C09996862 / invoice 10000

SUBJECTIVE
Reason for visit/main concern:
CHF - seen Dr RW for an echo 3 days ago. 
Breathing a bit faster recently so increased by half tab of frusemide either am or pm
This morning breathing up 2.5tab frusemide am, still shallow. A bit quieter.
Coughing+ this morning. Dry cough. Intermittent C last few days. 
Being fussy. Bit soft stools but O has changed up her diet recently 
Last night and this am >30brpm; previous days low 20s 

Current medication/supplements: 30mg frusemide 7am and 7pm, pimo 2.5mg BID - not missed recent doses; last given pimo this morning
Current preventatives: 
Current diet:

OBJECTIVE
BAR
mm pink and moist, CRT <2sec
Lymph nodes: normal submandibular, prescapular and popliteal
Cardiac auscultation: Gr5/6 heart murmur, no arrhythmia, strong synchronous pulse HR: 160
Pulmonary auscultation: NAD, increased crackles on RHS chest, increased expiratory effort RR: 60
Eyes: NAD
Nose: NAD
Ears: NAD
Mouth: NAD
Dental Grade: 2 /4
Abdominal palpation: NAD, soft, comfortable
Skin: NAD
Neuro: NE, normal mentation
Myo-arthro-skeletal: 
Uro-genital: NE
Temperature: 38.7
BCS: 5/9 - gained 500g in 1 week 

ANALYSIS
Crackles in chest
Increased exp effort
Elevated SRR
Coughing
Likely CHF again
Gained 500g in 7 days - fluid retention vs other

PLAN
Rec admit for stabilisation and x-rays

0.5mL butorphanol (0.5mg/kg) given IV at 11.56am RR dropped to 36
Good level of sedation for x-rays
Small area of interstitial opacity at the base of the heart on LLR and RLR x-rays
Lots of food in stomach, faeces in colon
TFAST - confirmed a few B-lines
AFAST - confirmed no free fluid in abdo

3mg/kg frusemide IV at 12.17pm RR58 at 12.20pm
Kept on flow by O2 with nurses.

Bloods today - if K is low then need to add in spiro today, drop frusemide dose. otherwise plan below.

SC STO - 
Bloods - 
BUN 15 (2.5-8.9)
K+ 3.2 (3.7-5.8)

TGH with:
1. Stay on current dose frusemide and add in spironolactone 25mg BID (first dose spiractin given 2:35pm rd)
2. Continue pimobendan 2.5mg BID
3. Continue counting SRR over next few days

rv tuesday to see if able to reduce dose frusemide
make sure e/d ok
monitor SRR
Prognosis poor 

report from Richard Woolley 

As the congestive heart failure appears well controlled at present the frusemide and
pimobendan are to be continued at the current doses. We would be grateful if Romy's
referring vet could please continue to dispense:
Frusemide 30mg PO q12h
Pimobendan 2.5mg PO q12h
Romy's owner is to monitor her sleeping respiratory rate (SRR) to assess for the recurrence
of left sided congestive heart failure. If the SRR does not decrease to <30breaths/min during
sleep this is suggestive of pulmonary oedema and an increase in the frusemide dose would
be advised at this point. The addition of spironolactone (2mg/kg PO q12h) would also be
advised.
Romy is to return to her referring vets in a weeks time for a blood test to assess PCV/TP,
serum urea, creatinine and potassium. Monitoring of these parameters is advised every 2-3
months.
Thank you for referring this case and please do not hestitate to contact us if we can be of any
further assistance with this or any other case.
Kind regards,
Dr Kathryn Farquharson and Dr Richard Woolley

sent hx to reports@cprvictoria.com.au  TA