Amy

Signalment

 10 year old, spayed female

 Cocker spaniel-cross

Past Pertinent History

 Vax current, on HW preventative

 Murmur for 1 year

 CXR: Cardiomegaly

Presenting History

 Cough, tachypnea, p. anorexia

 HR=180, RR > 100 per minute

 No GI, PU/PD

 rDVM: Furosemide prior to referral

Physical Examination

 T=38.5, P=160/wk, R=64, 7.5kg

 CRT=1.5-2 sec, MM=pink

 5/6 L apical, plateau-shaped murmur & S3 gallop

 No Adventitial lung sounds

Problems

 Partial anorexia

 Cough, tachypnea

 Cardiomegaly (historical)

 Murmur & S3 gallop

Differential Diagnoses?

Plan?

 Diagnostic?

 Therapeutic?

 Client Education?

Swayze

Signalment

 8 year-old male, Doberman pinscher

 History

 Wobbler--surgical candidate

 Cardiovascular--asymptomatic

 Cardiac consult requested due to breed

Physical Exam (12/20/96)

 TPR = 101.5/120/30; BW: 35 kg

 MM = pink, CRT <2 sec

 Pulses = good and regular

 S₃ gallop

 Posterior ataxia, CP deficits

 ECG--NSR

 Echo--SF = 13%, thin-walled LV

CV Problem List: Compensated DCM

 Myocardial failure?

 Remodeling?

 Heart rate/arrhythmia?

 Heart failure?

 Hypo-, hypertension?

 Loading (pre-, after-)?

 Electrolytes?

 Oxygenation?

 Neurohumoral activation (RAAS, SNS)?

Plan

 Therapeutic options

 Furosemide

 Spironolactone

 Sodium restriction

 Digoxin

 Dobutamine

 Ca channel blocker (Amlodipine, Diltiazem)

 Beta blocker (Carvedilol, Atenolol)

 Nitroglycerin

 Hydralazine

 Enalapril

 Carnitine, taurine, fish oils, CoQ10, O₂, PTS?

Our Plan?

 NCSU treatment: Compensated DCM

 Enalapril (0.5-1 mg/kg PO daily)

 Carvedilol (3.25 mg PO daily, increasing/2wks)

 Modest sodium restriction

 Carnitine (as option)

 Avoid heavy exercise

Gabby

Signalment

 West Highland White Terrier

 12 years old, spayed female

History--Past

 Good vaccination and HW preventative history (recent negative test)

 Non-productive cough r/t steroids, antibiotics

 1 period of syncope (8-10 months ago)

 Cough returned; n/r to steroids, antibiotics

 Another syncopal episode, f/b 2 more with exercise

History--Current

 Arrhythmia) and crackles audible

 CXR: cardiomegaly & bronchointerstitial dz

 Diagnosed with L-CHF

 Treated with Lasix (25 mg BID) and theophylline (100 mg BID)

 Referred to NCSU

Physical Exam/MDB

 TPR Wt = 38.7°C, 80 bpm, 40 rpm, 7.8kg

 NSA, + Arrhythmia (dropped beats), loud S2

 Coarse crackles audible + expiratory effort

 CBC: mild, mature neutrophilia; thrombocytosis

 Chemistry: WNL

 UA: NA

Problem List?

 Cough

 Syncope

 Cardiomegaly

 Arrhythmia

 Loud S2

Differential Diagnoses?

Plan?

 Diagnostic

 Therapeutic

 Client Education

Tiger

Signalment

 6 year old, neutered male, Domestic short-hair, 4.5kg

Presenting Complaint

 Routine visit

 Examination and vaccination

 On no heartworm preventative

Physical Exam

 TPR=36/220/32

 4/6 right sternal border, pansystolic murmur

 Normal respiration

Problem List

 Murmur

 Tachycardia

Differential Diagnoses

 Differential diagnoses?

Plan?

 Diagnostic

 Therapeutic

 Client education