Nathalie Cunha

Thanks Andy for posting. After watching lesson 1 I was wondering if this could be the cricopharyngeal dysphagia that was mentioned.
Only water comes out the nose. Not food. You can see the abnormal swallowing movements and nasal water regurgitation on the video link.
Excited to have more input on the case.

Hi everyone,
In the past 3 weeks we had 2 similar cases. Both times indoor cats, both 1-2 years old, no recent vaccination or anesthesia and both presented with HCM phenotype and left sided CHF. Troponine measured 38 ng/ml in one case and 36 ng/ml in te other case. In both cases we suspect Covid.
One cat stabilized quickly on torasemide, the other cat staid in the clinic for 2 weeks and needed Oxygen at first and a feeding tube since she stopped eating. She is finally doing better now. It is nice for cases like these if we can put some image material on the discussion forum but I don’t think that is possible at this moment?

Replying to Liz Bode 21/06/2021 - 20:49

Hi Liz,

Is the ECG speed 50 mm/sec? I don’t see it on the last ECG exercise.

Kind regards

Nathalie

Replying to Liz Bode 17/06/2021 - 22:15

Hi Liz,

I was not notified by e mail that you responded to the ECG, nor that you posted a new one. Maybe it is because of the new website (which looks awesome by the way).

This ECG looks regular. Rythm 160 bpm if I do pen complexes / 180 bpm if I count boxes. I see a P pulmonale suggesting right atrial enalrgement. QRS is splintered. The T wave is difficult to me if the enlargement means anything (like myocardial hypoxia). Because it is regular, and I have P:QRS coupling 1/1 at this rate I would say it is sinus tachycardia.

The P pulmonale and splintered QRS combined with the signalement (young Labrador) would make me think this dog has tricuspid valve dysplasia.

Kind regards

Nathalie

Hi Liz,

Would you expect the same for dogs. Improved systolic function after 3 months of Taurine supplementation?

Kind Regards

Nathalie

Hi Liz,

I was able to watch the video’s when I downloaded the powerpoint file 🙂

My attempt:

PLAX view:
The IVS looks like it is bowed to the right side suggesting right ventricle volume overload.
The IAS also looks like it is bowed to the right suggesting left atrial enlargement.
Systolic function looks depressed.
There is little movement of the mitral valve leaflets suggesting elevated EPSS if you would perform an M mode on this view.
I don’t see any thickened leaflets but MMVD in large breed dogs usually don’t have thickened leaflets. But no thickening also suggests to me that MV endocarditis is more or less excluded? I did read once that not all lesions are vegetative and you can also have erosive lesions which are harder to diagnose?
I don’t see any signs of mitral valve dysplasia in this view.
Colour Doppler: shows a central jet suggesting DCM (primary or secondary) since MMVD or MV dysplasia would have a eccentric jet.

Short axis:
Systolic function looks depressed on the short axis B mode of the left ventricle.
M mode: hypokinesia of the IVS. I thinks posterior wall thickness might be a bit overestimated because the cursor goes trough the pappilary muscle a bit? Since PW moves more than lateral wall I think this also speaks against MMVD since IVS would move more than PW.
The LA/Ao looks enlarged suggesting left atrial enlargement. The pulmonary artery also looks enlarged (Ao/PA less than 1). PA enlargement suggests shunt or pulmonary hypertension to me.

Further testing:
I think blood works did not say anything about Taurine yet? If not tested yet then I would send this in especially because of the diet this dog gets.
I think I would still order a Holter since I am not shure if tachy arythmia could still be a cause even though it was not visible on a short ECG. Could a tachy arythmia be paroxysmal and causing secondary DCM?
In the history of this dog a reverse shunt causing PHT sounds less likely with this patient history but bubble study would exclude these causes?
I would still like to have a thorax x-ray in this patient especially looking for signs of lung disease, thrombo embolism or parasites. I tend to lean to pulmonary hypertension type II caused by left heart systolic dysfunction but sometimes you have multiple diseases in 1 patient so I would like to exclude some other concurrent diseases also causing pulmonary hypertension.

The issue I am doubting … what about chronic myocarditis? Troponine would not be elevated anymore? How to diagnose this in the chronic stage because myocarditis can look like DCM on echo.

Kind regards

Nathalie

Hi Liz,

I have no idea what BAR means in your case? Breathing:ausculatation/respiration?

My attempt

Problem list:

– Lethargy and exercise intolerance.
These symptoms are not pathognomonical to me an can be caused by multiple causes like endocrine disorders
(hypothyroidism, diabetes, cushings, …) , heart problems (structural heart disease and arrythmias), infection,
anemia, ….. the list goes a bit on and on.
– Cough: Non productive honking cough at night
My first thought would be tracheal instability or something pressing against the trachea. I would put
tracheobronchitis in my list to I think.
– Hypodynamic pulse
My differantials would be hypovolemia, hypotension, forward heart failure, pericardial effusion (but then I would
expect to have muffled heart sounds and prononced jugular distention), severe subaortic stenosis could give weaker
slow rising pulses but this does’t fit with the region of the heart murmer since it would be located at heart base.
– Grade III left apical systolic murmer
Differentials: MMVD, DCM with secondory traction on the mitral annulus due to heart enlargement (however I wonder
if grade III is to loud for a DCM murmer?), MVendocarditis, MV dysplasia
– Grade II right apical systolic murmer
Differentials TV degeneration, TV dysplasia, murmer caused by radiating left sided murmer, I don’t know if DCM that
also affects the right side can give a right sided apical murmer due to traction on the tricuspid annulus?

I would advice:
Bloodworks: hematology, biochemistry and I usually already ask for Troponine in a case like this
ECG (5 minutes) or Holter
Echo of the heart
X-ray of the thorax
Blood pressure measurement

Kind regards

Nathalie