– 6 month old M German Shephard presented for neuter who had a history of a grade 3/6 systolic heart murmur diagnosed at about 8 weeks of age
– I heard the murmur up until 5 months of age but today I could not hear it on pre-op exam but decided to scan the heart anyway (was a possible innocent murmur?)
– as pet very uncooperative, pre-meded with hydro/ace prior to echo (typical pre-neuter pre-med)
– sedation was great but pet was tachypenic and bradycardic (65-85 bpm) for the echo
– 6 month old M German Shephard presented for neuter who had a history of a grade 3/6 systolic heart murmur diagnosed at about 8 weeks of age
– I heard the murmur up until 5 months of age but today I could not hear it on pre-op exam but decided to scan the heart anyway (was a possible innocent murmur?)
– as pet very uncooperative, pre-meded with hydro/ace prior to echo (typical pre-neuter pre-med)
– sedation was great but pet was tachypenic and bradycardic (65-85 bpm) for the echo
– m-mode of LV was terrible due to tachypnea so took measurments from 2-D which were wnl (diastolic and systolic)
– the LA was just midly enlarged on measurements and I am wondering if the right heart looks a little subjectively enlarged esp. the RA?
– there was trivial PI and TR, no MR or AI, TR Max Vel 2.5m/s, Ao Max Vel 2m/s, Pul Max Vel 1.5 m/s
I went ahead and neutered the patient without a problem as the heart looked overall normal to me except for the mild LAE and possible R heart changes. Could bradycardia cause the changes I saw on echo? Am I missing something?
Comments
May be just an athletic
May be just an athletic heart… the need not contract much. TV dysplasia possible as well need CF and CW doppler views and better morphology views like position 2 on the SDEP echo protocol. The first video I can kind of see maybe elongated TV leaflets but need more interrogation to define. If the right heart is functionally a problem my dirty way of seeing if this is an issue is looking at the CVC/ao ratio in the cranial abdomen that should be 1:1. I need to do a study on this but if the right heart is failing then the CVC increases in size as do the HV typically.
ECG normal? No Heart block?
3/6 is pretty big murmur.. small VSD? TV dysplasia that can be tough to hear sometimes… SAS if ejection?? Sometimes these pathologies are present but need doppler interrogation to define them if minor morphological changes are present.
May be just an athletic
May be just an athletic heart… the need not contract much. TV dysplasia possible as well need CF and CW doppler views and better morphology views like position 2 on the SDEP echo protocol. The first video I can kind of see maybe elongated TV leaflets but need more interrogation to define. If the right heart is functionally a problem my dirty way of seeing if this is an issue is looking at the CVC/ao ratio in the cranial abdomen that should be 1:1. I need to do a study on this but if the right heart is failing then the CVC increases in size as do the HV typically.
ECG normal? No Heart block?
3/6 is pretty big murmur.. small VSD? TV dysplasia that can be tough to hear sometimes… SAS if ejection?? Sometimes these pathologies are present but need doppler interrogation to define them if minor morphological changes are present.
To me the L side of the heart
To me the L side of the heart looks pretty good.
L apical- it almost appears that the tricuspid valve does not close properly and R atrium appears to be about the same size as the L atrium – or maybe a bit larger- which would be abnormal.
Short axis of the heart the pulmonic outflow tract appears to be narrowed compared to the aorta.
Grade 3/6 murmur would probably not be innocent.
I really wanted to get my 2 cents in before EL- but like usual I had to commit.
I am attaching some pears the Peter posted when I made a forum entry. Worth repeating- along with EL pearls.
oops- the pears are small- not sure why. Click on the box to make them larger
To me the L side of the heart
To me the L side of the heart looks pretty good.
L apical- it almost appears that the tricuspid valve does not close properly and R atrium appears to be about the same size as the L atrium – or maybe a bit larger- which would be abnormal.
Short axis of the heart the pulmonic outflow tract appears to be narrowed compared to the aorta.
Grade 3/6 murmur would probably not be innocent.
I really wanted to get my 2 cents in before EL- but like usual I had to commit.
I am attaching some pears the Peter posted when I made a forum entry. Worth repeating- along with EL pearls.
oops- the pears are small- not sure why. Click on the box to make them larger
The murmur actually appears
The murmur actually appears to be gone now in this patient. I was also wondering if the IAS looked a little funny (thin?) but didn’t notice this until afterwards so I didn’t get Doppler on it.
I have recommeneded follow-up in this patient – clinically he has been normal.
The murmur actually appears
The murmur actually appears to be gone now in this patient. I was also wondering if the IAS looked a little funny (thin?) but didn’t notice this until afterwards so I didn’t get Doppler on it.
I have recommeneded follow-up in this patient – clinically he has been normal.
I inserted a still of the
I inserted a still of the MPA/AO ratio which was normal
I inserted a still of the
I inserted a still of the MPA/AO ratio which was normal