Dilated Cardiomyopathy

 

Patient: XXXXXXX
Species: Canine
Breed: Great Dane
Gender: Male/Neutered
Age: 6y 0m
Weight: 62.1 kg. / 137.0 lbs.
ECG Findings
Heart Rate 300
Rhythm Atrial fibrillation
Interpretation Abnormal

Data available for interpretation
Data available for interpretation ECG, thoracic radiographs, echocardiogram

Radiographs
Radiographic evaluation The cardiac silhouette is round in the lateral view but it is of normal size and shape in the VD view. Cranial and left caudal lobar pulmonary vessels are of normal size; right caudal lobar pulmonary vessels are not clearly seen. No obvious abnormalities are noted within the lungs. The visible tracheal lumen is open.
Interpretation The round cardiac silhouette in the lateral view suggests enlargement.

Echocardiography
Echocardiographic evaluation Right parasternal 2D, M-mode, and pulsed wave and color flow Doppler longitudinal and cross sectional images were reviewed. Diastolic dimensions of interventricular septum (IVSd= 6.7 mm) and left ventricular free wall (LVFWd= 7.7 mm) are moderately decreased (thin). Diastolic internal diameter of the left ventricle (LVIDd= 73.0 mm) is mildly to moderately increased (dilated). Contractility is reduced (fractional shortening approximated at 17%). The left atrium is mildly to moderately enlarged (LA:Ao up to 1.8:1.0). Although suspected, mitral insufficiency is not seen. The right heart is unremarkable. Tricuspid insufficiency is not seen.
Interpretation Thin left ventricular walls and mild to moderate left heart enlargement are consistent with dilated cardiomyopathy.

Recommendations and Therapy
Additional comments ECG: Atrial fibrillation is again present (first noted 3/12/08); the heart rate remains quite high (was 290 3/12/08).
Therapeutic considerations Because of atrial fibrillation, maintain digoxin 0.3125 mg (2.5 of 0.125 mg tablets) PO q 12 h and diltiazem 30 mg PO q 8 h. Because of dilated cardiomyopathy, begin enalapril 20 mg PO q 12 h. Furosemide and pimobendan are not yet recommended; they should be reserved until the development of pulmonary edema and/or ascites. Evaluate the patient, serum biochemistry profile, serum digoxin concentration (obtained 6-8 hours after the morning dose), and ECG in 7-10 days.
Matthew Krecic, DVM, MS, Diplomate ACVIM

 

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