C09992861 / invoice 20000

Has a cough

Hx:-->Intermittent cough. Had doxycycline and helped . Cough early mornng and late at night. Antihistamine helps as well. 


Clin:-->HR=96, has a significant heart murmur, Coughs once after pinching the trachea . Abdomen a bit pot bellied. mm pink. 
T=38.3C, 

Rx/Plan-->Bloods to check for evidence of cushing's or other resp related issues. 
bronchishield oral 5245047A  10.2.2027
protech Pi2 5264018 25.2.2027

Diff Dx:-->


Test results-->


GA log:-->
Chest rads - cause of cough, heart size.

Hx:
Coughing for the last ~6 months - cough is not triggered by anything in particular. Not linked to exercise, excitement etc. Still has very good energy levels. 
Also drinking more water for the last ~6 months. 
Bloods wnl, except ALKP high end normal

Ex - BAR
Grade 4/6 heart murmur, PMI L apex, HR = PR = 81 
RR 20, normal chest sounds 

Assess 
1) coughing 
2) heart murmur 

Recc echo as well as the chest rads already planned. 

Chest radiographs: 
VHS 13
Trachea deviating dorsally
Bronchial pattern 
Does not appear to have pulmonary oedema. 

Echocardiogram Dr Dave Collins BVSc FANZCVS
10-15kg
LA long axis 37.1mm
LA short axis 30.2mm (13-25mm)
Ao 16.6mm (14-24mm)
LA:Ao 1.81 (0.8-1.5)

IVSd 7.1mm (5-11mm)
LVIDd 38.7mm (25-41mm)
PWd 7.7mm (5-11mm)
IVSs 8.9mm (13-25mm)
LVIDs 25.6mm (15-30mm)
PWS 11.1mm
FS 33.85% (25-40%)

MR VMax 6.08m/s 148mmHg
PV VMax 0.83m/s 
TR VMax 3.05m/s 37.2mmHg
Ao VMax 1.04m/s 

Findings -
Myxomatous mitral valve disease - stage B1
Large eccentric MR jet taking up 2/3 of LA, bulging of the septal mitral valve leaflet. 
Moderate E wave 1.34m/s
Tricuspid valve regurgitation 
Increased left atrial size.
Normal left ventricular size.
Adequate myocardial contractility.
There was evidence of mild pulmonary hypertension.
No evidence of pericardial effusion. 

MMVD Stage B1 with atrial enlargement.
No evidence that pimobendan is beneficial at this stage
Repwate cho in 6 monthstime, monitor resting respiratory rate, which should be < 30 pm at all times

No evidence of pulmonary oedema or pulmonary venous enlargement on  radiographs.
ie cough is not caused by cardiac disease

Bronchial changes on radiographs supportive of airway cough: chronic bronchitis +/- dynamic airway disease


Recommend GA, bronchoscopy/BAL to investigate cough, otherwise trial steroids +/- codeine