Nimbus has been doing reasonably well at home. She has good energy and is very active, but she tires easily and will lay on her side and pant until she catches her breath again. She has not had any syncope. Her appetite and water consumption are unchanged.
Physical Examination
General: BARH. T = 101.0°F.
Integument: Normal.
EENT: Normal.
Musculoskeletal: BCS = 5/9.
Cardiovascular: IV/VI left parasternal systolic murmur. Strong synchronous femoral pulses. HR = 200. MMs pink and moist, becoming cyanotic when stressed by restraint. CRT < 2 sec. No jugular pulses.
Respiratory: Bronchovesicular sounds ausculted in all lung fields. RR = 40–60.
GI: Normal.
GU: Normal.
Nervous system: Normal.
Lymph nodes: Normal.
Comments
Echocardiogram: Marked right ventricular concentric hypertrophy with right ventricular free wall thickness of 6 mm and a left ventricular free wall thickness of 4 mm. Large ventricular septal defect with laminar flow from right ventricle into the overriding aorta; narrowed RVOT with malpositioning of pulmonic valve and pulmonic stenosis – highest velocity recorded across pulmonic valve 5.4 m/s (pressure gradient of 117; therefore approximate RV and LV pressure of 140 mmHg).
Thoracic rads: Static cardiomegaly and pulmonary hypoperfusion.
PCV: 51%; TP = 7.4 gm/dl
Conclusions: Echocardiography findings again document tetralogy of Fallot with pulmonic stenosis, overriding aorta, VSD, and RV concentric hypertrophy. Right-to-left shunting of blood flow is present with laminar flow evident from the right ventricle through the large ventricular septal defect into the aorta. The PCV of 51% is elevated. If she becomes more polycythemic and exhibits clinical signs we will consider hydroxyurea therapy or phlebotomy. Clinically Nimbus is not cyanotic at rest. When severely stressed by restraint, she did progress to open-mouth breathing with increased abdominal effort and cyanosis which resolved within minutes with rest. The owner is interested in providing a good quality of life for Nimbus, but declines invasive treatments.
One Year Later
Pertinent History
Nimbus was diagnosed with tetralogy of Fallot here in 1/02. She has been doing reasonably well at home since then. She has good energy and is very active, but she tires easily and will lay on her side and pant until she catches her breath again. The owner is concerned that Nimbus is obese. She is also worried about Nimbus’s strange habit of drinking contact lens solution due to the high sodium concentration.
Physical Examination
General: BARH. P = 186. RR = 60.
Integument: Full hair coat, shedding. No masses or lesions noted.
EENT: Normal.
Musculoskeletal: BCS = 6/9.
Cardiovascular: III/VI left parasternal systolic murmur. Strong synchronous femoral pulses. HR = 186. MMs pink and moist. CRT < 2 sec. No jugular pulses.
Respiratory: Bronchovesicular sounds ausculted in all lung fields. RR = 40–60.
GI: Normal.
GU: Normal.
Nervous system: Normal.
Lymph nodes: Normal.
Clinical Diagnosis
Tetralogy of Fallot
Comments
Echocardiogram: No change from last echocardiogram.
PCV: 50%
Conclusions: Echocardiography findings again document tetralogy of Fallot. The PCV of 50% is static, which is a good prognostic sign. The owner was instructed to come back in one year for a recheck unless Nimbus has any problems.
Six Years Later
Telephone conversation – In a conversation with Nimbus’ owner, he indicated that she is alive and doing well. She will still play a bit hard and then get winded and have to lie on her side for a while and breathe heavily. Other than that he feels that she is quite normal clinically. She is the only pet in the household since the owners feel that another pet would put too much stress on Nimbus. Besides, he feels that Nimbus enjoys being an only child.
Twelve Years Later (goes into right heart failure)
Presenting Complaints
Labored respiration
Anemia
Pertinent History
Nimbus, a 12 year old spayed, indoor/outdoor female DSH, presents for recheck of her lethargy, inappetence and increased RR/effort.
She was diagnosed with a tetralogy of Fallot about 10 years ago, and had not been seen by a veterinarian until her visit on April 26, 2013.
About a month ago, Nimbus became lethargic, flopping to her side after walking only a few steps, and had heavy or labored respirations. She also became anorexic except for fish and shrimp table scraps she received.
Blood work at that time showed a mild, normocytic, normochromic, non-regenerative anemia with a Hct of 27.7%. No other abnormalities were noted on the differential analysis.