I recently did an echo on Bella.
Bella is a 12 year old Maltese that weighs just over 8 pounds
Grade 4/6 mitral regurgitation and 2/6 Tricuspid regurgitaion
Chest X-rays: cardiomegally with dilated L atrium. No indication of pulmoary edema. Collapse/compression of the L main stem bronchus. Historical cough
Echo findings:
I recently did an echo on Bella.
Bella is a 12 year old Maltese that weighs just over 8 pounds
Grade 4/6 mitral regurgitation and 2/6 Tricuspid regurgitaion
Chest X-rays: cardiomegally with dilated L atrium. No indication of pulmoary edema. Collapse/compression of the L main stem bronchus. Historical cough
Echo findings:
2D: Subjectively the wall thickness of the IVS and VFW appar to be normal. The L vetnricluar chamber is dilated as would be expected with mitral valve disease. The L atrium is dilated. The R side of the heart looks to be WNL.
CFI: only done on the MI. Reveals a large mitral regurgitant jet.
M mode: all values in mm
IVSd: 6.2 (5.7-7.6)
LV chamber d: 30.7 (17-19.2)
LVWd: 6.2 (4.6-6.1)
IVSs: 12.8 (8.6-10.7)
LV chamber s: 11.7 (9.2-11.2)
LVWs: 11.7 (7.7-9.6)
FS: 62
Aorta: 13.1
L Atrium 16.6
LA/AO: 1.3 (0.8-1.1)
EPSS: 4.1
IVSd/LVIDd 0.2 (.22-.34)
LVIDd/ LVPWd 5.0 (>3 < 5)
2D measurements:
Aorta 11.4
L Atrium 23.8
LA/AO: 2.1 < 1.6
Doppler: (m/sec)
Aorta: I could not get this reading
Pulmonary: 1.1
Tricuspid regurgitation: 2.7
Mitral Regurgitation: 5.6
Echocardiographic summary:
1. Normal wall thickness. This is of some concern. The normal response to chamber dilation would be concentric hypertrophy
2. Dilated L ventricular chamber in both diastole and systole consistent with a volume overload.
3. Dilated LA in both M mode and 2D consistent with mitral regurgitation and volume overload
4. Tricuspid regurgitation consistent with mild pulmonary hypertension
5. Good compensatory FS
At this time I believe that Bella is not in CHF and is compensating OK.
The big ?- when do we start a diuretic and Pimobendan.
I will submit this ? to Sonopath
Comments
Randy Im a visual guy any
Randy Im a visual guy any chance you can post a few m-modes?
Peter and I recently did a case like this on the road in NJ while he was here for the sonopath echo seminarand we both start triple therapy (lasix, acei, pimo) earlier than traditional CHF (wet lung) because that is getting redefined as soon as the cardio gods align themselves… if it ever happens. Big LA and LV with valve disease (stage B2 VD and beyond) and increased HR and early PHT to me gets triple TX and some rearly unpiublished research that we are privvy too will support this. In fact the dog we treated that was getting minimalist tx from a cardiologist is now jumping around non exercise intollerant and it was the vets own dog so she is excstatic.
My point is why make the heart work harder owiht the pathology it has… true volume overload without measurement error needs tx to preserve starlings laws and keep from spinning down the drain wiht volume overload hypoxia and myocardial stress. The counter argument is there are no studies that prove they live longer…. but Im about trying to make the animal live better and maybe longer. So if the meds work and owner says no more ex intollerance and the dog is happier then who can argue with that? So whatever you do ask yourself and the owner the simpe question “How’s the dog?” Then you hae your answer on whether the meds are necessary or not:)… as long as measurments are correct and azotemia not an issue…
If you can get some images up I will let you know what I would do… but I throw meds at the patient earlier than many and treat the dog not numbers so many may not agree with me….but if the dog is doing better on the meds then we win:)
Hi!
As I always say: I don’y
Hi!
As I always say: I don’y treat populations, I treat individuals, and I want to avoid CHF, not to wait until they suffocate.
What I usually do is: Once the LA/AO ratio exceeds 1.8 I start with ACEI/Spiro/Pimo. If it exceeds 2.0 I start with low dose Furosemide. (I do that from 1.8 on if there is severe pulmonary venous congestion, a jet that directly enters the PV, if there is PHT (<3 m/s on TR), or if I don’t expect the owners to see me again within a reasonable time because of low compliance).
I want to avoid that the patients come as emergency case without having got any therapy to prevent that before.
….and exercise intolerance is a symptom as well, not only dyspnea.
… of course surgery would be the best to do 🙂
Thank you EL and Peter.
I am
Thank you EL and Peter.
I am attaching a few stills here showing my 2D and M mode measurements.
Im not too excited about the
Im not too excited about the LV as it looks pretty solid. The LA/AO heart base looks like a little plump LA. The la/ao june boon has some lung artifact and the av isnt clean and Boon la/ao doesnt reflect chronic LA enlargement so in these cases I give less importance to it. Any chance you have a clean LA max here and a rad or 2?
Your lv mmode image has a nice b mode 4 chamber long in it and the atrial septum is not deviated and the LA looks upper limits of normal at 3 cm or so eyeballing it so that doesnt excite me regarding LAE.
Thanks EL
Here are some
Thanks EL
Here are some x-rays. I appreciate your feedback.
LA is plump, in fact right
LA is plump, in fact right and left enlargement, on the rads did you treat with lasix between rads and the echo?
I believe your heart based measurement here and likely chronic LA enlargement which is where the la max image comes in handy to support your heart based LAE. I would expect and LA max that looks something like this wiht that rad and maybe a little smaller if you treated before the echo.So lasix and acei +/- Pimo on this one is what I would do if the la max looks like mine attached here with deviated atrial septum.
Thanks EL.
I did not treat
Thanks EL.
I did not treat with any diuretic between the x-rays and echo
I will go back to my machine and get an LA max.
I really think this dog would benefit from Lasix and Pimobendan
Yeh just look at that atrial
Yeh just look at that atrial septum whether its flat and in line with the LV septum in 4 chamber long. If the AS is deviated toward the right atrium like my last image then thats classice LAE that la max and la/ao heart base will show but the June boon la/ao does not reflect well and may be nearly normal in many cases.