– 11 year old MN Brittany Spaniel referred to me for echoe due exercise intolerance and concern of tachycardia wt 26.5kg
– referring vet did not take chest rads but started pet on furosemide
– no heart murmur detectable
– CBC, biochem, T4 and cardiac proBNP test wnl
– on presentation pet’s HR was 150 but very stressed with tachypnea and loud upper airway sounds
– light sedation with IV butorphanol/midazolam given for echocardiogram
Measurements:
IVSd 12.9
LVDd 34.4
PWd 12.4
IVSs 14.4
LVDs 26.3
PWs 16.7
– 11 year old MN Brittany Spaniel referred to me for echoe due exercise intolerance and concern of tachycardia wt 26.5kg
– referring vet did not take chest rads but started pet on furosemide
– no heart murmur detectable
– CBC, biochem, T4 and cardiac proBNP test wnl
– on presentation pet’s HR was 150 but very stressed with tachypnea and loud upper airway sounds
– light sedation with IV butorphanol/midazolam given for echocardiogram
Measurements:
IVSd 12.9
LVDd 34.4
PWd 12.4
IVSs 14.4
LVDs 26.3
PWs 16.7
FS% 24%
LA 30.1
Ao 23.4
LA/Ao 1.2
EPSS 2.9 2-D
LA/Ao 0.92
MPA 23.5
Ao Vel 1.65m/s
Pul Vel 1.04 m/s
TR Jet 1.5m/s
Trace MR and trace TR present
I have recommended a chest x-ray and from this echoe do not believe that this pet’s signs of exercise intolerance are due to cardiac disease but likely respiratory disease or laryngeal paralysis. The FS is low (but LVs wnl) and I believe the LV walls in diastole are thicker than normal for a pet this size. Why would this occur? The pet was very athletic according to the owner prior to the onset of exercise intolerance, so could these abnormal values be consistent with an athletic heart or should I be concerned about something else? hypertension?
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Thanks for your insight ahead of time
Jacquie
Comments
Another thought – could
Another thought – could dehydration (from furosemide therapy) cause the decreased FS% as the result of decreased preload?
Another thought – could
Another thought – could dehydration (from furosemide therapy) cause the decreased FS% as the result of decreased preload?
Jacquie, this looks like a
Jacquie, this looks like a very normal athletic heart to me. In my experience athletic hearts have a lower fs% and eyeballing the m-mode contractions before and after the one you measured in the short axis i think its more in the 28-30% range which would fit athletic heart. The chamber sizes are normal. Did you get similar fs% in long axis by chance? Sounds like chest/neck rads are i order +/- bronchoscopy …LARPAR and the rest especially give the age. Event monitor would be appropriate in case paroxysmal arrhythmia is occurring … press the button when the intolerance occurs and see what it shows but structurally looks solid. Thyroid ok too?
Beautiful images BTW
Eric
Jacquie, this looks like a
Jacquie, this looks like a very normal athletic heart to me. In my experience athletic hearts have a lower fs% and eyeballing the m-mode contractions before and after the one you measured in the short axis i think its more in the 28-30% range which would fit athletic heart. The chamber sizes are normal. Did you get similar fs% in long axis by chance? Sounds like chest/neck rads are i order +/- bronchoscopy …LARPAR and the rest especially give the age. Event monitor would be appropriate in case paroxysmal arrhythmia is occurring … press the button when the intolerance occurs and see what it shows but structurally looks solid. Thyroid ok too?
Beautiful images BTW
Eric
Re the fs% and volume
Re the fs% and volume contraction from my experience that will cause, if anything, pseudohypertrophy of the LV and maybe a hyperdynamic state since it has less volume to contract against and still has to maintain output…..unless shocky then fs% drops… I am sure Peter has more on this. I have a sequence on my other computer and ppt that shows this combination of events on the heart (volume contraction, shock, volume restitution…) after a good liver bx bleed and the effects of plasma expanders and atropine on the heart compared to CRT times and amount of hemoabdomen initially and after absorption and shock treatment. I will see if i can post it when back stateside as its on my other computer.
