– this is an echo of a 7 week old male Rottweiler pup that the rDVM found a heart murmur on routine exam wt 5.2kg
– he was sedated with 0.4 mg/kg Butorphanol IV as he was just too uncooperative otherwise
– the rDVM thought it was at least a systolic grade 4-5/6 but when I listened, I would classify it more like a grade 3
– this is an echo of a 7 week old male Rottweiler pup that the rDVM found a heart murmur on routine exam wt 5.2kg
– he was sedated with 0.4 mg/kg Butorphanol IV as he was just too uncooperative otherwise
– the rDVM thought it was at least a systolic grade 4-5/6 but when I listened, I would classify it more like a grade 3
– the sire of this pup had a history of a previous litter in which two of the littermates that had a heart murmur died suddenly before 1 year of age (no post-mortem to confirm diagnosis however) – so one concern I have would be the possibility of SAS in this pup
– the echo was pretty normal with a max aortic velocity of around 2m/s taken several times both subcostally and intercostally
– other than the LVIDd measuring a bit small, all other parmaters were wnl; no LAE; MPA:Ao was 1.1
– I did not see evidence of a VSD, pulmonic stenosis and history and echo did not fit for a PDA
– there was no MR or TR seen on colour Doppler but I did get a TR reading that was likely underestimated in CW Doppler; I think the valves look normal
So either this pet has an innocent murmur that should go away on its own or am I missing something? Could this pet have subclinical SAS that I just can’t see yet. I understand that SAS should be assessed when the pet is mature. Would a murmur of SAS be present before evidence of it on spectral Doppler? Is is best to re-examine at 6 months of age if the murmur persists?
Thanks ahead of time
Comments
Hi!
2 m/s is certainly too
Hi!
2 m/s is certainly too much. Normally, the vmax is below 1,8 m/s (particularly in a sedated dog…) . A 2 m/s aortic flow can already cause a heart murmur. (Thus, I would not call it “innocent”) Moreover, the left ventricle seems to be a bit concentrically hypertrophied.
I would re-check this pup every 3 months to see what happens.
Peter
Very good to know this.
Very good to know this. Thanks Peter. I was wondering if the sedation may have influenced the study. The owners are prepared that future scans are warranted and SAS is on their radar.
JP
Do you see any morphological
Do you see any morphological change on 2D at this point?
No, the sedation should not
No, the sedation should not really influence your measurements. It has been shown that increased sympathetic tone can increase the vmax, but Botorphanol usually does not cause any significant hemodynamic changes.
Sometimes you can see early changes on 2D-images such as a slight subvalvular ridge, but given the 2m/s here, the changes can be hard to image at this time.
Thanks for posting!
Peter
guys in an out of the box
guys in an out of the box view I have seen puppies have these murmurs and a round of ABs resolves them and the MV looks a touch vegetative to me…I usually use clindamycin in older pups but we have tons of bartonella in NJ so I cover that and have seen 3-4 month old dogs with mumurs and vegetation dissappear with a month of abs… negative culture but who cultures for bartonella. Uterine infection at all??? Did the other pups die from bacterial infection and this one made it through with a little low grade bug? Anyway conspiracy theory aside I always wonder about low grade endocarditis on these things as every bug loves NJ and they hate austria becayuse its too darn cold there lol… but thats changing:(
Interesting thought EL. Would
Interesting thought EL. Would you not expect MR if this is affecting the MV’s?
Not necessarily especially in
Not necessarily especially in these cases… vegetation is one thing, insufficiency is another. An ugly door can still close well and keep out a draft:)
JP this is along the lines of
JP this is along the lines of what I see in NJ on occasion and its tough to get people to run titers and is a bit of a separate issue than the puppy sepsis (high grade some pups and fetal death and others survive and carry an endocarditis theory) potential that are AB responsive which may be going on with your case or not. But I think at least in NJ and wherever we have bartonella and fleas I believe low grade endocarditis is underdiagnosed because the reality is nobody does blood cutlures (which have poor SE anyway) and full work-ups unless the animal is very sick…and typical acute signs like shifting leg lameness, fever and such which is often not present. We know that in general infectious more often runs subclinical or low grade chronic than it does acute otherwise it couldnt survive. Bart is great at this as is Toxo and other bugs… sarcocystis in horses… babesia in Remo’s world.. so thinking along these lines and there are vegetative lesions or odd murmurs in non valve breeds or in cats I wonder about Bart and friends may be in the mix and a 3 week round of zithromax, clindamycin or doxy never hurts anything especially when you live in a doxy responsive disease state like NJ:) & you may just see vegetative lesions go away in a few weeks on follow up echo… or maybe just a flow murmur or minor congential defect… its all guesswork but if a cheap script makes a lesion go away Im all over it:)
here is a screen shot from Zuku review (great tool for ABVP prep by the way https://zukureview.com/abvp) and a link to Breitschwerdt’s ppt on Bart
http://www.ncagr.gov/oep/oneMedicine/noms/2010/Breitschwerdt_Edward_Bartonellosis_The%20Hidden_Epidemic.pdf ppt on bartonella
Remo is the infectious expert and I don’t know what experience he has here but hope he can chime in. Again this is a geopraphically sectorial concept but they don’t call NJ the grden state for nothing… everything grows here.
This is good info EL. Didn’t
This is good info EL. Didn’t have this on my radar. I was always under the impression that a dog with endocarditis had to look clinically “sick” – at least that’s what I was taught when decifering the difference between a dog with endocardiosis from endocarditis, however a 7 week old pup will not have CVD of course.
Not sure about the incidience of Bartonella in Ontario however we know that Lyme is creeping in.
An infectious etiology is
An infectious etiology is always possible, epecially with the history of fetal deaths and fairly normal echo. Most common cardiovascular sign with infectious endocarditis is a murmur. Are there any other signs such as tachycardia, pyrexia, leukocytosis?
Bartonella is often blamed but bacteria such as Streptococcus, Staphylococcus, E. coli, Pseudomonas are also common. Important to repeat echo in 2-3 months time but as Eric states, no harm in treating for a possible infectious origin.