C09991982 / invoice 10000

Reason: Echo 11am Drop Off Okayed By RKCHistory: Here for echo today. Seen by RCS yesterday for consultation. Referred by GP department as new grade II/VI heart murmur was auscultated at vaccination appointment last week. Subjective:BARObjective:RR: pant , RE: normalHR: 120 MM: pink, CRT <2sBT: 38.8CBP readings: Systolic/Diastolic (Mean)1pm...............135/85 (102)Ultrasound: Echocardiography:ECG: sinus arrhythmia with wandering pacemakerReference Values for 15kg DogLA = 30  (16.0 - 20.0mm) RA = 20LA:Ao ratio = 1.68AOT Vmax = 0.83m/sPOT Vmax = 0.88m/s Right parasternal long axis view:Mitral RJ Vmax = 6.6m/s ......................................PG = 177mmHg   "       "   Vmean = 5.09m/s...................................PG = 119mmHgLeft 4-chamber view:Mitral RJ Vmax = 6.03m/s .....................................PG = 145mmHg  "       "   Vmean 5.49m/s ......................................PG = 125mmHg Tricuspid RJ = none seen Pulmonic RJ = none seen Aortic RJ = none seen M mode:RVD = subjectively normal IVSd/s = 7/11  (6.8 - 8.5mm[D] / 10.5 - 12.8mm[S]) LVIDd/s = 35/22 (34 - 39mm[D] / 22 - 26mm[S])LVPWd/s = 7/13 (6.0 - 7.6mm[D] / 9.0 - 11.5mm[S])Ejection Fraction = 69%Fractional Shortening = 38%DIASTOLIC STUDIES:Mitral E wave = 0.91m/s Mitral A wave = 0.73m/s E:A ratio = 1.25DecelT: 117ms Assessment:DMVD, stage B1-2Plan:No medication indicated. Repeat echocardiography in 12 months    Vital Signs    Weight: 15.5;       

Reason: Heart Murmur (Referral From GP)Appointment Notes: MGLHistory: Received annual vaccinations with GP department 1 week ago. Novel heart murmur auscultated in consult - Grade 2 systolic, left-sided murmur. Recommended echo. Panting a lot recently. Increasing exercise intolerance - used to love walks but can't go as far. Seems to be hungry but needs to lose weight. Current diet: Lyka and hypoallergenic (has resolved her food responsive enteropathy)Current medications: none - CT scan Nov 2023 bilateral elbow disease, left worse than right. Left has enthesiopathy and tendinopathy. Lumbar spine IVDD MRI diagnosed 2019 and chronic skin issues. - Last bloods 2024 Subjective: BAR. OverweightObjective: MM pink, CRTEupnoeic, lung sounds normalHR =  bpm, Grade I-II/VI systolic plateau murmur pmi left apicalPlan:- Echo with RCS tomorrow    Vital Signs    

Reason: Check UpAppointment Notes: kngHistory:  Previous Hx- CT scan Nov 2023 bilateral elbow disease, left worse than right. Left has enthesiopathy and tendinopathy. Lumbar spine IVD L6/6 MRI diagnosed. 2019 and chronic skin issues. Last bloods 2024 Current Hx- Panting a lot No medication presently Weight is 15.5kg today Has a big appetite, always has done, no changes to thrist, maybe a bit less, energy levels are normal, happy to go on walks all the time. 4 x 25 min walks a day No medicationJoint supplements from pet circleFed Lyka and hypoallegenic, no diarrhoea, this diet seems to work well Examine:Eyes, ears, nose NAD, oral exam grade 2 dental dz, MM pink, moist, CRT <2sec, Grade 2 systolic, left sided heart murmur, strong and syncrhonous pulses, HR 132bpm, panting +, no adventitious lung sounds audible, LNs submandibular LNs enlarged, rest are wnls, abdo palp NAD, BCS 8/9, coat no alopecia. Discussed findings of exam- new murmur- discussed with O re breed and what causes a murmur, investigation, ideally echo with RC. Advised O re severely overweight, has known joint disease and spinal dz, best thing we can do for the joint dz is to keep a lean body mass. Advised reduce food intake by 20% and re-weigh in 3-4 weeks time. Discussed dental disease and recommend booking for dental but ideally echo and weight loss first. (considered HyperAC but no PU/PD or polyphagia) Plan: Book for echo Reduce caloric intake Dental once above achieved Given Nobivac DHPPi SC Nobivac Bb Oral    Vital Signs    Weight: 15.5;