puppy cardiology question

Re: puppy cardiology question

Gillian Mostyn — Thu, 13 Nov 2014 23:04:54 GMT

It's no big deal... I know you was trying to help! I didnt mention that I had started symptomatic treatment while puzzling over what was causing the problem. You can be rather blunt with your comments... But to criticise you for that would be rather hipocritical of me.

I found all the comments from everyone very helpful...thanks.

Re: puppy cardiology question

Anthony Todd — Thu, 13 Nov 2014 22:42:26 GMT

[quote user="robloxley"]My sarcasm and it's point is obviously lost. In blunter terms, often your postings are bordering on the offensive: here suggesting people would sit around waiting for test results before instigating some treatment.[/quote]

Lighten up, didn't you notice the smiley at the end [which didn't make it to the quote....]

But i was actually trying to make a serious point, and trying not to be blunt too.

So nobody these days ever "waits for the bloods" with a blocked cat?

I'll cite examples, certainly in derm cases, the classic field, as they recur.

I've actually listened to a leading vet in a meeting state she did not treat until she has a diagnosis, you know, the old "steroids will affect the histology".

And in the case in question Gillian didn't mention the treatment given so I naturally assumed none had been given, and apologised.

My only intention is to better the lot of animals you see.

The difference in priorities when dealing with an uncomfortable animal now and "back in the day" is striking and sometimes not to the comfort of the patient.

[edited to make the last sentence coherent]

Re: puppy cardiology question

Rob Loxley — Thu, 13 Nov 2014 18:08:36 GMT

[quote user="Anthony Todd"]

[quote user="robloxley"]I lost count of how many dead and dying animals I tripped over this morning in my haste to reach the fax machine for some lovely blood test results...![/quote]

Perhaps if you'd just used the history, your full examination and experience and just taken a punt using the likely and/or only possible treatments some, or many, may be on the mend and able to avoid you, or, at least, wag their tails......

[/quote]

My sarcasm and it's point is obviously lost. In blunter terms, often your postings are bordering on the offensive: here suggesting people would sit around waiting for test results before instigating some treatment.

Re: puppy cardiology question

Anthony Todd — Thu, 13 Nov 2014 11:35:12 GMT

[quote user="robloxley"]I lost count of how many dead and dying animals I tripped over this morning in my haste to reach the fax machine for some lovely blood test results...![/quote]

The results, if and when they arrived, would have just confirmed [or not] what you'd guessed.......

Nowadays my grandchildren have explained, you can press buttons on your sort of plastic typewriter thingy and the results just appear on a little screen in front of you so no need even to move from your coffee mug.....

Re: puppy cardiology question

Hannah Wynne Richards — Thu, 13 Nov 2014 10:24:29 GMT

Gillian No helpful ideas, but my sympathy. Cases like this are really horrible.

Wynne

Re: puppy cardiology question

Rob Loxley — Thu, 13 Nov 2014 10:24:07 GMT

[quote user="Anthony Todd"]Sorry, I thought it was going to be the long search for a diagnosis whilst the animal just deteriorated..[/quote]

I lost count of how many dead and dying animals I tripped over this morning in my haste to reach the fax machine for some lovely blood test results...!

Re: puppy cardiology question

Anthony Todd — Thu, 13 Nov 2014 10:14:04 GMT

You couldn't just take a blood/serum/intracardiac sample and get parvo titre and possible culture etc?

The sampling could be non-invasive so the owner mightn't even know, and may give us some information.

Any chance of getting info on the littermates?

With the sort of pulse you describe it doesn't sound like heart failure??

Re: puppy cardiology question

Anthony Dennison — Thu, 13 Nov 2014 10:03:46 GMT

Sounds like it could be endocarditis, with the neuro symptoms being due to hypoxia? Parvo can cause damage to the myocardium, but it's possible that the suspected parvo wasn't that at all but something more sinister, leading to SIRS or possible DIC?

Re: puppy cardiology question

Gillian Mostyn — Thu, 13 Nov 2014 00:18:03 GMT

Thanks Andrew... makes me feel a bit better. I realise there is so little information to go on that a diagnosis is impossible without further diagnostics, but was struggling to think of something that would cause all the symptoms I was seeing.

The devastated owner is collecting the puppy tomorrow so PM is unlikely but I will offer it.

Re: puppy cardiology question

Anthony Todd — Wed, 12 Nov 2014 23:18:36 GMT

[quote user="Gillian Mostyn"]-I also considered endocarditis and started iv antibiosis on admittance,[/quote]

Sorry, I thought it was going to be the long search for a diagnosis whilst the animal just deteriorated..

No PM?

Re: puppy cardiology question

Andrew Kent — Wed, 12 Nov 2014 22:56:53 GMT

Recurrent bacteraemia is not uncommon in shunts and could explain the pyrexia.

