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WHEN THE CARDIOLOGIST IS OUT:
CASE-BASED APPROACH TO CARDIAC DISEASE FOR THE GENERALIST
Diplomate, ACVIM (Internal Medicine & Cardiology) 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?

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


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
TPRWt = 38.70 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
Name: 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

Source: http://www.laveccs.org/biblioteca/file/When%20the%20cardiologist%20is%20outt.pdf

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