufficiency noted on CDI is severe too. The LVOT and aortic valve are normal on 2D images as well as in terms of flow (no turbulence, no stenosis). Left ventricular systolic function appears to be impaired (septal hyperkinesis). The right ventricle and atrium are normal, the tricuspid valve is moderately degenerated causing moderate tricuspid insufficiency. The velocity of this regurgitant jet indicates normal pressures within the pulmonary artery. Flow across the RVOT is normal (no stenosis, no turbulence, no insufficiency).

DX

Severe DVD causing severe mitral and moderate tricuspid insufficiency.

Clinical Differential Diagnosis

Cardiac – progressive mitral/tricuspid endocardiosis, vegetative endocarditis, myocardial weakness Tracheo-bronchial – tracheal collapse, chronic bronchitis, tracheitis (viral, bacterial, allergic), environmental (dust, tobacco smoke, chemicals), obesity, neoplasia Pulmonary – neoplasia, allergic, pneumonia, pulmonary hypertension

Sampling

None

Patient Information

Gender : Female, Spayed

Species : Canine

Type of Imaging : Ultrasound

Status : For Review

Clinical Signs

Coughing
Heart Murmur

Clinical Signs

Coughing
Heart Murmur