C09986840 / invoice 10000

Reason: Needs Echo- Admit Booked For Same DayAppointment Notes: RQHistory:Had an echo with DL in Sept 2024 - Severe stage C DMVD and CHF with mild pulmonary hypertension. Saw Dr Armin in GP early Jan 2026 for a GHC - they had been to another vet over the holidays as his SRR was high, no coughing noted - furosemide was increased to 60mg per day. Settled down once they got home and since then was reduced back to 40mg PO per day. SRR has been in the 20s, nothing consistently high. O has been away for a few weeks - O has noticed he his not moving around as much. No collapse/syncope episodes noted. Going on short walks daily. Had hip dislocation and had surgery, very tender on it at night. On gabapentin for this. Current medications: - 12.5mg Spironolactone PO q12h - 2.5mg Vetmedin PO q12h - 2 tablets (78) HypoK PO q12h- 20mg Furosemide PO q12h- 100mg Gabapentin PO q24h (once in the evening) Subjective: BAR, ambulatoryObjective: MM pink, CRT 2 secEupnoeic, lung sounds normalHR 120 bpm, Grade V/VI pansystolic mitral regurgitant murmur. Fremitus right thoracic wallOccasional extra depolarisation. Assessment: Needs echo & ECGProcedure: ECG: sinus arrhythmia with wandering pacemaker. Very occasional left ventricular extra depolarisationUltrasound: Echocardiography:Reference Values for 10kg DogLA = 30mm (13.5 - 19.5mm) (was 33)Mitral valve leaflets thickened. The posterior leaflet and its chorda tendinae show marked myxomatous nodular change.RA = 22mmLA:Ao ratio = 1.39   (was 1.9)AOT Vmax = 0.71m/sPOT Vmax = 0.64m/sMitral RJ Vmax = 5.58m/s......................................................PG = 125mmHg   "      "    Vmean = 3.98m/s...................................................PG = 72mmHgRegurgitant jet occupies 50% of LATricuspid RJ Vmax = 2.61m/s ...............................................PG = 27 mmHgPulmonic RJ Vmax = 1.70m/s................................................PG = 11.5mmHgAortic RJ = trivial, not measured M mode:RVD = subjectively normal IVSd/s = 7/13 (6.0 - 8.2mm[D] / 9.2 - 12.5mm[S])LVIDd/s = 37/18  (29 - 36mm[D] / 18 - 24mm[S])LVPWd/s =  6/14 (5.0 - 7.2mm[D] / 7.5 - 11.0mm[S])Ejection Fraction = 84%Fractional Shortening = 52%DIASTOLIC STUDIES:Mitral E wave = 0.93m/sMitral A wave = 1.17m/sE:A ratio = 0.80Decel time 114ms Assessment: DMVD stage B2. Grade 1 diastolic dysfunction (impaired relaxation). It is difficult to believe this dog was in LCHF 18 months ago.Plan:Stay on current medication:Pimodendan 2.5mg PO q12hSpirinolactore 25mg PO q24h (NOT 12.5mg q12h)Frusemide 20mg PO q12hRecherck echo in 12 months    Vital Signs    

Appointment Notes: Overdue remindersNeeds script for meds: Vetmedin Spirinolactone Frusemide Stop hypoK OK to cont w gabapentin    Vital Signs    

Appointment Notes: Overdue reminders    Vital Signs