C09986596 / invoice 10000

Reason: Echo GAP ONLY HISTORYFirst clinical signs - heart murmur first detected Jan 2024, coughing at nightSummary - MMVD Stage B2, mild bronchial pattern and bronchial compression from enlarged cardiac silhouette Diagnosis - MMVD Stage B2, chronic bronchitis Treatment - commence Pimobendan 2.5mg PO BID Presented for evaluation of a systolic heart murmur.Murmur detected Jan 2024  Clinical signs: coughing over the last few months at night, RRR normal when sleeping, but has been seen panting more at other times Cardiac exam: BAR. HR 124bpm, regular. Grade III/VI left apical systolic heart murmur. Normal respiratory rate and effort, no crackles or other abnormal lung sounds detected.Echocardiogram 2-DAo Diam 9.6mmLA Diam 20mmLA/Ao 2 (Stage B2 criteria =1.6) previously 1.4M-ModeIVSd 9.2 mmLVIDd 34.6 mmLVPWd 6.5 mmIVSs 19.7 mmLVIDs 15.4 mmLVPWs 13 mm%FS 55.47 %Echo Findings Left Ventricle: Eccentric hypertrophy present (LVIDDn 1.74 Stage B2 =1.7 ). Previously 1.4Right Ventricle: Normal size and function. Left Atrium: Moderate/severe dilatation. Right Atrium: Normal size. Mitral Valve: Mitral valve is thickened with myxomatous degeneration, septal leaflet prolapse, large regurgitate jetPulmonic Valve: Structurally normal, no stenosis or regurgitation. Aortic Valve: Trileaflet, structurally normal, no stenosis or regurgitation. Tricuspid Valve: Structurally normal, mild regurgitation. Pericardium: The pericardium is normal. There is no pericardial effusion.Procedure:Views taken: right lateralDiaphragm: intact Pleural space: no air or fluid visualised. No evidence of pneumothorax, hydrothorax or pleural effusion Mediastinum: cranial mediastinum grossly normal with homogenous soft tissue appearance. Width is within normal limits with no masses or fluid identified.Pulmonary: mild bronchial pattern, no evidence of pulmonary oedema Trachea/Bronchi: grossly normal, normal dorsal tracheal membrane Oesophagus: grossly normal with no air, dilation or foreign bodies identified Cardiac: cardiomegaly and atrial enlargement, VLAS 2.8 previously 2Extra-thoracic structures: no significant abnormalities identified. Normal skeletal and subcutaneous structures Interpretation:- cardiac and LA enlargement - mild bronchial pattern ASSESSMENT1. Mitral valve thickening and prolapse, moderate mitral regurgitation, moderate-marked left-sided volume overload consistent with myxomatous mitral valve disease2. MMVD stage B2. Significant risk of developing LSCHF in the futurePLAN1. Commence Pimobendan 2.5mg PO BID, dispensed 40 tablets to see if well tolerated, can dispense 3mths worth next time 2. Re-check in 2 weeks to assess response and if improvement in coughing as can consider low dose Frusemide trial to see if coughing responds 3. Monitor sleeping respiratory rates daily, should be <30bpm, if consistently increased then complete thoracic radiographs to assess for evidence of pulmonary oedema then commence Frusemide4. Avoid strenuous activity and avoid high salt dietary intake5. Repeat echo in 6 months time6. Moderate-marked increase in anaesthetic risk. Avoid more than maintenance fluid rates if possible. Pre-medication with low dose acepromazine/opiod, induction with alfaxane and maintenance with isoflurane.7. Prognosis can vary for Stage B2 patients with LSCHF taking months to years to develop, with the average time to progress into Stage C MMVD is approximately 2 years. Pimobendan delays onset of CHF by average of 15 months. Average lifespan from the onset of CHF is 12-18 months.--- 04/03/2026 08:44:57 JP:Dental Checkup - Skipped on 21/05/2025    Vital Signs