Case Study

Congestive heart failure with pulmonic stenotisis, mitral and tricuspid regurgitation and biatrial dilation in a 14 year old FS Bull Terrier

This 14 year old FS Bull Terrier presented for irregular breathing and panting. Appetite decreased.

Physical exam: pot-bellied appearance, grade 2/6 murmur, epidermal collarettes, free fluid in abdomen and thorax.

Rads showed mild pleural effusion, bronchointerstitial lung pattern, mild right heart enlargement

This 14 year old FS Bull Terrier presented for irregular breathing and panting. Appetite decreased.

Physical exam: pot-bellied appearance, grade 2/6 murmur, epidermal collarettes, free fluid in abdomen and thorax.

Rads showed mild pleural effusion, bronchointerstitial lung pattern, mild right heart enlargement

DX

CHF with biatrial dilation, pulmonic stenotisis and mitral and tricuspid regurgitation

Image Interpretation

Moderate diffuse thickening of mitral valve leaflets (anterior> posterior) with mild prolapse into the left atrial lumen. Moderate eccentric mitral regurgitation with moderate left atrial dilation. Normal LV diameter with mild decline in myocardial function. The tricuspid valve appears mildly thickened with moderate regurgitation. Severe right atrial and ventricular dilation with moderate RV hypertrophy. The pulmonic valve leaflets are thickened and tethered consistent with valvular PS. The aortic valve leaflets are severely thickened with decreased mobility (aortic stenosis). Mildly elevated pulmonic outflow velocity. Severely elevated aortic outflow velocity. Moderate pulmonic and aortic insufficiency.

Outcome

The complex nature of this disease is considered severe given biatrial
dilation and development of congestive heart failure (CHF). Full medical management
is indicated as below and the prognosis is guarded to poor. Most animals with CHF
can however maintain a good QOL once stabilized for some time. Abdominocentesis
should be considered should the ascites be affecting comfort/appetite.
Omega fatty acid supplementation and mild salt restriction may be of some long term
benefit. Going forward, monitor for development of a labored breathing, exercise
intolerance, recurrent abdominal distention or collapse episodes.
Plan: Consider abdominocentesis. Institute Pimobendan 7.5mg PO BID. ACE-I
(Benazepril or Enalapril) 15mg PO BID. Initiate diuretic Lasix 40mg PO BID. Initiate
Spironolactone 25mg PO BID.
A renal panel is recommended in 10-14 days following the above changes.
Recommend recheck echocardiogram in 4-6 months to assess for progression, sooner
if any development of clinical signs.