Case 7 — Heart Murmur
Cindy — 4-month-old female toy poodle, 2.2 kg.
Primary clinician: Darcy Adin, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)
Signalment
- Species: Canine
- Breed: Toy poodle
- Age: 4 months
- Sex: Female
- Weight: 2.2 kg
- Name: Cindy
Presenting Complaint
- Heart murmur / Congenital Heart Disease
Pertinent History
- Cindy was diagnosed two months ago with severe congenital heart disease but was too small to intervene at that time. She has grown a little since then.
- The owner reports significant worsening of clinical signs. Cindy is more active (attempts to play with a new puppy) but her shortness of breath is gradually getting worse such that any activity precipitates dyspneic episodes.
- She gags when she drinks water.
- No persistent vomiting, diarrhea, coughing, or sneezing.
- Appetite very good; urination and drinking normal in volume and frequency.
- Diet: Pedigree Puppy and Nutromax kibble.
Physical Examination
- T = 101.3°F; P = 148; R = 52
- General physical examination unremarkable.
- Cardiovascular/Respiratory: Lung sounds unremarkable bilaterally, though difficult to auscultate due to the loudness of the heart murmur. Femoral pulses moderately strong bilaterally. No jugular pulse noted. Grade V–VI/VI systolic murmur heard loudest and palpated strongest on the right, but prominent at the left base as well. Possible split S2. Mucous membranes slightly darker than normal (difficult to evaluate given slight pigmentation); moist with a 1-second capillary refill time.
ECG
- Heart rate 100 beats/minute. Normal sinus rhythm. Deep S waves in the left and caudal limb leads (I, II, III, and aVF) producing a terminal right axis deviation. QRS complex duration normal (0.04 seconds).
Lab Work
- PCV = 68%
- Systemic arterial oxygen tension breathing 100% oxygen (soon after anesthetized) = 55 mmHg (normal is >90 mmHg on room air and >400 mmHg on 100% oxygen).