Case #1

"George"--13 year old neutered male DSH cat (4.1 kg)

Presenting complaint--acute paraparesis

Physical examination--mildly depressed; heart rate = 230 beats/min, regular rhythm; 4/6 holosystolic murmur (left hemithorax); femoral pulses absent bilaterally; nail beds cyanotic; rear limbs cool; increased respiratory rate (80 breaths/min) and effort; increased large airway sounds bilaterally

Emergency management--furosemide 2 mg/kg IM, O2 cage, nitroglycerin ointment

Thoracic radiographs:

Doppler echocardiography:

2DE:

Color Doppler

Spectral Flow Doppler: LVOT peak velocity (CW Doppler) = 3.7 m/s (DP = 55 mmHg) (normal = 0.8-1.4 m/s) IVRT = 46 ms (normal = 45-55 ms) (transmitral E & A peaks fused)

Arterial blood pressure: 110 mmHg (systolic)

ECG:

Other--serum creatine kinase = 2537 IU/L (normal 60-350 IU/L)

Treatment:

Case #2

"Bodhi"--1 year old male, neutered Labrador retriever (18.2 kg)

Presenting complaint & history--Presented to emergency service for labored breathing. Thoracic radiographs showed severe pleural effusion. 2.4 L fluid removed from pleural space (serum triglyceride = 31 mg/dl; pleural fluid triglyceride = 407 mg/dl)

Physical examination--Slightly thin; 2/6 holosystolic murmur (right hemithorax)

Doppler echocardiographic examination:

2DE:

Color Doppler:

Spectral Doppler:

 LVOT peak velocity (CW) = 1.15 m/s (DP = 5.3 mmHg)

 PA peak flow velocity (PW) = 0.80 m/s (DP = 2.54 mmHg)

 TR jet peak velocity (CW) = 2.66 m/s (DP= 28 mmHg)

ECG--Heart rate = 90 beats/min; negative P waves (sinus rhythm?)

Diagnosis:

Case # 3

"Digby"--1.5 year old neutered male American cocker spaniel (13.5 kg)

Presenting complaint & history--asymptomatic dog with a murmur. The dog had surgical RV outflow reconstruction in at 10 months of age for treatment of severe pulmonic stenosis.

Physical examination--grade 5/6 holosystolic ejection murmur over pulmonic valve area; left precordial thrill

Doppler echocardiographic examination

2DE:

Color Doppler:

Spectral Doppler--PA peak velocity (CW) = 5.72 m/s (DP = 131 mmHg)

Case # 4

"Phoebe"--9 week old female Shih tzu (1.7 kg)

Presenting complaint & history--asymptomatic dog with a murmur

Physical examination--grade 4/6 holosystolic ejection murmur loudest on right

ECG--WNL

Blood Pressure--108 mmHg (systolic)

Doppler echocardiographic examination:

2DE:

Color Doppler--mild pulmonic and aortic regurgitation; moderate mitral regurgitation

Spectral Doppler--peak LVOT velocity (CW) = 5.73 m/s (DP = 131 mmHg)

 peak PA velocity (PW) = 0.80 m/s (DP = 3 mmHg)

 IVRT = 126 ms

 transmitral (MV) E =0.78 m/s; MV A = 0.57 m/s; E/A =1.37

 transmitral A dur = 61 ms

 (pulmonary venous flow velocities not obtained)

Treatment

 atenolol 1 mg/kg PO BID

 enalapril 0.5 mg/kg PO BID

Follow up evaluation at age 9 months:

History--dog remains asymptomatic (weight = 3.6 kg)

Physical examination--normal

Blood pressure--122 mmHg (systolic)

Doppler echocardiographic examination:

2DE:

Color Doppler--trivial tricuspid regurgitation; trivial mitral regurgitation (no AoR)

Spectral Doppler--peak LVOT velocity (CW) = 0.99 m/s (DP = 4 mmHg)

peak PA velocity (PW) = 0.64 m/s (DP = 2 mmHg)

 IVRT = 79 ms

 transmitral E = 0.7 m/s; transmitral A = 0.46 m/s; E/A = 1.75

 transmitral A dur = 44 ms

 pulmonary venous (PV) S = 0.52 m/s; PV D = 0.56 m/s; PV Ar = 0.23 m/s; PV Ar dur = 61 ms

Case #5

"Orange"--5 year old, neutered male domestic short hair (5 kg)

History and presenting complaint--presented to emergency service for acute respiratory distress (thoracic radiographs showed severe pleural effusion; cytology suggestive of chyle)

Physical examination--increased respiratory rate and effort; rapid, irregular heart rate

Blood pressure--28 mmHg (systolic)

ECG:

Doppler echocardiographic examination:

2DE--spontaneous echo contrast; dilated LA; hypokinesis

Color Doppler--mild mitral regurgitation

Spectral Doppler--peak LVOT velocity = 0.78 m/s (normal 0.8-1.4 m/s); peak PA velocity 0.62 m/s (normal 0.8-1.7 m/s); IVRT 43.9 ms (normal 45-55 ms); MV E 0.90 m/s; MV A 0.62 m/s; E/A = 1.46

Diagnosis--probable restrictive cardiomyopathy with secondary chylothorax & secondary atrial fibrillation

Treatment--digoxin 0.3 mg PO QOD & quinapril 1.25 mg PO QD (furosemide ???? anticoagulation ????)

Follow up--cat returned in 8 days in respiratory distress due to pulmonary edema; 10 days later cat had embolic event and was euthanized

Case # 6

"Tundra"--5 year old, neutered male Rottweiler (39 kg)

History & presenting complaint--severe respiratory distress; murmur

Physical examination--increased respiratory rate and effort; 4/6 holosystolic left-sided murmur

Blood pressure--147 mmHg (systolic)

ECG:

Doppler echocardiographic examination:

2DE:

Color Doppler:

Spectral Doppler--peak LVOT velocity = 4.78 m/s (DP = 91.6 mmHg)

Case #7

"Rastus"--4 year old, neutered male domestic short hair (4.9 kg)

History & presenting complaint--weight loss; irregular cardiac rhythm

Physical examination--thin, + hepatojugular reflux; bradycardia with irregularly irregular cardiac rhythm; hepatomegaly; intermittent jugular pulsations

ECG:

Blood pressure--110 mmHg (systolic)

Doppler echocardiographic examination: M-mode values:

Paradoxical septal motion

2DE--Severe RA & RV dilation; mild pleural effusion; mild ascites; passive congestion of liver

Color Doppler--severe tricuspid regurgitation (no other regurgitant valves)

Spectral Doppler--peak LVOT velocity 0.8 m/s (normal 0.8-1.4 m/s)

peak TR jet velocity 0.9 m/s (DP = 3-4 mmHg); early peaking TR jet profile

Diagnosis--probably right ventricular dysplasia; early right-sided CHF; probable atrial standstill