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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
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