Re: puppy cardiology question

Gillian Mostyn — Wed, 12 Nov 2014 22:55:15 GMT

Hmm....all possible. The puppy was 'happy' to be manipulated and didn't seem to be in pain on neck/back so I don't know if that rules out meningitis? . I can't explain the pyrexia either in relation to the shunt... Just seemed that the symptoms seemed to become more neuro.

PM unlikely to be possible.

Re: puppy cardiology question

Sammy82 — Wed, 12 Nov 2014 22:18:28 GMT

How would a systemic shunt explain the fever? I would think an infection much more likely. Maybe meningitis +/- endocarditis? Endocarditis does not nescessarily cause a murmur. I remember a dog with endocarditis at university which did have confirmed endocarditis (died of it) but did not have a murmur, but marked arrhythmia. A mild murmur would also be very difficult to hear at the reported high HR.

Would the owner consider a PM?

Re: puppy cardiology question

Gillian Mostyn — Wed, 12 Nov 2014 21:59:59 GMT

Thanks Anthony, some very reasonable points.

- I also think distemper is very unlikely, was just wondering...

-I also considered endocarditis and started iv antibiosis on admittance, mainly due to the pyrexia. Just thought that the dog would be likely to have a murmer. It has also been on antibiotics a lot recently due to the gastroenteritis.

Anyway, it is all academic now. The puppy continued to deteriorate and by late afternoon was comatose. Some diarrhoea but no other symptoms became apparent. Biochemistry just showed low proteins, normal PCV. (No in house bile acids or ammonia). It was euthanased this evening.

I am assuming hepatic shunt...???...

Re: puppy cardiology question

Anthony Todd — Wed, 12 Nov 2014 20:52:08 GMT

Before the days when some sort of test, any sort of test, as the first step and trying not to tread on toes or teach grandmothers ,here goes:

History: How likely is distemper? Any littermates affected? Where did the pup come from? Any chance of talking to the breeder [not very likely to be productive I know....]

Litter history: Others would surely be affected if it was distemper or a contagious virus.

[Mind you back in the day [1962] in NZ the adage was any odd canine disease usually became obvious distemper in the end.]

And the signs suggest possible endocarditis?? Might fit with the pulse and the pyrexia?

Even if you do all the tests known to Vet. science and get a diagnosis you are left with just a few treatment options so:

Why not put it on broad spectrum antibiotics at a fraction of the cost of the tests and possibly cure the dog?

What other therapeutic avenues have you anyway?

Assuming the animal isn't suffering it's arguably the best you can do.

Treatment is the only thing likely to make the animal better apart from it's getting better on it's own....

Sometimes the diagnosis doesn't really help the animal, [particularly if you factor in the delaying of therapeutics], which seems to be ignored these days.

Re: puppy cardiology question

Evelyn Barbour-Hill — Wed, 12 Nov 2014 17:34:38 GMT

[quote user="Gillian Mostyn"](the nurse thought the puppy was starting to have seizures as the left pinna is moving with every heart beat!!) [/quote]

That could be distemper!

(Although it probably isn't).

Re: puppy cardiology question

Gillian Mostyn — Wed, 12 Nov 2014 15:13:22 GMT

(by bloods I meant biochem+FBC - as you said, no point in testing for CPV at this point.)

Re: puppy cardiology question

Gillian Mostyn — Wed, 12 Nov 2014 15:12:37 GMT

Hmm... now it has started with ataxia and strange neuro behaviour with sluggish PLRs. I am completely baffled. Distemper?? (Have never seen it..).

I agree - liver disease with jugular pulse on rhs is pretty common - just never seen it so pronounced on both sides before.

It has been gaining weight quite well so no reason to suspect a shunt... although obviously now becoming a significant differential....

Re: puppy cardiology question

Martin Atkinson — Wed, 12 Nov 2014 14:20:46 GMT

AFAIA CPV only caused cardiac problems in one litter of neo-natal puppies and has not been shown to cause an issue subsequently. So that and the fact it recovered from only suspected CPV probably means that there is no connection.

I thought prominent jugular pulses were more likely to be associated with restriction on the vena cava due to increased abdominal pressure often due to liver disease.

By bloods I presume you mean a CPV titre but based on the above I doubt this will throw much light. I guess NTproBNP blood test could theoretically be helpful but I have no idea how valid if would be in a puppy of this age as it is dependant on myocardial stretch. Maybe Graham Bilborough will be along soon or perhaps you could PM him (that means private message Graham not a PM examination on the puppy although I guess that would be diagnostic)!

Re: puppy cardiology question

Michael Woodhouse — Wed, 12 Nov 2014 13:31:47 GMT

In the dim and distant past parvo affecting the heart rings a bell. Thought usually fatal. Claim no expertise in this area whatsoever.