C10007105 / invoice 10000

Reason: Painting At HomeAppointment Notes: Overdue remindersHisTory:- Presented for dyspnoea. Recurrent episodes of gasping for air, particularly after excitement such as barking at possums. The current episode lasted for at least 20 minutes and was more persistent than previous events, prompting presentation.- Reports a change in diet today, having consumed a friend's dog food. Subsequently developed flatulence. No vomiting reported.- Demeanour now appears settled and normal. During the episode, exhibited increased abdominal effort to breathe but no neck extension.Investigation:- No previous diagnostic tests for cardiac issues have been performed.Prior History:- Known heart murmur. The referring vet has previously recommended commencing cardiac medication.- Vaccinations are due. A wellness appointment is booked for 27/03/2026.Current Medications:- No current medications.Physical Exam:Subjective: Bright, alert, and responsive. Seems comfortable.Objective: Temp: 38.8 MM: Pink, moist CRT: <2s HR: FP: S+S RR: Pant EupnoeicBCS:6 /9Weight: 17.0Cardiovascular: Grade 4/6 left apical systolic heart murmur. Pulses are strong and synchronous.Respiratory: Lungs clear on auscultation bilaterally. No crackles or wheezes. Breathing pattern is normal.GIT: Abdomen is soft and non-painful on palpation. Increased flatulence reported.U/G: N/ANeuro: Normal mentation. Ambulatory with no deficits.M/S: Normal.Integ: Normal.Ophth: Normal.LNs: No peripheral lymphadenopathy.Problem List:- Grade 4/6 heart murmur- Episodic dyspnoea/tachypnoea- Suspected diet-related gastrointestinal upset (flatulence)Assessment:The presenting complaint of dyspnoea is likely secondary to the underlying cardiac disease (MMVD prioritised), given the presence of a heart murmur. The episodes are consistent with turbulent blood flow leading to pulmonary congestion. While currently stable and not in congestive heart failure (CHF), the clinical signs are concerning. Differential diagnoses for dyspnoea include primary respiratory disease (e.g., pneumonia, bronchitis, neoplasia), but this is less likely given the clear lung sounds and history. The flatulence is likely an incidental finding related to the recent dietary change.Treatment:No treatments administered in hospital.Client Communications:- Discussed the likely link between the heart murmur and breathing difficulties. Explained the mechanism of CHF and how fluid accumulates on the lungs. Clarified that Ezra is not currently in overt heart failure, as he was able to return to a normal breathing pattern. Explained the grading of heart murmurs and the staging of heart disease. Discussed the role of medications, including those for heart contractility (inotropes) and fluid removal (diuretics).Options offered to client:- Option 1 (Recommended tonight): Commence medication to improve heart contractility (e.g., pimobendan) and follow up with the regular vet for chest x-rays and further management. Cost estimate approx. $356 for consultation and two weeks of medication.Discussed x-rays tonight but owner declined- Option 2: Decline medication (pimobendan) tonight and monitor closely at home. Instructions provided for monitoring sleeping respiratory rate (SRR). Advised to present for reassessment if SRR is >40 breaths/minute or if dyspnoea recurs or worsens. Follow up with regular vet as planned.- Discussed that chest x-rays are the recommended next diagnostic step to assess heart size and rule out other causes of dyspnoea. This can be done with the regular vet.Plan:- The owner has elected to wait to start medication and will follow up with their regular veterinarian.Plan:Diagnostic plan: Owner to monitor sleeping respiratory rate at home, aiming for <40 breaths/minute. A chart was provided. Follow-up with regular vet is booked for the 23rd and 27th of March for wellness check, vaccinations, and cardiac work-up including chest x-rays.Therapeutic plan: No medications started at this time. Owner advised on exercise restriction and avoiding situations that cause over-excitement to minimise cardiac strain.Discharge plan: Discharged to owner's care. Advised to return immediately if breathing difficulty worsens, persists, or if there is any other significant decline.Referral plan: A copy of the history will be emailed to the primary care clinic (Stud Park or Best Friends) for their records ahead of the upcoming appointments.    Vital Signs