- 8 year old, 7 kg, fs Miniature Schnauzer with acute onset of seizures and chronic mitral valve disease
- CBC and chemistry profile are normal
- Echocardiogram shows clubbed mitral valves, slight mitral valve prolapse, regurgitant jet occupying >50% of the left atrium, MR velocity of 5m/s, left ventricular enlargement, and severe left atrial enlargement
- There are no tricuspid, aortic, or pulmonic valve leaks. AO velocity=1.7m/s
- 8 year old, 7 kg, fs Miniature Schnauzer with acute onset of seizures and chronic mitral valve disease
- CBC and chemistry profile are normal
- Echocardiogram shows clubbed mitral valves, slight mitral valve prolapse, regurgitant jet occupying >50% of the left atrium, MR velocity of 5m/s, left ventricular enlargement, and severe left atrial enlargement
- There are no tricuspid, aortic, or pulmonic valve leaks. AO velocity=1.7m/s
- Cardiac measurements are as follows: IVSd=9.8, LVIDd=40.7, LVPWd=8.6, IVSs=14.4, LVIDs=20.21, LVPWs=14.3, FS=50.3%, HR=189bpm, BP=144mmHg
- An EKG has not been done yet. I have recommended a Holter monitor as well as chest radiographs to rule out pulmonary edema.
I am calling this a Stage B2….emerging stage C dog. Without an EKG, can you determine if this dog’s seizures are due to heart disease? The dog was placed on a 2 week enalapril trial by the rDVM with no improvement. In addition to an EKG and chest radiographs, what would be the next appropriate steps? Would you start this dog on pimobendan?
Comments
Nice images Electrocute. I
Nice images Electrocute. I have seen seizures suspected to be induced by hypoxia but at that age concurrent disease such as GME should be considered. We can see and treat the heart and there is still volume overload. I think adding lasix bid would be the next step.. pimo is debateable… I likely would wiht the prolapse and that LA/AO but many wouldnt. I think a b2 label wiht that LA is fair but there isnt consensus on pimo in B2. If C1 no problem pimo and triple therapy for sure but not quite that category yet. Maybe try lasix bid and see what happens maybe reecho in a week and see how the volume is doing. Peter and Remo may have more ideas.
Thanks Eric. The rDVM’s main
Thanks Eric. The rDVM’s main question is if the heart disease is significant enough to cause the seizures. It seems like I can’t really answer that questioon based upon the echo alone. After performing an EKG, would it be reasonable to try treating the heart disease with more than just an ace inhibitor (pimo, lasix) and see if the seizure episodes improve? Would you pursue an MRI next to continue looking for a cause for the seizures?
Nice images Electrocute. I
Nice images Electrocute. I have seen seizures suspected to be induced by hypoxia but at that age concurrent disease such as GME should be considered. We can see and treat the heart and there is still volume overload. I think adding lasix bid would be the next step.. pimo is debateable… I likely would wiht the prolapse and that LA/AO but many wouldnt. I think a b2 label wiht that LA is fair but there isnt consensus on pimo in B2. If C1 no problem pimo and triple therapy for sure but not quite that category yet. Maybe try lasix bid and see what happens maybe reecho in a week and see how the volume is doing. Peter and Remo may have more ideas.
Thanks Eric. The rDVM’s main
Thanks Eric. The rDVM’s main question is if the heart disease is significant enough to cause the seizures. It seems like I can’t really answer that questioon based upon the echo alone. After performing an EKG, would it be reasonable to try treating the heart disease with more than just an ace inhibitor (pimo, lasix) and see if the seizure episodes improve? Would you pursue an MRI next to continue looking for a cause for the seizures?
Yes to both questions ….tx
Yes to both questions ….tx cardiac and waiut and see… MRI +/- CSF tap if seizures progress. Interesting case. If losing weight then consider an anbdominal ultrasound for related badness… like a pheo or something.
Yes to both questions ….tx
Yes to both questions ….tx cardiac and waiut and see… MRI +/- CSF tap if seizures progress. Interesting case. If losing weight then consider an anbdominal ultrasound for related badness… like a pheo or something.