When the Cardiologist is Out: ASE-Based Approach to Cardiac Disease for the Generalist
World Small Animal Veterinary Association World Congress Proceedings, 2007
Clarke E. Atkins, DVM, DACVIM (Internal Medicine & Cardiology)
Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine

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

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

Clarke E. Atkins, DVM, DACVIM (Internal Medicine & Cardiology)
NCSU
NC, USA


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