Hi everyone,
13 year old male desexed Kelpie with grade 4/6 heart murmur. ECG showed atrial fibrillation. Dog is tachycardic (ave 180bpm) and is currently on pimobendin. Dog has terrible dental disease and was initially booked in for a dental clean however Owner reports lethargy. No coughing, no pyrexia, no bloods were done.
Echocardiographic study was performed and a 2.57mm X 2.88mm echogenic mass was seen on the tricuspid valve. Patient also has mitral insufficiency and an extremely large left atrium that the mitral valves don’t even meet!
Question:
Hi everyone,
13 year old male desexed Kelpie with grade 4/6 heart murmur. ECG showed atrial fibrillation. Dog is tachycardic (ave 180bpm) and is currently on pimobendin. Dog has terrible dental disease and was initially booked in for a dental clean however Owner reports lethargy. No coughing, no pyrexia, no bloods were done.
Echocardiographic study was performed and a 2.57mm X 2.88mm echogenic mass was seen on the tricuspid valve. Patient also has mitral insufficiency and an extremely large left atrium that the mitral valves don’t even meet!
Question:
1. What are our differentials with this mass? Could this be endocarditis? ( I know it is extremely rare on the tricuspid valve)
2. What are the chances of the ‘mass’ breaking off? Should we be worried?
Thank you!!
Comments
Hi!
Unfortunately, it can
Hi!
Unfortunately, it can be all three of them. What I cannot see here is: Is the mass clearly associated to the valve (does it stick to one part of the valve) or does it move free in the right atrium?
I would do a complete abdominal scan as well and take chest rads to look out for tumors. And I would check WBC and D-dimers. Blood cultures shodul be taken (10 ml 3 times, immediate culture) as well to r/o infection. Still, most infectious vegetations in dogs occur at the MV or aortic valve.
It is probably worth an attempt to remove the mass via inflow-occlusion (short term venous occlusion). I would potentially recommend that.
My favorites are thrombus or tumor.
Best regards!
Peter
Hi Pete!
Thanks so much for
Hi Pete!
Thanks so much for the reply. From what I can see the mass seems to be attached to only one part of the valve. It does not move freely in the right atrium.
Regards,
Priscilla
One more question Pete. Do u
One more question Pete. Do u reckon the mass in the right side is related to the atrial fibrillation or left side enlargement? Or more an incidental finding?? Will getting rid of the mass help with clinical signs? ( atrial fib)
Im betting on thrombus as
Im betting on thrombus as well as its right side and asssociated with the TV valve… any chance of rickettsials?… how about a doxycycline clindamycin plavix trial and see what happens?
Do you think the clinical
Do you think the clinical signs and the arrythmia are caused by the mass/thormbus? or is this incidental and not related to the dogs clinical signs.