Sonopath Forum

DCM in a schnauzer?

This is an older miniature schnauzer (wt ~ 12 pounds) who presented for dyspnea.

-The echo shows severely reduced contractility and dilated ventricles. I get LA:Ao of 2.75 with a %FS of 13%. The valves appear morphologically normal to me.

-This looks like a DCM dog to me but it is the wrong breed. Should I consider other differentials?

Thanks,

Suzanne

This is an older miniature schnauzer (wt ~ 12 pounds) who presented for dyspnea.

-The echo shows severely reduced contractility and dilated ventricles. I get LA:Ao of 2.75 with a %FS of 13%. The valves appear morphologically normal to me.

-This looks like a DCM dog to me but it is the wrong breed. Should I consider other differentials?

Thanks,

Suzanne

Comments

rlobetti

February 7, 2015 at 8:59 am -

Another possiblity would be

Another possiblity would be myocarditis. Considering running serum cardiac troponin. Reported causes in dogs are viruses (parvovirus, West Nile Virus), protozoal agents (Trypanosoma, Toxoplasma, Hepatozoon, Babesia), bacteria (Staphylococcus, Streptococcus, Citrobacter, Bartonella, Borrelia), fungi (Coccidioides, Cryptococcus, Aspergillus ), helminths (Toxocara), autoimmune reactions, toxins, trauma, heat stroke and hemodynamic shock.

rlobetti

February 7, 2015 at 8:59 am -

Another possiblity would be

VSI7tsherrill

February 7, 2015 at 10:29 am -

Suzanne. I am thinking Chagas

Suzanne. I am thinking Chagas Disease. It has become epidemic in south Texas. I recently scanned a dog in Fredericksburg whose heart look similar to your schnauzer. The Trypanosoma cruzi is of course the culprit and is transmitted by “kissing bug,” found in the Texas. However, Texas A&M University is currently conducting a study of the extent of the kissing bugs’ presence in the U.S.

VSI7tsherrill

February 7, 2015 at 10:29 am -

Suzanne. I am thinking Chagas

February 7, 2015 at 12:38 pm -

great thought Tom… in

great thought Tom… in general any non DCM breed with DCM type presentation its good to chase infectious… as myocarditis resembles DCM. I’ve seen parvo do this in puppies. Triple Tx (lasix, acei, pimo) cage rest define the tachyarrythmia, blood culture (even if i never have luck with these) and empirically tx for infectious in your area… if in NJ baytril clindamycin or doxy clinda is my choice because of all the rickettsials. Check for pht and dilated hepatic veins indicated right failure too and can add sildenafil gradually but not all at once let the pimo do its thing in a cage first. You can test for everything but this dog is sudden death risk for sure. If infectious the dcm presentation may improve dramatically under treatment. Thyroid profile always a good idea in systolic failure cases and hypothyroidism and arrtyhmia are 2 things that drop function additionally in these guys. Nice image set!

smbrowndvm

February 7, 2015 at 2:29 pm -

I should have thought of

I should have thought of Chagas. We have diagnosed 2 cases this year in our clinic. I will talk to the owner about all these possibilities.

Thanks again,

Suzanne

February 7, 2015 at 12:38 pm -

great thought Tom… in

smbrowndvm

February 7, 2015 at 2:29 pm -

I should have thought of

I should have thought of Chagas. We have diagnosed 2 cases this year in our clinic. I will talk to the owner about all these possibilities.

Thanks again,

Suzanne

randyhermandvm

February 8, 2015 at 9:37 pm -

I referenced VIN and it

I referenced VIN and it appears there is not a good treatment for the chronic phase of the disease other than symptomatic for the DCM. Living in Minnesota- I have never knowingly seen a case.

VIN:

Treatment/Management/Prevention:
SPECIFIC for Acute Phase

1) Currently there is no general consensus on what treatment regime works best.

