Case 10: Heart Failure

Case 10 — Heart Failure

Primary clinician: Brad Gavaghan, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Manny presented with exercise intolerance, weakness, and a moist cough.
Her referring veterinarian, based on a recent physical exam and chest and abdominal radiographs, diagnosed congestive heart failure.
She reportedly has had a heart murmur since the owner obtained her at four years of age.
Approximately 2.5 months ago she was treated by the referring DVM for coughing with 2 weeks of prednisone 20 mg BID. The coughing returned post-therapy and she was then treated with 2 weeks of prednisone 20 mg BID and Lasix 25 mg BID. The cough returned again upon completion of the prednisone therapy.
She remains on Lasix.
Referral radiographs show pulmonary edema, an enlarged cardiac silhouette, and hepatomegaly.
She is referred to the VMTH for further cardiac evaluation.

T = 101.8°F; P = 90; R = 60
General: Quiet and BARH. CRT <1.5 sec. MM pink and moist. Weight 32 kg.
Integument: Full coat, no lesions or abrasions. 1-cm dermal nodules on right sternum and left flank.
EENT: PLR bilateral. Ears clean. Tonsils in crypts.
MS: Full-fleshed; BCS 7/9.
Cardiovascular: Muffled heart sounds. Left apical systolic V/VI murmur; right apical III/VI systolic murmur. Brisk femoral pulses. Positive hepatojugular reflux test. Irregular rhythm.
Respiratory: Occasional deep wet cough. Enhanced bronchovesicular sounds and crackles in all areas. Eupneic to shallow breathing.
GI: Enlarged abdomen; ballottement does not suggest ascites. Liver approximately 2 cm from sternal border. Left caudal kidney pole smooth.
GU: Vulva pink and moist. Bladder smooth, roughly 2 cm in size.
Nervous: Not examined.
LN: Submandibular, prescapular, and popliteal <1.5 cm.

Loud systolic heart murmur / Congestive heart failure (historical) / Positive hepatojugular reflux test
Coughing / Pulmonary crackles
Arrhythmia