-Senior chihuahua
-Harsh lung sounds, if murmur present, is very low grade.
-Recent history of respiratory difficulties, including a bout with (presumed) bacterial pneumonia (elevated WBCs, interstitial lung pattern). Several episodes responded to oxygen, short-acting steroids, single injection lasix when pneumonia not suspected.
-Recent rad review suggests possible pulmonary hypertension
-Senior chihuahua
-Harsh lung sounds, if murmur present, is very low grade.
-Recent history of respiratory difficulties, including a bout with (presumed) bacterial pneumonia (elevated WBCs, interstitial lung pattern). Several episodes responded to oxygen, short-acting steroids, single injection lasix when pneumonia not suspected.
-Recent rad review suggests possible pulmonary hypertension
***I had a VERY hard time imaging this patient. I do not have the required views to diagnose PH. I believe the one view of the PA was enlarged compared to the Ao but I can’t prove it. I did not see TR although I could have missed it. She is tiny and strongly resists any type of restraint.
Systemic blood pressure is normal.
I was surprised by the degree of LV hypertrophy and would like your opinion. I don’t believe she is in heart failure.
Thanks!
Suzanne
Comments
Hi Suzanne
Thought I would
Hi Suzanne
Thought I would chime in- looks like impressive hypertrophy, any way you could measure diastolic and systolic LV wall and chamber measurements?
The myocardium looks hyperechoic (LV freewall) in places possibly indicating myocardial fibrosis and chronicity to the disease
Any exercise intolerance/syncope?
Aortic outflow velocities would be helpful to know if the LV hypertrophy is secondary to increased afterload.
I couldn’t see any obvious SAS in the videos here and it isn’t the right breed but may need more views…
You could use low dose ACP butorphanol to sedate for a more detailed exam…I agree dog doesn’t look like in failure, but also is unlikely to get CHF with LV hypertrophy.
Best wishes
Raj
Very thick LV and volume
Very thick LV and volume contracted LA so no left CHF. Mild right ventricular thickening… Older chihuahua exercise intollerance…. any chance of reverse pda with the large PA? Cyanotic caudal mucosae by chance? Would need a bubble study to rule this out while scanning the abdominal aorta. Would need spectral doppler of the AO and PA of course.
Here are some bubble study cases from the basic search
http://sonopath.com/members/case-studies/search?text=bubble+study&species=All
and the description of the procedure from interventional procedures
http://sonopath.com/resources/interventional-procedures
Hi!
Yes, I agree. The LV
Hi!
Yes, I agree. The LV myocardium is fibrotic as well (chronic pressure overload). Would consider subaortic stenosis and do a Spectral Doppler exam in this patient.
Peter
I appreciate the comments, I
I appreciate the comments, I know the views I provided are less than optimum.
I did try an m-mode out but measuring would be difficult. The septum and left ventricular free wall completely obliterate the lumen during systole.
I will see about attaching a color Doppler of the aortic outflow (albeit in a strange position). I don’t see SAS but will see what you think. I will also include a clip of the mitral and tricuspid color flows.
I did not consider a reverse PDA; I’ll have to look into that more if I see her. Somehow I know a bubble study is not in her future; there are some patients I would try it on but not this one!
Thanks again!
I thought this small handout
I thought this small handout I made some time ago would be helpful in characterizing cardiac change.
I did not think about a reverse PDA. It probably would not have a very loud murmur.
Looks like diastolic function is very poor in this little guy. A doppler mitral inflow evaluation like Peter suggested would be a good idea.
Please let me know if you see any inaccuracies in my handout.
Thanks
I did not have time to look
I did not have time to look at your handout in detail but it looks great! I was thinking that I wish there were a table I could go to so I could see a list of causes to consider for each of the severe changes I saw. Thank you! – I will print it out and refer to it often.
Suzanne