Name: Gertrude
Age: 10 years
Sex: Female, spayed
Breed: Cavalier King Charles Spaniel

Please review Gertrude’s clinical history.

Gertrude is apparently healthy according to the owner. She is here today for an annual wellness exam. She has a history of stage B1 MMVD that was diagnosed last year. A loud, grade III-IV/VI left apical systolic murmur was detected today. Click here for the ABCD brochure.

View Gertrude's right lateral radiograph View Gertrude's ventral-dorsal radiograph

Click here to view Gertrude radiographic viewer   Technical details
Location of images: Thoracic radiographs obtained.
Views of images: Right lateral and ventral-dorsal.Radiographic findings
Technical issues: Good quality films.
Cardiac size including VHS/VLAS: VHS is 12.0 and VLAS is 2.8. There is loss of the caudal waist on the right lateral consistent with moderate left atrial enlargement.
Radiographic interpretation: Moderate generalized cardiomegaly with left atrial enlargement with normal pulmonary vasculature and parenchyma. No evidence of heart failure.

 
Discussion:  An echocardiogram showed progressive mitral valve regurgitation, left atrial and left ventricular enlargement. Moderate left ventricular and left atrial dilation with normal left ventricular systolic function was documented. Her LVIDDn was 1.9, and the LA/Ao=1.85. A diagnosis of myxomatous mitral valve disease, Stage B2, was made.
Treatment/management: The dog was started on pimobendan dosed at 0.25 mg/kg q12 hr in hopes of delaying progression of heart failure. An ACE-inhibitor, such as enalapril or benazepril, can also be considered at this stage of heart disease. The owner should be educated to monitor for clinical signs of heart failure such as increase respiratory rate, coughing, syncope, decreased appetite or activity. A recheck was recommended in approximately 6 months to monitor for progression of her heart disease, sooner if there are concerns.