Cardiac Case Study
Bowie Culp
Advanced Veterinary Terminology
Angela Culp
Bowie at the time of initial visit on 5/18/2013 was 13 years 6 months old neutered male, mixed pointer,
weighing 41.8 pounds. Patient was presented by owner to the clinic with an acute onset of respiratory distress, pale
gums, coughing and gagging at times. Physical exam in November 2012 marked a history of II/VI heart murmur. Blood
work at the time was unremarkable and within normal limits.
On the first initial visit, over an 8 month case, the physical exam of the patient was that he had harsh lung
sounds on the right side with possible crackles. Patient was using an increase in respiratory effort, but was bright alert
and responsive. Eating and drinking well with a playful attitude and tail wag. On the radiographs it was determined by
the Vertebral Scale System that there was a slight enlargement in the heart with a 1 point increase. Radiographs also
indicated an interstitial pattern of pulmonary edema around the dorsal heart. At this time the patient was diagnosed
with pulmonary edema secondary to chronic heart failure, possible mitral valve issues. Patient was placed on Lasix 20
mg: ½ tablet by mouth every 12 hours and Benazepril 5 mg: 1 tablet by mouth every 12 hours.
Second visit was a week later and patient was in respiratory distress and now had emesis. Patient had
pale pink mucous membranes. At this time an intravenous catheter was placed as well as intranasal oxygen tubing.
Overnight the patient was on 3-4 Liters/minute for an overnight stay with an injection of Lasik 1.25 ml given
intravenously. Radiographs were retaken and showed more advanced pulmonary edema. At this time patient was
diagnosed with progressive chronic heart failure. Oral medications to be continued dosed as Lasik 50 mg: ½ tablet by
mouth every 12 hours and Benazepril 5 mg: 1 tablet by mouth every 12 hours. Patient was to follow up in the morning
with an echocardiograph with the cardiologist.
Canine Echocardiograph report found that there was dilation in the left atrium. There is a slight separation of
the mitral valve. Overall blood pressure was 157.5 with no signs of hypertension or arrhythmia’s. The patient was also
placed on Vetmedin 5 mg: 1 tablet every 12 hours.
Three months later the patient came in for a visit of a recheck of radiographs to check the vertebral heart score.
This had increased by another point and was reading at 12. There was also an increase in the left atrium that was
causing airway impairment and causing a slight cough. Medications prescribed were Prednisone 20 mg: ½ tablet every
12 hours, Tramadol 50 mg: 1 tablet every 12 hours, and Spirolactone 25 mg: 1 tablet every 12 hours. Patient was to
continue with previously prescribed medications of Benazepril, Lasik and Vetmedin.
A recheck echocardiogram was performed by the cardiologist two months later. At this time the physical exam
revealed an abdominal fluid wave with the accumulation of ascites. Patient’s heart now had an arrhythmia with an
increase of a heart murmer with a grade of VI/VI. The echocardiogram showed left ventricular dilation with a 5.5
centimeter internal diameter. Fractional shortening is measured at 29% due to significant mitral regurgitation. Septal
separation increase suggested left ventricular dilation and systolic dysfunction. Left atrium is significantly enlarging with
a ration of greater than two. The cardiologist said to up the Vetmedin to every 8 hours and to keep an eye out for
distress.
Owner brought in the patient on 12/19/2013 showing signs of respiratory distress. Patient was now weighing 38
pounds with a significant muscle mass lost. Patient was coughing and showing more signs of weakness. Owner had tried
to increase Lasik to 25mg every 12 hours to help with the ascites. We agreed at this time that this was the right time to
euthanize due to his discomfort. An intravenous catheter was placed and 10 milliliters of Propofol was administered for
sedation. Gave the patient 6 milliliters of Euthasol and followed with heparinized saline. Patient is to be cremated and to
be returned to owner.