When the Cardiologist is Out: Case-Based Approach to Cardiac Disease for the Generalist
World Small Animal Veterinary Association World Congress Proceedings, 2011
Clarke Atkins, DVM, DACVIM (Internal Medicine and Cardiology)
Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine, North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA



 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


 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


 Partial anorexia

 Cough, tachypnea

 Cardiomegaly (historical)

 Murmur & S3 gallop

 Differential diagnoses?




 Client education?



 8 year-old male, Doberman pinscher


 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


 Echo - SF = 13%, thin-walled LV

 CV problem list:

 Compensated DCM

 Myocardial failure?


 Heart rate/arrhythmia?

 Heart failure?

 Hypo-, hypertension?

 Loading (pre-, after-)?



 Neurohumoral activation (RAAS, SNS)?


 Therapeutic options - What would you do?



 Sodium restriction



 Ca channel blocker (Amlodipine, Diltiazem)

 Beta blocker (Carvedilol, Atenolol)




 Carnitine, taurine

 Fish oils






 West Highland White Terrier

 12 year 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

 TPRWt = 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


 Problem list?





 Loud S2

 Differential DIagnoses?




 Client education



 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



 Differential diagnoses




 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)
Department of Clinical Sciences, College of Veterinary Medicine
North Carolina State University
Raleigh, NC, USA

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