Case 19 — Collapsing

Primary clinician: Aaron Wey, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Signalment

  • Species: Canine
  • Breed: Labrador retriever cross
  • Age: 8 years
  • Sex: Male castrated
  • Weight: 35 kg
  • Name: Axel

Presenting Complaint

  • Collapsing Episodes

Pertinent History

  • Two weeks ago the owner noted Axel had a cough. Taken to referring DVM; thoracic radiographs taken; kennel cough diagnosed. Ciprofloxacin 250 mg PO q12h prescribed. Cough responded to treatment.
  • One week ago Axel fell and was found in lateral recumbency, unresponsive. He urinated and defecated during the episode (~30 sec). Was disoriented afterward. Later that day, collapsed while playing ball — a shorter episode while remaining responsive.
  • Four days ago had another short collapse and a longer episode with urination/defecation and unresponsiveness. CBC and serum chemistry WNL at referring DVM.
  • Cardiac ultrasound: SF = 10%, LVFW = 0.5 cm, RVFW = 0.9 cm, increased RV lumen. Digoxin 0.125 mg PO q12h started.
  • Episodes continued (~2 daily for last 3 days). Owner reports lethargy and polydipsia.

Physical Examination

  • Presented to ICU after acute collapse in parking lot. Upon presentation, responsive and standing.
  • T = 101.8°F; RR = panting; HR = 120. Pulses adequate; MM pale.
  • Well-fleshed; BCS 6/9. Eyes clear. CRT = 2 sec.
  • 3/6 left basilar murmur. No pulse deficits; femoral pulses fair.
  • Bronchovesicular sounds in all lung fields.
  • No masses on abdominal palpation. No peripheral lymphadenopathy.

Problems

  • Collapsing episodes
  • Heart murmur
  • Polydipsia

Plans and Progress Notes

Axel was admitted to ICU. PCV = 45%; TP = 6.5; blood glucose = 62; lactate = 3.6 mmol/L (normal <1); Na = 150; K = 3.4; Ca = 1.04. When walked from ICU to cardiology, Axel had a collapse episode — fell to lateral recumbency, unresponsive, urinated and defecated. MM pale; pulses fair. HR ~80 bpm increasing to 150 bpm over 30 seconds. Became responsive but remained lateral and vocalized. Recovered within 5 minutes.

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