– 9 year old FS Doberman (approx 100lbs) presented to rDVM due to 3 day history of night time coughing; new grade 3/6 systolic heart murmur
– chest rads consistent with CHF; ECG tachycardia with no arrhythmias seen
– Echo was a little unusual on m-mode as the IVS was contracting well and the PW was not
– I took several LV m-mode measurments and FS% ranged from 11%-21% (could not get a consistent reading)
– 2-D LV FS% measurement calculation was 21% (too high for DCM and CHF) – so more likely CVD
– 9 year old FS Doberman (approx 100lbs) presented to rDVM due to 3 day history of night time coughing; new grade 3/6 systolic heart murmur
– chest rads consistent with CHF; ECG tachycardia with no arrhythmias seen
– Echo was a little unusual on m-mode as the IVS was contracting well and the PW was not
– I took several LV m-mode measurments and FS% ranged from 11%-21% (could not get a consistent reading)
– 2-D LV FS% measurement calculation was 21% (too high for DCM and CHF) – so more likely CVD
– there was a mild MR with a slightly eccentric jet; EPSS was slightly elevated at about 1.0cm; severe LAE; aorta and pul max vel wnl
– the pet has been started on pimo and furosemide with an ace-inhibitor to come once stable
What are you thoughts on this echo and the unusual LV wall contraction pattern on m-mode?
Comments
Im having a tough time seeing
Im having a tough time seeing 20% FS% as the free wall isnt moving thought the septum is sort of moving…. 15%-ish at best… You didnt post an epss but eyeballing im seeing an epss of about 1.2 (normal < 0.8 cm). This is key because MR with myocardial insufficiency has a wnl epss whereas oinly DCM and DCM-like myocarditis will elevate the epss. That being said the MV is vegetative….Regardless what you call it this dobie is in left CHF.
I would consider myocarditis but more likely dcm and the mv happens to be vegetative but tx dcm and see what happens.. check thyroid and systemic disease as well.
Triple tx lasix ace-i pimobendan and neutraceuticals if you like them and recheck in 10-14 days. If th epss normalizes then not dcm but if it stays elevated > 0.8 cm in proper position then it is dcm… any this is a rule I’ve always lived by on myocardial insufficiency secondary to chronic mvd vs DCM.
Im having a tough time seeing
Im having a tough time seeing 20% FS% as the free wall isnt moving thought the septum is sort of moving…. 15%-ish at best… You didnt post an epss but eyeballing im seeing an epss of about 1.2 (normal < 0.8 cm). This is key because MR with myocardial insufficiency has a wnl epss whereas oinly DCM and DCM-like myocarditis will elevate the epss. That being said the MV is vegetative….Regardless what you call it this dobie is in left CHF.
I would consider myocarditis but more likely dcm and the mv happens to be vegetative but tx dcm and see what happens.. check thyroid and systemic disease as well.
Triple tx lasix ace-i pimobendan and neutraceuticals if you like them and recheck in 10-14 days. If th epss normalizes then not dcm but if it stays elevated > 0.8 cm in proper position then it is dcm… any this is a rule I’ve always lived by on myocardial insufficiency secondary to chronic mvd vs DCM.
Thanks EL for your thoughts.
Thanks EL for your thoughts. I got an EPSS measuremwnt of about 1.0cm. Regardless of the diagnosis I guess treatment is pretty much the same at this stage. Just does not appear to be a classic case for either DCM or CVD. Maybe this poor Dobie has a degree of both?
Thanks EL for your thoughts.
Thanks EL for your thoughts. I got an EPSS measuremwnt of about 1.0cm. Regardless of the diagnosis I guess treatment is pretty much the same at this stage. Just does not appear to be a classic case for either DCM or CVD. Maybe this poor Dobie has a degree of both?
Could be both but consider
Could be both but consider infectious in a non MVD breed with mv vegetation. Once you treat wiht triple tx and reevaluate see what the epss does… stays > 0.8 then dcm if it doesn’t and normalizes then MVD and myocardial insufficiency.
That being said there are lots of DCM – like presentations out there that don’t follow the rules especially in Labradors in my experience… as one of my mentors always said just describe out what you see and tx what you see and leave the dx a bit vague especially with the heart as the presentation may change.. like a UCM cat in failure after tx and stabilization then may meet HCM criteria…
The heart changes all the time under many influences as an effector organ… what I see the Cardiologists I respect the most doing is less labeling of a presentation and just describing out more as they get and respect this concept of dynamic change… they tend to be the more politically correct ones as well on second opinion.
With a weak heart always always look for systemic disease that may not be the cause of FS% differences but may be making it worse… Thyroid, infectious, abdominal disease of all types even cns disease.. and of course systemic hypertension that gets missed often.
Could be both but consider
Could be both but consider infectious in a non MVD breed with mv vegetation. Once you treat wiht triple tx and reevaluate see what the epss does… stays > 0.8 then dcm if it doesn’t and normalizes then MVD and myocardial insufficiency.
That being said there are lots of DCM – like presentations out there that don’t follow the rules especially in Labradors in my experience… as one of my mentors always said just describe out what you see and tx what you see and leave the dx a bit vague especially with the heart as the presentation may change.. like a UCM cat in failure after tx and stabilization then may meet HCM criteria…
The heart changes all the time under many influences as an effector organ… what I see the Cardiologists I respect the most doing is less labeling of a presentation and just describing out more as they get and respect this concept of dynamic change… they tend to be the more politically correct ones as well on second opinion.
With a weak heart always always look for systemic disease that may not be the cause of FS% differences but may be making it worse… Thyroid, infectious, abdominal disease of all types even cns disease.. and of course systemic hypertension that gets missed often.
Good advice!
Good advice!
Good advice!
Good advice!