Case Study

Mitral insufficiency in a 4 year old MN Cavalier King Charles Spaniel

A 4-year-old MN Cavalier King Charles Spaniel dog with history of a grade IV/VI heart murmur was presented for intermittent, but persistent coughing and gagging. On physical examination enlarged submandibular lymph nodes were present. Abnormalities on CBC and blood chemistry included anemia, thrombocytosis, and increased BUN.

A 4-year-old MN Cavalier King Charles Spaniel dog with history of a grade IV/VI heart murmur was presented for intermittent, but persistent coughing and gagging. On physical examination enlarged submandibular lymph nodes were present. Abnormalities on CBC and blood chemistry included anemia, thrombocytosis, and increased BUN.

DX

Severe mitral insufficiency. Right-sided congestive heart failure. Pulmonary hypertension.

Sonographic Differential Diagnosis

Severe mitral insufficiency. Right-sided congestive heart failure and pulmonary hypertension. Passive congestion of the liver with mild to moderate hepatic vein dilation.

Image Interpretation

The echocardiogram presented a prominent right heart with mild right ventricular hypertrophy, and normal right atrial size. Severe tricuspid insufficiency was noted in this patient. The prominent right heart is likely due to excessive intra-thoracic pressures caused by chronic respiratory disease or conformational issues. There was mitral valve insufficiency with severe prolapse of the anterior leaflet and left atrial enlargement. Tricuspid insufficiency velocity 4.75 m/sec. Mitral insufficiency velocity 5.2 m/sec. The liver presented hepatic vein and vena caval congestion with uniform hepatic contour. This is consistent with early right-sided congestive heart failure.

Outcome

Blood pressure measurements were recommended to establish a baseline for monitoring. Lasix therapy at 2-3 mg/kg BID, an ace inhibitor at 0.5 mg/kg BID, pimobendan at 0.25 mg/kg BID, and aspirin therapy at 1 mg/kg SID were all advised. Sildenafil (Viagra) therapy was also recommended. A recheck echocardiogram within 10 days was strongly recommended, but a very guarded prognosis was given as the patient was at risk for sudden death. The patient was discharged with pimobendan and enalapril.

Clinical Differential Diagnosis

Cardiac disease: mitral/tricuspid valve insufficiency with heart failure; Lung disease: allergic, cardiogenic, infectious, tracheal collapse, pulmonary hypertension, inhalation injury; Lymphoma; GI disease: gastric ulceration, IBD, neoplasia; Esophageal disease: obstruction, reflux esophagitis.