Dear all, I would appreciate your input in this case.
10y old MN CKC.
In March 2016 was presented for echocardio to investigate degree of MVD. At this point, mild bouts of nocturnal coughing reported. EXam grade 4 systolic murmur. Xrays:no obvious signs of pulm edema. VHS:11.75
Dear all, I would appreciate your input in this case.
10y old MN CKC.
In March 2016 was presented for echocardio to investigate degree of MVD. At this point, mild bouts of nocturnal coughing reported. EXam grade 4 systolic murmur. Xrays:no obvious signs of pulm edema. VHS:11.75
Echo showed moderate MR (5.2m/s approx). mild to moderate LA enlargement (1.8 LA/Ao ratio) and LV diast dilation. After this, no medical treatment was initiated, intstead, heart supportive prescription diet and supplement with Co-Q10 and home monitoring of SRR (owner not clear about whether cough was present or not).
July 2016: echocardio and findings are similar. Very similar in M-Mode and MR readings. See pics below. Question is, SRR has been recorded and is between 25-30 consistently over weeks. Occasional cough. Changed to Metabolic Hills diet for gradual weight loss.
Question: I do not have the E wave readings, but going to the MR pictures, is it possible to estimate the value of E wave from that-approx 1m/s? I understand it would be mildly underestimated. Also, from previous scan, it appeared to me that LA and LV dilation was mild to moderate but FS is still good. I had suggested starting medical treatment from previous scan but it was decided against it by vet in charge of case due to lack of consistent symptoms. Is my grading correct? Can we use any of the parameters from the echo to decide whether medicine is adviced? Like E wave peak velocity?nI know is the eternal question, but may be I am missing something from the exam that is really important…
With the occasional cough and the slightly high SRR (less than 30 but surely not below 20), I would at least do a furosemide trial…
Thanks for any input
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Oh.., my pics have not
Oh.., my pics have not loaded…
Good morning GCSM! I added
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My apologies Kelly. I never
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right…going through the
right…going through the refence ranges of Mmode actually…the LV in diastole seems fairly within the range for a 9kdog(up to 3.5). The LA is 2.54cm now. In march was very similar (2.51)…
Guys please keep to bullet
Guys please keep to bullet format for concise quick evaluation. If you are writing a paragraph its out of the format. We do this so eveyone cant get to the facts quickly through the forum otherwise we are doing telemnedicine consultation on the forum which is not our scope here. Thank you for you attention to this policy. For telemedicine consultation please refer to the upload link on the home page that have many options including email only and sonopod cast as well as the usual report by cardiologists or myself.:
http://sonopath.com/spa
I never like a deviated atrial septum in a coughing dog with valve disease no matter what the numbers say as long as you are in proper position which you are in on the video. Im guessing there is a vertical LA on rads?
Numbers are numbers but in my opinion and many others never take the full spectrum of breed and metabolic differences into perspective and starlings lawas are defined by the individual noit the 150 cases or so with multiple different breeds and ages that made up the tables we use…… that is why the la/ao controversy is always there… do we use june boon or swedish or la max???.
So my advice is treat the patient not the numbers. If the dog is coughing and the la is vertical and the AS is deviated and LA looks big subjectively if you have been scanning a while … this case has all that criteria… the kicker is hows the exercise tolerance on a walk. My guess is the owner says he isnt as lively as before…. and coughing at night when lying down typical cardiac vs chronic seasonal cough coming and going (allergic cough for example).
I would actually lasix/acei tx this dog (assuming bloods are fine) as a trial and not just lasix…and if that works I have my hand on pimo as well. Check the cough and the liveliness of the patient afterwards and then post what the owner says. Many may disagree with me but Peter and I worked together on this premise here in NJ with a Drs dog and worked like a charm….as have I on many other similar cases. Remember treat the dog not the numbers… We have wayyyy to few numbers and variables in vet med… human field good study is in the thousands of patients and we have a lot more variability with breeds.
That being said many of these guys have both cardiac and bronchopulmonary disease so can be a combination.
Thank you Eric. Apologies for
Thank you Eric. Apologies for the wrong format. You have mentioned this before in my posts and I’m not sure sometimes what exactly is the wrong bit. I tried to put clear questions, as brief as I can and ultrasound related. Any reference to history, symptoms and treatment is only an attempt to provide info that can help interpret the clips and answer the questions. It is not my intention to have a telemedicine case answered here. My apologies.
No worries Im happy to help
No worries Im happy to help everyone just trying to keep it wihtin context of the forum. One of the difficulties with other forums is they end up being exhaustive to get through which is what we want to thwart here.
Here is how we would like you to post this one… though this is an elaborate question but good content to discuss so this represents a longer thna normal post… but see the abbreviated wording here:
>>10y old MN CKC.
>>March 2016 echocardio for MVD. Nocturnal coughing reported. Grade 4 systolic murmur. Xrays:no pulm edema. VHS:11.75
>>Echo: moderate MR (5.2m/s approx). mild to moderate LA enlargement (1.8 LA/Ao ratio) and LV diast dilation. no medical tx, heart supportive prescription diet with Co-Q10 and home monitoring of SRR (owner not clear about whether cough was present or not).
>>July 2016: echocardio similar. Very similar in M-Mode and MR readings. See pics below. Question: SRR has been recorded and is between 25-30 consistently over weeks. Occasional cough. Changed to Metabolic Hills diet for gradual weight loss.
>>Question: I do not have the E wave readings, but going to the MR pictures, is it possible to estimate the value of E wave from that-approx 1m/s? I understand it would be mildly underestimated. Also, from previous scan, it appeared to me that LA and LV dilation was mild to moderate but FS is still good. I had suggested starting medical treatment from previous scan but it was decided against it by vet in charge of case due to lack of consistent symptoms. Is my grading correct? Can we use any of the parameters from the echo to decide whether medicine is adviced? Like E wave peak velocity?nI know is the eternal question, but may be I am missing something from the exam that is really important…
>>With the occasional cough and the slightly high SRR (less than 30 but surely not below 20), I would at least do a furosemide trial…
Thanks:) very much.
Thanks:) very much. Again.
All makes sense ( format advice and case advice). I’ll try harder next time:)
Another point.
The FS in this
Another point.
The FS in this dog is 36. The normal response to MI might be in the 50’s or 60’s.
This would give me concern about the health of this dogs myocardium.
If this was my case I would not hesitate to start Furosemide, Enalapril and Pimobendan
I think the PWs was slight
I think the PWs was slight underestimated but would only raise to about 40% so certainly good point… myocardial insufficiency may be looming… need to get Starling back in the house because he has a foot out the door:)