Case Study

15_00074 Scarlet P DMVD Mild MR

An 11-year-old FS Shih Tzu presented for evaluation of bradycardia. Heart rate is 60 BPM and went down to 48 during surgery for cyst removal. No overt clinical problems except for decreased appetite. Bloods showed elevated BNP and ALP activity. Blood pressure was within normal limits.

An 11-year-old FS Shih Tzu presented for evaluation of bradycardia. Heart rate is 60 BPM and went down to 48 during surgery for cyst removal. No overt clinical problems except for decreased appetite. Bloods showed elevated BNP and ALP activity. Blood pressure was within normal limits.

Sonographic Differential Diagnosis

Degenerative mitral valve disease causing mild mitral regurgitation. No sign of volume overload or atrial enlargement.

Image Interpretation

The mitral valve is moderately degenerated, and the anterior leaflet is mildly prolapsing into the left atrium. On CDI, diastolic regurgitation of the aortic and mitral valve is present, which is attributable to the slow heart rate and the increased diastolic filling (causing widening of the valve anuli). There is also mild pulmonic insufficiency present (considered normal), and mild systolic regurgitation of the mitral and tricuspid valves.

DX

DMVD causing mild mitral regurgitation.

Outcome

A 6-month recheck echo to look for increase in left atrial size is recommended. The DMVD and mitral insufficiency do not require therapy at the moment.

Comments

A ECG showed a grade 2 Type II AV-Block. This can be due to increased vagal tone (e.g. chronic respiratory disease, chronic gastrointestinal disease, cervical tumor) or a dysfunction of the conduction system itself. Further diagnostics with Atropine testing is recommended to better define the bradycardia.

Clinical Differential Diagnosis

Primary conduction anomaly. Non-cardiac – excessive vagal tone (GI tract, respiratory, CNS lesion, cervical pathology), drug reaction, chronic organophosphate toxicity.