Pulse deficit case

RE: Pulse deficit case

Dave Dickson — Sun, 07 Apr 2019 21:10:11 GMT

Hi Alan

I'd go with preclinical DCM and mitral regurgitation on this one. I agree the MR is severe, so it's more than 'just' DCM, but the systolic function looks bad so it isn't mitral valve disease on it's own either. You see these from time to time and I never know what to label them - so I just stick with MR with systolic dysfunction.

I agree with pimobendan, but the dose is quite high. Not that I think it's dangerous, but I tend to go 0.25-0.3mg/kg bid.

Although this is most likely just genetics (this is common in Cockers), I'd check diet history for anything unusual and if funds allow, check taurine. This can be charged at £120-130 in some labs and over £200 in others so worth shopping around. If the owners can't afford that test then just get them to give taurine (500mg bid). It's cheap and safe. I'm not a carnitine believer but you can use it on the same basis as taurine.

As to the cause of the pulsus alternans, the classic mechanism is myocardial failure leading to inadequate contraction on every other beat, thanks to alternations in calcium handling. You are correct in that a very short filling time will reduce outflow - like you see with SVPCs or VPCs that come very early - but it isn't really diastolic dysfunction per se. Not that it matters really, it's just a point of physiology. Have a look here: https://en.wikipedia.org/wiki/Pulsus_alternans and here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845944/

Dave

RE: Pulse deficit case

AlanH — Fri, 05 Apr 2019 18:39:39 GMT

Hi Dave,

Was more thinking that the cause of the pulse deficit must have been poor ventricular filling therefore diastolic dysfunction? I said stage B1 MMVD and this is incorrect - he's Stage B2, large mitral leak and atrial enlargement and currently on pimobendan at 0.4mg/kg bid. His systolic function is poor with a FS of 23%, I'll go back and check EF also .

I measured his LVDd at 41mm (26-38) and LVDs at 32 (16-28) so a degree of volume overload and poor systolic function given that with a large leak id expect a hyper dynamic LV so perhaps this is pre clinical DCM with MMVD? Is there anything else I could add in given he's pre-clinical or just continue with pimobendan - L-carnitine???

Thanks for your input - its much appreciated

Alan

www.vetsurgeon.org/.../Mitral-regurg.avi

www.vetsurgeon.org/.../RPS-tilted.avi

RE: Pulse deficit case

Dave Dickson — Thu, 04 Apr 2019 20:48:31 GMT

Hi Alan

This looks and sounds like a condition called 'pulsus alternans'. It is almost always associated with DCM in Cockers - can you post either some videos of the left ventricle (right parasternal long axis and short axis) or an M-mode of the left ventricle?

[quote user="AlanH"] initially put this down to poor diastolic function due to reduced filling time[/quote]

Did you mean poor systolic function? You do get some variation in aortic outflow velocity and pulse pressure with sinus arrhythmia but never to this extreme.

Dave