Case 17: Heart Murmur

Case 17 — Heart Murmur

Primary clinician: Darcy Adin, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Chico presented to the referring DVM 7 weeks ago to be neutered. Postponed due to coughing. Auscultation unremarkable; placed on Clavamox 62.5 mg BID for 14 days.
Two weeks later neutered without complication. Cough had subsided.
Represented four weeks ago for mucoid nasal discharge and cough. Placed on Clavamox again.
Placed on Tussigon 5 mg BID two weeks ago, then Torbutrol 1 mg TID ten days ago for continued coughing.
One week ago a IV/VI systolic murmur was auscultated; thoracic radiographs revealed cardiomegaly and pulmonary edema. Placed on Lasix 10 mg BID with no response in cough.
Owner has had Chico 8 weeks. No change in activity or appetite. He is very active. Coughs throughout the day; possibly coughs up saliva/fluid.
Owner has been giving Lasix once a day instead of BID (misunderstood instructions). No vomiting or diarrhea.
Owner noticed odd respiratory motions (lurching when breathing, lasting about a minute) and yelping/squealing while eating.
History of one strangulation/choking episode on choke collar at previous owner’s house.

General: BARH. Very active. No integument, EENT, MS, or LN abnormalities.
GI/GU: Slightly tender on abdominal palpation. Small smooth bladder.
CV: HR 140. Grade V/VI continuous murmur heard best over the left cranial–ventral thorax (left axillary region). Regular rhythm. Very strong/bounding femoral pulses. No jugular pulses or pulse deficits.
R: RR 40; eupneic. Clear lung sounds all fields. Tracheal palpation elicited a cough.