|Breed||Cavalier King Charles Spaniel|
|Weight||26.4 pounds (12 kg)|
|Reason for Visit||Hailey was presented for her yearly physical examination. The family has reported no clinical signs other than bad breath. There has been no cough, respiratory distress, weakness, decreased exercise tolerance or change in appetite|
|Medications||Heartgard® Plus, no other chronic medications|
Please review Hailey's clinical history.
|Weight Change (loss or gain)||None|
|Usual Diet||Eukanuba™ Adult with some "people food"|
|Change in urinary habits||None|
|Change in drinking habits||None|
|Other symptoms or signs||None|
Please review the results of Hailey's physical exam.
|Body Condition||Mildly obese - BCS 3.5/5|
|Attitude||Alert, but calm|
|Mobility | Gait||Normal gait upon inspection|
|Posture||Laying in sternal recumbency, resting|
|Body Temperature||100.6 F|
|Arterial pulse - rate, regularity, intensity||120 bpm, regularly irregular, normal strength|
|Rate & Respiratory Effort||32 breaths per minute, normal|
|Mucous Membranes - Color & CRT||Pink, <2sec|
|Jugular Venous Pulse & Pressure||Normal|
|Abdominal Palpatation||Normal, moderate size bladder|
|Oral Cavity||Mild dental calculus|
|Other abnormalities||Strong odor from mouth|
Let's ascult Hailey's heart
Direct HR: 120 beats/min
Heart Rhythm: Suspect respiratory sinus arhythmia
Intensity of Heart Sound: Normal
Extra Sounds - Clicks or Gallops: None
Heart Murmur: Grade 3/6 holosystolic murmur, loudest over the mitral area and left apex. Barely audible on the right
Precordial Palpation: Normal precordial impulse, but no thrill
The CEG considers the following differential diagnosis as most likely (and why):
A cardiac murmur in a patient of this breed and age, is highly likely to be degenerative valve disease, and the location and timing suggests mitral regurgitation. Physiologic flow murmurs typically occur at the left base, and in this breed would typically be associated with concurrent disease such as anemia or fever. The presence of a new heart murmur makes congenital heart disease less likely. Infectious valvular endocarditis is often suspected in patients with shifting leg lameness, fever, and inappetence, none of which were present in this patient. The incidence of endocarditis in small breed dogs is low.
The CEG considers the following diagnostic tests as the highest priority:
A cardiac murmur in a patient of this breed and age is highly likely to be degenerative valve disease and the relative lack of symptoms suggests a stage B patient. However, further staging of the disease requires imaging of the heart. This can be accomplished by thoracic radiography or echocardiography.
Please review Hailey's thoracic radiographs.
Technical Quality: Good
Pulmonary Venous Congestion: Normal pulmonary vasculature, no congestion noted.
Pulmonary Infiltrated Distribution: None.
Pulmonary Infiltrate Pattern: Mild bronchointerstitial pattern.
Other Findings: n/a
|BUN||19 mg/dL, Normal: <30 mg/dL|
|Creatinine||1.1 mg/dL, Normal: <2.1 mg/dL|
|Sodium||144 mEq/L, Normal:138 - 154 mEq/L|
|Potassium||4.4 mEq/L, Normal: 3.6 - 5.2 mEq/L|
|Chloride||113 mEq/L, Normal: 105 - 119 mEq/L|
|ALT||40 IU/L, Normal: <75 IU/L|
|ALP||56 IU/L, Normal: <100 IU/L|
|Heartworm Test Results||Negative|
|Urinalysis - USG||1.024|
|Urinalysis - Protein||Negative|
|Urinalysis - Biochemical||Normal|
|Urinalysis - Sediment Evaluation||Normal|
Please review the results of Hailey's echo
|Subjective - lesions of valves, myocardium, pericardial space||No pericardial effusion; normal systolic function of the left ventricle, thickened mitral leaflets with posterior leaflet mitral valve prolapse.|
|LV chamber size and thickness||Normal thickness but high normal to mildly increased chamber diameter.|
|Left atrial size||Mild dilation|
|LVIDd & LVIDs||Diastole (3.4 cm); systole (2.2 cm).|
|LV shortening fraction||Normal - 35%|
|RA, RV and Pulmonary Artery||Not remarkable (detailed images not shown).|
|Doppler results||Mitral regurgitation (MR); eccentric jet of MR is typical of primary valve disease; velocity of MR predicts normal systemic pressures; No tricuspid valve regurgitation (TR). Normal mitral inflow velocities.|
|Technical Quality, Leads, Paper Speed, Calibrations:||Satisfactory recording; 6 frontal leads and lead 2 rhythm strip recorded; paper speed 50 mm/sec; calibration 10mm/mV.|
|Rhythm- regular or irregular/ patterns:||Regularly irregular. Heart rate 110 bpm.|
|Heart Rhythm Disturbances:||Respiratory sinus arrhythmia; no premature complexes were detected.|
|P Wave Abnormalities- morphology, amplitude, duration:||Normal P wave height and width.|
|QRS Abnormalities- axis, morphology, amplitude, duration:||Normal frontal axis, no significant increase in height or width (insensitive measurement of chamber size).|
|Abnormal Intervals- PR, QRS, QT:||Normal intervals.|
|Other:||Slurred ST segments.|
You're ready to form a diagnosis and treatment plan for Hailey! Please select your answer to each question below.
THE CEG RECOMMENDS:
The CEG recommends no treatment at this stage of heart disease. They also do not have isgnificant increase in cardiac anesthetic risk and are typically resilient to fluid administration. They also do not have a significant increase in cardiac anesthetic risk or iatrogenic fluid overload.
|Initial Therapy||No medication indicated due to lack of significant cardiac enlargement and normal systemic blood pressure.
|Treatment||Continue monthly preventative per referring veterinarian. There is no treatment recommended for Stage B1 valve disease in the absence of systemic hypertension. ACE inhibitors have not been shown to be beneficial at this stage and pimobendan may be harmful to these patients.|
|Lifestyle Adjustments||Avoid high sodium treats and foods, e.g. processed meats, hot dogs, cheese, some table scraps.|
|Follow Up||The rate of change in cardiac size may be indicative of progression of disease. Increases in cardiac size may be detected with radiographs, echocardiography or both - this repeat testing may be scheduled for 6-12 month intervals, or may be performed sooner if signs of congestive heart failure occur.|