Eric
Re the fs% and volume
Re the fs% and volume contraction from my experience that will cause, if anything, pseudohypertrophy of the LV and maybe a hyperdynamic state since it has less volume to contract against and still has to maintain output…..unless shocky then fs% drops… I am sure Peter has more on this. I have a sequence on my other computer and ppt that shows this combination of events on the heart (volume contraction, shock, volume restitution…) after a good liver bx bleed and the effects of plasma expanders and atropine on the heart compared to CRT times and amount of hemoabdomen initially and after absorption and shock treatment. I will see if i can post it when back stateside as its on my other computer.
Eric
Hi!
I totally
Hi!
I totally agree.
Besides this very little MR this heart doesn´t look very abnormal. If you give furosemide there is consequently less preload, means less of the Frank Starling mechanism and consequently less FS (highly dependent on pre and afterload). And if the animal is very alert, you have a combination of decreased preload and increased afterload which enhances this phenomenon. I have seen quite a lot normal dogs with a FS between 20 and 25%. Real hypertrophy could be, but is less likely. Aortic stenosis would cause a heart murmur and hypertension causing real concentic hypertrophy is quite rare in dogs (e.g pheochromocytoma). Severe volume depletion and low FS occurs also with morbus Addison. ( but I don´t think that this is the case here)I would recommend performing a bronchioscopy, as already mentioned by Eric.
Best Regards!
peter
BTW: I read the email from Mr Haslauer. I worked a lot with the PA 230 probe. I would try it, it´s quite comparable to the 240 and you dón´t have to update the machine. If you like, I can send you some pics taken with that probe.
Hi!
I totally
Hi!
I totally agree.
Besides this very little MR this heart doesn´t look very abnormal. If you give furosemide there is consequently less preload, means less of the Frank Starling mechanism and consequently less FS (highly dependent on pre and afterload). And if the animal is very alert, you have a combination of decreased preload and increased afterload which enhances this phenomenon. I have seen quite a lot normal dogs with a FS between 20 and 25%. Real hypertrophy could be, but is less likely. Aortic stenosis would cause a heart murmur and hypertension causing real concentic hypertrophy is quite rare in dogs (e.g pheochromocytoma). Severe volume depletion and low FS occurs also with morbus Addison. ( but I don´t think that this is the case here)I would recommend performing a bronchioscopy, as already mentioned by Eric.
Best Regards!
peter
BTW: I read the email from Mr Haslauer. I worked a lot with the PA 230 probe. I would try it, it´s quite comparable to the 240 and you dón´t have to update the machine. If you like, I can send you some pics taken with that probe.
Thanks Eric – T4 was normal
Thanks Eric – T4 was normal and I did get some m-modes of the long axis LV but lines were not as distinct as in the short axis view so I didn’t bother measuring them but can go back and look again to get a rough idea to see if the FS is repeatable.
Thanks Peter – it would be great to see some images with the PA 230 probe and may be an option as I really do not want to spend the $$ to upgrade my machine for the PA 240. How big of footprint does it have? I really appreciate your help and Mr. Haslauer’s help at Esaote! (do you still have my e-mail?)
Question for both Eric and Peter: What reference range tables are you using to interpret the numbers on your echocardiograms? I am using a chart given to me from June Boon from the Sound-Eklin courses but is there another I should be using?
By the way – Happy Good Friday and Easter Weekend!
Jacquie
Thanks Eric – T4 was normal
Thanks Eric – T4 was normal and I did get some m-modes of the long axis LV but lines were not as distinct as in the short axis view so I didn’t bother measuring them but can go back and look again to get a rough idea to see if the FS is repeatable.
Thanks Peter – it would be great to see some images with the PA 230 probe and may be an option as I really do not want to spend the $$ to upgrade my machine for the PA 240. How big of footprint does it have? I really appreciate your help and Mr. Haslauer’s help at Esaote! (do you still have my e-mail?)
Question for both Eric and Peter: What reference range tables are you using to interpret the numbers on your echocardiograms? I am using a chart given to me from June Boon from the Sound-Eklin courses but is there another I should be using?
By the way – Happy Good Friday and Easter Weekend!
Jacquie
We use June Boon numbers here
We use June Boon numbers here in NJ
We use June Boon numbers here
We use June Boon numbers here in NJ