2) Ravuconazole has potent suppressive but not curative activity in the canine model of acute Chagas’ disease, probably due to its unfavorable pharmacokinetic properties (half-life, 8.8 h).¹¹

3) Benznidazole has been used in humans and dogs.^12-13

4) Albaconazole seemed to suppress the proliferation of the parasite and prevent death of infected dogs but parasitological cure depended on the strain of T. cruzi. Parasitological cure indices of 25 and 100% were found among dogs inoculated with T. cruzi strain Y when treated at 1.5 mg/kg of body weight/day for 60 and 90 days, respectively. In those infected with the Berenice-78 T. cruzi strain, no parasitological cure was observed, even when a longer treatment period (150 doses) was used.¹⁴

SPECIFIC for Chronic Phase

1) There is no effective treatment for this phase other than symptomatic therapy for the heart failure and arrhythmias. Therapy directed at killing the organism does not alter the course of the disease at this stage.

smbrowndvm

February 9, 2015 at 2:31 am -

My understanding of treatment

My understanding of treatment for the acute phase is that the drugs used are reserved for human use. I was told by the local zoonosis control officer that acquiring those drugs requires authorization by the CDC. I believe a few people have attempted to treat it in dogs with imported drugs from Central and South America but I’m not sure how successful that has been.

randyhermandvm

February 8, 2015 at 9:37 pm -

I referenced VIN and it

I referenced VIN and it appears there is not a good treatment for the chronic phase of the disease other than symptomatic for the DCM. Living in Minnesota- I have never knowingly seen a case.

VIN:

Treatment/Management/Prevention:
SPECIFIC for Acute Phase

1) Currently there is no general consensus on what treatment regime works best.

2) Ravuconazole has potent suppressive but not curative activity in the canine model of acute Chagas’ disease, probably due to its unfavorable pharmacokinetic properties (half-life, 8.8 h).¹¹

3) Benznidazole has been used in humans and dogs.^12-13

SPECIFIC for Chronic Phase

smbrowndvm

February 9, 2015 at 2:31 am -

My understanding of treatment

rlobetti

February 9, 2015 at 10:09 am -

Another drug that has been

Another drug that has been used is nifurtimox (2-7 mg/kg TD for 3 months). Recent work in humans for chronic disease is combination of amiodarone (antiarrhythmic) and itraconazole or posaconazole. Not sure about the drugs used/available in South America.

smbrowndvm

February 14, 2015 at 3:12 am -

Good call Dr. Sherrill!
It is

Good call Dr. Sherrill!

It is Chagas – the titer came back positive at 640 today.

The dog is doing clinically well on supportive care for CHF at this point.

Thanks,

Suzanne

rlobetti

February 9, 2015 at 10:09 am -

Another drug that has been

smbrowndvm

February 14, 2015 at 3:12 am -

Good call Dr. Sherrill!
It is

Good call Dr. Sherrill!

It is Chagas – the titer came back positive at 640 today.

The dog is doing clinically well on supportive care for CHF at this point.

Thanks,

Suzanne

VSI7tsherrill

February 14, 2015 at 2:28 pm -

Thanks for the update

Thanks for the update Suzanne. I am glad you have a diagnosis. My comment was a lucky guess. I appreciate the more informative comments by you, Remo, Eric and Randy on this interesting discussion.

Tom

VSI7tsherrill

February 14, 2015 at 2:28 pm -

Thanks for the update

Thanks for the update Suzanne. I am glad you have a diagnosis. My comment was a lucky guess. I appreciate the more informative comments by you, Remo, Eric and Randy on this interesting discussion.

Tom

February 14, 2015 at 2:42 pm -

Great oposts and forum string

Great oposts and forum string members!!! This is exactly what SonoPath was built for! Proud of everyone here:) Hopefully sherilin’s patient responds as a benefit fo the discussion.

If anyone has the latest info available on chagas please post because not exactly a frequent thing in New Jersey… nothing infectious doing much here when its 1 degree farenheit today and my car is hermetically closed with ice:(

February 14, 2015 at 2:42 pm -

Great oposts and forum string

Great oposts and forum string members!!! This is exactly what SonoPath was built for! Proud of everyone here:) Hopefully sherilin’s patient responds as a benefit fo the discussion.