Case 4: Syncope

Case 4 — Syncope

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

Yankee was seen by the referring DVM two weeks ago with the complaint of fainting spells during active play. PE at referring DVM revealed a grade 3–4/6 left basilar systolic murmur and weak pulses.
Treatment was begun and consisted of furosemide 50 mg once a day and atenolol 25 mg TID.
Two days ago Yankee suffered another fainting spell during rest and the referring DVM increased the dose of furosemide to 50 mg TID.
The owner has been restricting exercise since then. Indoor at night/outdoor during the day, vaccines current, leash exercise only at park 3×/week.
No other past medical problems except cryptorchid. Neutered.
Diet: Lamb and Rice Pedigree kibble free choice and 1 cup rice + ½ can Pedigree (PM). No vomiting, diarrhea, coughing, or sneezing.

T = 103.6°F (excited), HR = 100, RR = panting, BCS = 5/9
BARH, well-fleshed, nice coat, no musculoskeletal abnormalities, no organomegaly.
Lymph nodes: left prescapular and popliteal lymph nodes slightly enlarged at 2 cm.
Lungs auscult clearly.
CV: CRT 2 sec, MM pink, weak femoral pulses, no jugular distension, Grade 4/6 left basilar systolic murmur with radiation to the right base and up the carotid arteries.