Case 26 — Heart Murmur

Clinician

Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Signalment

  • Species: Canine
  • Breed: Chow Chow
  • Age: 6 months
  • Sex: Female
  • Weight: 17 kg
  • Name: Tiffany

Presenting Complaint

  • Heart murmur

Pertinent History

  • Tiffany is presented to the VMTH Cardiology Service today for a second opinion of a previously diagnosed ventricular septal defect.
  • Tiffany was discovered to have a grade III–IV/VI systolic heart murmur at 12 weeks of age by the referring veterinarian, who recommended further evaluation with echocardiography.
  • Several weeks ago, a veterinary internist on consultation found Tiffany to have grade IV/VI left- and right-sided systolic murmurs. By echocardiography, the internist diagnosed a ventricular septal defect with an overriding aorta. Tiffany’s owners were told that there was no cure and that Tiffany may live 2–3 years before she developed severe heart failure.
  • Tiffany’s owners were told to watch for signs of coughing and abdominal distension indicating that Tiffany’s heart was failing.
  • Recently they were concerned that Tiffany’s abdomen was enlarged. Abdominal ultrasound by the referring veterinarian revealed enlarged hepatic vessels, but no ascites.
  • Tiffany comes from a litter of 6 pups. She and one of her brothers live together.
  • She is current on her vaccinations (DA2PPL, rabies, Bordetella). She has not begun to receive heartworm preventative.
  • She is kept outdoors in a run in the day and indoors at night.
  • She is fed Iams moist 1/3 can + Iams kibble 1 cup in the morning, then allowed free choice Iams kibble throughout the day.
  • Currently she is not receiving any medications.
  • Tiffany tires easily on walks. She also sneezes often and has consistent mild epiphora OU, as does her brother.
  • Tiffany developed moderate diarrhea 2 weeks ago when her owners changed her food. They gave her 2–3 teaspoons of Pepto Bismol and the diarrhea resolved within 2 days.
  • Her owners report no coughing, anorexia, vomiting, or PU/PD.

Physical Examination

  • General: BAR, playful and excited. T = 103.2°F; P = 140; R = panting. BCS 5/9.
  • Integument: Full, healthy hair coat.
  • EENT: Mild epiphora and staining of medial canthi OU, sclera and conjunctiva clear OU. Ears clean AU. Mild serous nasal discharge bilaterally. Moderate mandibular brachygnathism with mild palatal defects due to malposition of mandibular canines.
  • Musculoskeletal: No gait abnormalities, no palpable asymmetry.
  • Cardiovascular: Grade IV/VI left-sided and III/VI right-sided systolic murmurs. No arrhythmias or pulse deficits. CRT = 1 sec, mm pink and moist.
  • Respiratory: Intermittent stertor, eupneic, quiet inspiratory breath sounds auscultated diffusely.
  • GI: Smooth gut loops palpated, no pain elicited on palpation.
  • GU: Smooth and symmetric kidneys palpable, no vulvar discharge or erythema.
  • Nervous system: No gross deficits noted on physical examination.
  • Lymph nodes: Mandibular and popliteal lymph nodes < 1.5 cm diameter. Prescapular, axillary, inguinal lymph nodes not palpable.

Problems

  • Heart murmur previously diagnosed as ventricular septal defect
  • Mandibular brachygnathism
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