A 9-year-old 4.4-kg (9.7-lb) castrated male Pomeranian was referred to the University of Missouri Veterinary Medical Teaching Hospital for evaluation of a murmur. The murmur was first ausculted a month earlier by the referring veterinarian during a recheck examination of the dog, which had been previously evaluated because of coughing. The dog had been treated with amoxicillin-clavulanic acida (14.2 mg/kg [6.45 mg/lb], PO, q 12 h) for 2 weeks, and at the recheck examination, the owner reported that coughing had resolved. However, the owner had noticed progressive inappetence and lethargy. Serum biochemical analysis performed at the recheck examination
Objective—To evaluate assessment of circulating amino terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration as a means to discriminate between congestive heart failure and primary pulmonary disease in dogs.
Design—Prospective case series.
Animals—46 dogs with signs of respiratory distress or coughing.
Procedures—All dogs underwent physical and thoracic radiographic examinations. Dogs with evidence of heart disease (eg, murmur, arrhythmia, or large cardiac silhouette detected by radiography) also underwent echocardiography. Dogs with no evidence of heart disease or failure were included if they underwent bronchoalveolar lavage (with cytologic examination and bacterial culture of the lavage fluid). Blood samples for NT-proBNP assay were obtained within 12 hours of the diagnosis of heart failure or prior to bronchoalveolar lavage in dogs with primary pulmonary disease. Circulating concentrations of NT-proBNP were compared between groups and correlated with radiographic and echocardiographic measures of cardiac size.
Results—Congestive heart failure and primary pulmonary disease were diagnosed in 25 and 21 dogs, respectively. Dogs with congestive heart failure had significantly higher median serum or plasma NT-proBNP concentration (2,554 pmol/L; interquartile [25% to 75%] range, 1,651.5 to 3,475.5 pmol/L) than dogs with primary pulmonary disease (357 pmol/L; interquartile range, 192.5 to 565.5 pmol/L). Radiographic vertebral heart score and echocardiographic left atrial-to-aortic diameter ratio were not correlated with NT-proBNP concentration. Left ventricular end-diastolic diameter (measured echocardiographically) and NT-proBNP concentration were weakly correlated.
Conclusions and Clinical Relevance—Serum or plasma NT-proBNP concentration assessment may be useful for discrimination of congestive heart failure from primary pulmonary disease in dogs with respiratory distress or cough.
A 5-month-old 218-kg (480-lb) Appaloosa filly was evaluated because of fever, inappetence, abdominal distension, and labored breathing of 1 week's duration. The owner also reported that several horses on neighboring premises had had mucopurulent nasal discharge for a few days preceding onset of the foal's signs. The foal had been previously treated with gentamicin, phenylbutazone, and flunixin meglumine for 3 days, but no improvement in clinical signs was reported. On initial evaluation, the foal was quiet but alert and responsive. The foal had a rectal temperature of 39.4°C (102.9°F), heart rate of 60 beats/min, and respiratory rate of 56
A 2-day-old 44-kg (97-lb) purebred female Holstein calf was evaluated for weakness, signs of depression, and inability to stand unsupported. Immediately after birth, the calf could stand and was tube fed with approximately 4 L of colostrum. Twenty-four hours after birth, the calf was standing and suckled its daily requirement of milk replacer, but 48 hours after birth, the calf was recumbent and only drank half of its 2-L morning milk replacer feeding. The owner had treated the calf with 100 mg of tulathromycin that morning. On initial examination, rectal temperature (39°C [101.5°F]) and heart rate (120 beats/min) were
Case Description—A 13-year-old llama was examined because of lethargy, inappetence, and syncope.
Clinical Findings—Physical examination revealed muffled heart and lung sounds and peripheral edema. Clinicopathologic abnormalities included lymphopenia, hyperglycemia, prerenal azotemia, mild hyponatremia, mild hypoalbuminemia, and high γ-glutamyltransferase and creatine kinase activities. On ultrasonography, the liver appeared hyperechoic and ascites and pleural effusion were seen. Echocardiography revealed severe dilatation of the right atrium, right ventricle, and pulmonary artery; severe tricuspid regurgitation; and high right ventricular systolic pressure consistent with right-sided heart failure secondary to pulmonary hypertension.
Treatment and Outcome—Treatment with furosemide was attempted, but because of failing health, the llama was euthanized 4 weeks later. Macronodular cirrhosis of the liver, glomerulonephritis, and intimal fibrosis and medial hypertrophy of muscular pulmonary arteries were seen on histologic examination of postmortem specimens.
Clinical Relevance—Findings in this case were similar to those reported for human patients with portopulmonary hypertension secondary to hepatic cirrhosis. Pulmonary hypertension secondary to hepatic disease should be considered in the differential diagnosis of right-sided heart failure.
Case Description—A 12-week-old female English Springer Spaniel was evaluated for lethargy, vomiting, and pyrexia 1 week after treatment of patent ductus arteriosus (PDA) via coil occlusion.
Clinical Findings—Test results were consistent with septicemia, and the assumption was made that the PDA occlusion coils were infected. Radiography revealed partial migration of the coil mass into the pulmonary artery and signs of congestive heart failure.
Treatment and Outcome—After successful treatment of the septicemia and heart failure, surgical removal of the coils and resection of the PDA were undertaken. Although the coil that embolized to the pulmonary vasculature was left in place, the dog's clinical signs resolved.
Clinical Relevance—This case highlights the fact that as PDA coil occlusion devices become more widely used in dogs, practitioners must be prepared to treat implant infections aggressively, with both medical and surgical interventions if necessary.