-10 year old male intact Labrador Retriever
-single episode of syncope
-Grade 4-5/5 systolic murmur, occasional arrhythmia
-significant financial restrictions, have not done separate ECG
-Measurements: La:Ao 1.94; %FS – 36%; LVIDd:LVFWd 6.1; EPSS 0.88 (other measurements available).
-Significant mitral regurgitation, other valves compentant. No signs of pulmonary hypertension.
-10 year old male intact Labrador Retriever
-single episode of syncope
-Grade 4-5/5 systolic murmur, occasional arrhythmia
-significant financial restrictions, have not done separate ECG
-Measurements: La:Ao 1.94; %FS – 36%; LVIDd:LVFWd 6.1; EPSS 0.88 (other measurements available).
-Significant mitral regurgitation, other valves compentant. No signs of pulmonary hypertension.
-This does not fit all the typical criteria for DCM but I’m not sure what to call this. What would be the next (most cost-effective) next step? We DO have Chagas in the area (and HWD).
Thanks!
SMB
Comments
I am not an expert on Chagas
I am not an expert on Chagas disease. Don’t see it in my area. You can run serology to test for it- but from what I understand treatment for the chronic disease is not all that effective.
I can’t tell from the recording but is this dog in Atrial Fib? Do you see a P wave?
Either way this dog needs to be treated with Pimobendan and Enalapril +/- furosemide. Try to get an EKG if possible.
We can wait and see what Peter or EL has to say.
Labs get a form of DCM thats
Labs get a form of DCM thats different than the dobie versions… but infectious for sure is a concern tat will look like dcm. LVIDD LA aand epss (<0.8 normal) have to be elevated in dcm wiht fs% < 20 to be clinical dcm as parameters to go by… and that doesnt fit here… eyeballing your video im seeing a 35% fs% +/- and epss is borderline.
Chagas for sure… doxy clinda trial and triple therapy is where I woud go here and rescan in 10 days
Yes, testing for Chagas is
Yes, testing for Chagas is easy. There is no treatment aside from treating the cardiac manifestations (I believe there are some drug therapies that are reserved only for people). But I usually try to get people to test if I am suspicious anyway.
I planned to start this patient on pimo. I have the owner monitoring sleeping respiratory rate at home to see if he needs the lasix, he was not dyspneic during the exam.
I will push for an EKG. He didn’t sound like an a-fib dog and I think I see p-waves but I’m not sure.
I guess I just wanted to figure out whether it was likely his cardiac output led to his syncopal episode (but his %FS is more reasonable that I expected.) or if it was more likely an arrhythmia that did it. I’m not sure I’ll be able to get chest rads or an ECG; Holter is likely out of the question.
Thanks!
Yes, testing for Chagas is
Yes, testing for Chagas is easy. There is no treatment aside from treating the cardiac manifestations (I believe there are some drug therapies that are reserved only for people). But I usually try to get people to test if I am suspicious anyway.
I planned to start this patient on pimo. I have the owner monitoring sleeping respiratory rate at home to see if he needs the lasix, he was not dyspneic during the exam.
I will push for an EKG. He didn’t sound like an a-fib dog and I think I see p-waves but I’m not sure.
I guess I just wanted to figure out whether it was likely his cardiac output led to his syncopal episode (but his %FS is more reasonable that I expected.) or if it was more likely an arrhythmia that did it. I’m not sure I’ll be able to get chest rads or an ECG; Holter is likely out of the question.
Thanks!
Not sure why my reply posted
Not sure why my reply posted twice above?
Does the fact that his murmur has been documented for many months make a difference in the likelihood of it being infectious? I know it could still be Chagas but are the diseases that can be treated with doxy/clinda likely to have that sort of history? I’m guessing that’s aiming at Bartonella? Others?
Thanks!
The murmur can certaionly be
The murmur can certaionly be an old MV insult and now the heart is failing but since this is not a valve disease breed we have to consider infecitous but its a poorly studied phenomenon…rickettsials, tick bornes… thats what we are targeting… Ive had some respond and others not and you can chase titers forever… specific disease such as chagas i think is worth a titer and maybe a 4dx and bartonella but biology is much more vast than what we test for as well… hence the blanket dual AB approach i recommended.
That makes sense, thanks for
That makes sense, thanks for your help!!