I would like a cardio consult on Libby. She is a 13+ year old Cavalier King Charles Spaniel with Mitral Valve disease.
I recently did a follow up on Libby. She had an Echo done in November 2015 and found to have advanced B2 cardiac disease. She was started on Pimobendan as per the EPIC study. Libby and been doing OK but recently I have heard an arrythmia. When I did th EKG I could not reproduce it. She may require monitoring.
Below is the results of her echo that I did recently and what was done by the cardiologist in November 2015. The 2015 results are on the right.
I would like a cardio consult on Libby. She is a 13+ year old Cavalier King Charles Spaniel with Mitral Valve disease.
I recently did a follow up on Libby. She had an Echo done in November 2015 and found to have advanced B2 cardiac disease. She was started on Pimobendan as per the EPIC study. Libby and been doing OK but recently I have heard an arrythmia. When I did th EKG I could not reproduce it. She may require monitoring.
Below is the results of her echo that I did recently and what was done by the cardiologist in November 2015. The 2015 results are on the right.
M Mode: all values in mm
5/9/17 11/18/15
IVSd: 9.3 (6.6-8.1) 7 (4-9)
LVIDd: 34.6 (23.1-25.2) 37 (22-31)
LVPWd: 9.3 (5.3-6.5) 3.8 (4-9) (This has to be a typo)
IVSs: 16.2 (10-11.6) 14 (7-12)
LVDs: 20.4 (13.5-15.3) 16 (12-22)
LVFWs: 12.4 (8.8-10.3) 14 (7-13)
FS: 41 56.76
Aorta: 17.9 18
Left atrium 20.2 19
LA/AO: 1.1 1.06
EPSS: 5.4 1
IVSIDd/LVPWd: 0.27 ( 0.22-0.34)
LVIDd/LVPWd: 3.7 (>3<5)
2D:
Aorta: 13.9
LA: 21.6
LA/AO: 1.6 (<1.6)
Spectral Doppler: (m/sec) & mm/Hg
5/9/17 11/23/15
Aortic Flow: 1.3 1.37
Aortic Flow PG: 6.5 7.51
Pulmonary Flow: 1 0 .96
Pulmonary Artery Flow PG: 4 3.69
Tricuspid Regurgitation: 1.2 2.72
Tricuspid Reg PG: 5.5 5
Mitral Regurgitation: 5.6 5.54
Mitral Reg PG: 126.3 122.77
Echo Findings:
1. Myxomatous Mitral Valve disease
2. Eccentric hypertropy
3. Mitral valve regurgitation
4. Mild Tricuspid regurgitation
5. Mild Pulmonary hypertension
My main concern here is the decrease in FS and increase in EPSS.
I am concerned that we are now starting to see L sided myocardial failure.
I believe the mycardium is compromised as noted by the decrease of FS in the normal range (was elevated before as your would expect) and the increase in the EPSS.
My questions:
1. Do you agree with my assessment above?
2. Why haven’t we seen a more dramatic dilation of the L atrium?
3. Would you institute any change in Rx beside the Pimobendan.
No indication of CHF at this time
I am posting a few photos.
Thanks
Comments
Hi!
For me, this is not a
Hi!
For me, this is not a case of myocardial failure. The left ventricular free wall is sufficiently moving, and I trust this finding more than Fs-measurements. Moreover, myocardial failure would lead to significant LA enlargement which is not the case (btw: did you measure LA/AO SAX at end-systole?) Looking at the measurments of 2015, the LVDd was higher and LVDs was lower – maybe there was more preload and therefore more contraction (Frank-Starling). Also, for me this is not pulmonary hypertension since the TI vmax is 1.2 m/s. Re the EPSS measurments: I would recommend to take the measurement frome the particular cardiac cycle where it is lowest – means from the next cycle in your image. I guess, it is somewhere between 2 and 3 mm there.
I would continue Pimobendan as mono-therapy.
Best regards!
Peter
As always – thank you Peter
As always – thank you Peter