C09980597 / invoice 10000

Diagnostic Imaging:  ECHOCARDIOGRAMPerformed by Dr Sylvana ZhuSedation: butorphanol 0.23ml IV, ACP 0.04ml IV (attempted with only butorphanol, but was very wrigglyReport:B-mode (each figure averaged over a minimum of 3 measurements, unless otherwise specified)LA (LAx) 24.73 mmAo (LAx) 13.3 mmLA:Ao (LAx) 1.85 (normal <2.6)LA (SAx) 23.33 mmAo (SAx) 16.03 mmLA:Ao (SAx) 1.39 (normal <1.6)PA:Ao approx 1:1M-mode (each figure averaged over a minimum of 3 measurements, unless otherwise specified)IVSd 9.16 mmLVIDd 24.53 mmLVPWd 7.7 mmIVSs 12.63 mmLVIDs 15.1 mmLVPWs 10.5 mmFS 38.4 %DopplerPA Vmax 0.68 m/s (normal <1.4 – 1.8)Ao Vmax 1.17 m/s (normal <2)MR Vmax 5.06 m/sSonographic findings:- normal LA size and normal LA/Ao- normal LV dimensions during diastole- adequate systolic function- moderate MR with MV thickening and mild prolapse- mild PI (likely incidental)= suggestive of stage B1 MMVD, although it is possible that there has been mild and temporary reduction in heart size secondary to commencement of heart meds1355 SZ tried to call Hergeanne to discuss results; O did not answer and was unable to leave voicemail1620 SZ had long conversation with O over the phone (O only able to pick up Nacho in evening, after SZ finishes shift). Discussed echo findings still suggestive of stage B1 MMVD, and T-FAST unremarkable. Therefore I am not 100% convinced that Nacho is truly in CHF. Advised that echo is more sensitive cf thoracic rads for assessing heart size, and possibly there has been slight reduction in heart size resulting from mild dehydration caused by furosemide use - however, even if this were the case, wouldn't have expected complete normalisation. LA/Ao today was ~1.4, which is fairly comfortably WNL.O confirmed that there has not been much change in breathing since starting the heart meds; still completely normal during the day, but intermittently tachypneoic overnight, possibly correlated with ambient temperature. Seemed to breathe ok overnight while Os were away, as the accomodation had aircon, but the times when he did breathe up overnight might have correlated when O was back at home with no aircon.Discussed potential gradual reduction in furosemide - e.G., dropping from 10mg BID -> 10mg in AM and 5mg in PM -> 5mg BID etc, only dropping dose if clinically unchanged over 4-5 days. O to monitor RRR closely and to ideally maintain stable ambient temperature. Will call next Tuesday to check in on Nacho.Discharge notes:Nacho’s echocardiogram was suggestive of Stage B1 Myxomatous Mitral Valve Disease (MMVD), similar to the previous echocardiogram performed in February 2025. The heart did not appear to be significantly enlarged. As we discussed over the phone, it is possible that the commencement of heart medications (particularly the diuretic – furosemide) may have caused a temporary and mild reduction in heart size. However, given there has not been a dramatic improvement in Nacho’s breathing following the commencement of heart medications, we can consider tapering the diuretic medication (furosemide). The following would be a reasonable plan:- Currently on furosemide 10mg (½ of a 20mg tablet) morning and night- Reduce to furosemide 10mg (½ of a 20mg tablet) in morning and 5mg (¼ of a 20mg tablet) at night- If unchanged over 4-5 days, reduce further to furosemide 5mg (¼ of a 20mg tablet) morning and night- If unchanged over 4-5 days, reduce further to furosemide 5mg (¼ of a 20mg tablet) once in the morning- If still unchanged, consider discontinuing entirely- The pimobendan (Vetmedin) is fine to continue with indefinitely.Throughout this process, please monitor Nacho closely for any changes in respiratory rate or effort. If you are concerned that his breathing is deteriorating at any stage, please resume the furosemide at previous doses, and please contact us for advice. If possible, please also aim to maintain a stable ambient temperature.    Vital Signs    Weight: 7.7;