Is this pulmonic stenosis?

RE: Is this pulmonic stenosis?

Dave Dickson — Mon, 11 Mar 2019 19:22:23 GMT

Fair enough, thanks for the update.

Dave

RE: Is this pulmonic stenosis?

Anthony Dennison — Mon, 11 Mar 2019 16:38:40 GMT

Hi Dave,

Thanks for the information. I'm afraid my echo skills are still relatively basic so am still working on improving this. The dog was referred to a local cardiologist and diagnosed with DCM. No sign of pulmonic stenosis.

RE: Is this pulmonic stenosis?

Dave Dickson — Sun, 10 Mar 2019 22:44:34 GMT

Hi Anthony

I'm new to the forums so forgive me, but can you post any video loops here? That would be so much better.

I agree with other posters on here - with PS I'd expect to see a thickened (concentric hypertrophied) right ventricle. The LV and LA are large, which means there is a volume load on the left heart and given the degree of mitral regurgitation on the colour image, I think this is more than I'd expect with athletic heart or flow murmur. How well was the LV contracting? If you thought it looked pretty normal then that makes DCM very unlikely.

The main differentials for a young dog with a big left heart are mitral dysplasia, PDA and DCM. We should be able to differentiate these on examination - mitral dysplasia will typically have a loud (or even palpable) left apical systolic murmur; PDA will have a continuous left cranial continuous murmur (nearly always with a thrill) and DCM will have no murmur or a soft-moderate left apical murmur. PDA will have a normal or strong femoral pulse too. I see plenty of dogs where the PDA was missed - you need to listen really really high up in the left axilla, as close to the shoulder as you can get. And always palpate with the palms of your hands before you auscultate, to detect any thrills.

So I think a useful step here would be to repeat the examination (if possible) doing a really thorough palpation and auscultation to see if you can get more information on the murmur location and intensity. DCM is unusual (though not rare) in young dogs and degenerative mitral valve disease is very unusual in young dogs.

Hope this isn't teaching you to suck eggs, but if this dog has a PDA we can potentially fix it, so worth making sure. Likewise knowing that it has mitral dysplasia, DCM or something else means we can figure out the best treatment.

Hope that helps

Dave

RE: Is this pulmonic stenosis?

Sarah Keir — Tue, 19 Feb 2019 15:36:14 GMT

Still ultrasound images are notoriously difficult to interpret and heart even more so than something static! So sorry, cannot tell anything from the attached images. Cocker spaniels do get DCM but in a young, athletic breed it can be hard to diagnose (my springer had a fractional shortening of 12% and she did not have DCM). They also get myxomatous valve disease but does this fit with your case?

The heart description as abnormal - was this a murmur, an arrhythmia, difference in intensity of beats, gallop? Remember the heart may also be affected by extra-cardiac processes - was that pyrexia significant and what was the cause, was there a neutrophilia?

I think you should run the case by you local friendly referral centre cardiology department.

RE: Is this pulmonic stenosis?

David Mills — Tue, 19 Feb 2019 14:39:21 GMT

Difficult to say from stills of scans, but there may be for mold thickening of the leaflets present.

Regardless, it sounds like the dog may have DCM, although it can be difficult to diagnose. May be one to refer on to you local cardiologist for a scan.

If no evidence of pulmonary oedema, just continue on pimobendan.

RE: Is this pulmonic stenosis?

Anthony Dennison — Sun, 17 Feb 2019 18:20:37 GMT

Not that I remember off the top of my head, the heart looked globoid/rounded. Right side wasn't massively enlarged either.

RE: Is this pulmonic stenosis?

Camilla Edwards — Sun, 17 Feb 2019 18:05:36 GMT

In the short axis view of the heart at the level of the papilla - did the septum look flattened? I'd expect that to be the case if pressures are up on the RHS of the heart with pulmonic stenosis? Happy to be corrected than someone more knowledgeable than me!

RE: Is this pulmonic stenosis?

Anthony Dennison — Sun, 17 Feb 2019 17:33:03 GMT