Case 40: Ascites

Case 40 — Ascites

Primary clinician: Rita Singh, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Chanel, a 3yo FS Maltese, was presented to the UC Davis Cardiology Service for evaluation of ascites.
2–2.5 months prior to presentation, the owner noted that Chanel’s abdomen was distended. A friend suspected that this was abnormal and Chanel was presented to a veterinarian. Radiographs revealed a large caudal vena cava and ascites. An abdominocentesis was performed.
2 or 3 weeks prior to presentation, Chanel was seen by a veterinary cardiologist who diagnosed a congenital heart defect.
ECHO: Objective measurements: LV measurements not taken. LV and LA are WNL in size and structure and contractility is good. LA/Ao ratio 1.2, LVOT velocity 0.73 m/s, PG 2.13 mmHg (laminar flow), RVOT velocity 0.97 m/s, PG 3.75 mmHg (laminar flow), Tricuspid inflow: laminar, E wave 0.58 m/s, A wave 0.67 m/s, EA ratio 0.87 mg.
Abdominocentesis was repeated with each veterinary visit. Furosemide was prescribed and Chanel was referred to the UC Davis VMTH for further evaluation and treatment.
The owner noted that Chanel’s appetite and energy level improved following abdominocentesis. Chanel occasionally breathes heavily after exercise. These episodes were described as resembling an asthma attack.
The owner reports normal drinking, urination and stools. No C/S/V/D. No other significant medical diseases or surgeries aside from a spay.
DIET: Nutro dry kibble, and Cesar’s wet food.
MEDICATIONS: Furosemide 12.5 mg PO BID.

GEN: BARH, T 101.6, P 200, R pant, MM pink, CRT <1s.
INTEG: Full clean hair coat, no evidence of ectoparasites. Clean skin, no masses.
EENT: Eyes: Cornea and anterior chambers clear OU. Clear lens OU. No discharge noted OU. Ears: Clean, no discharge. Nose: Clean and moist. Oral: No masses or foreign bodies noted, tonsils in fossae.
MS: BCS 5/9, ambulatory x4; adequate and symmetrical muscling.
CV: HR 200. II/VI right basilar continuous murmur, pulses thready and synchronous.
RESP: RR pant. No crackles or wheezes auscultated.
GI/GU: Markedly distended abdomen with palpable fluid wave. RECTAL: Not performed.
NS: Appropriate mentation and gag reflex.
PLN: Mandibular, superficial cervical, and popliteal lymph nodes approximately 1 cm.