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A 13-year-old NM dog that had been diagnosed with a grade 3/6 murmur and currently on Enalapril BID was presented for ongoing mild coughing. Blood pressure was elevated (180/100 mm/Hg).
A 13-year-old NM dog that had been diagnosed with a grade 3/6 murmur and currently on Enalapril BID was presented for ongoing mild coughing. Blood pressure was elevated (180/100 mm/Hg).
This is a case of degenerative mitral valve disease (DMVD) stage B2 according to the Consensus Statement of the ACVIM. Mitral insufficiency is moderate to severe, left atrial enlargement is moderate. There is always discussion going on about whether stage B2-patients should be treated or not and how. Even though I got no Rays I would not expect pulmonary edema in this patient. But due to the fact that coughing is often caused by left atrial enlargement and compression of the left mainstem bronchus I would start with triple therapy (Pimobendan, go on with ACEI and add Furosemide at for example 2 mg/kg in order to reduce left atrial size). If symptoms do not resolve totally I would add cough suppressants (codeine f.e.). Based on the state of the art it would not be compulsory to start therapy prior to heart failure but the study by Hansson (JSAP 2010) shows that if left atrial size increases rapidly heart failure is going to start within about 12 months. And we have the ethical need for prevention of pulmonary edema. But always keep in mind that there can be some other causes for coughing (tumor, tracheal collapse, bronchitis etc.) So please make always rays in two directions.
Moderate left ventricular volume overload (eccentric hypertrophy), moderate left atrial enlargement, moderate thickening of the mitral valve with the anterior leaflet prolapsing into the LA. The right ventricle and atrium are normal. CDI reveals moderate to severe mitral insufficiency. Flow velocities across LVOT and RVOT are within normal ranges thus ruling out any kind of aortic or pulmonary stenosis. The flow profile across the RVOT is symmetric, the mild tricuspid insufficiency recorded indicates a normal pressure gradient so clinically significant pulmonary hypertension can be ruled out too.
Cardiac – mitral/tricuspid endocardiosis, vegetative endocarditis, myocardial weakness Coughing secondary to La enlargement, ACI inhibitor side effect Tracheo-bronchial – bronchiectasis, tracheal collapse, chronic bronchitis, tracheitis (viral, bacterial, allergic), environmental (dust, tobacco smoke, chemicals), obesity, neoplasia (tracheal, pulmonary)
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