A 7-year-old 26.8-kg (59-lb) neutered male Golden Retriever was presented for recheck assessment of left-sided congestive heart failure. The dog had undergone combined cutting and high-pressure balloon valvuloplasty for severe subvalvular stenosis (pressure gradient, 170 mm Hg) at 6 months of age and had received atenolol (0.47 mg/kg [0.21 mg/lb], PO, q 12 h) since the time of diagnosis. The procedure reduced the pressure gradient to 70 mm Hg and improved the dog's exercise tolerance. The dog was reevaluated 6 years after valvuloplasty because of signs of congestive heart failure. Electrocardiography revealed atrial fibrillation (AF) with a rapid rate of 220 beats/min. The dog had echocardiographic evidence of pleural effusion, severe left atrial enlargement (left atrial-to-aortic diameter ratio, 2.72), left ventricular enlargement with systolic dysfunction (normalized left ventricular diastolic and systolic diameters, 1.88 and 1.29, respectively), and severe subvalvular aortic stenosis (pressure gradient, 91 mm Hg). The dog was treated with thoracocentesis, pimobendan (0.29 mg/ kg [0.13 mg/lb], PO, q 8 h), furosemide (2.3 mg/kg [1.05 mg/lb], PO, q 8 h), immediate-release diltiazem hydrochloride (2.0 mg/kg [0.91 mg/lb], PO, q 8 h), digoxin (0.0048 mg/kg [0.002 mg/lb], PO, q 12 h), and enalapril maleate (0.38 mg/kg [0.17 mg/lb], PO q 12 h). Three months later, the dog was rechecked and was doing well clinically. At that time, mild pleural effusion was present, serum biochemical findings were within reference intervals, and serum digoxin concentration at 7 hours after administration was 2.0 ng/mL (therapeutic range, 1.0 to 2.0 ng/mL). Electrocardiography was repeated to assess heart rate control.
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