VN April 2021

Vetnews | April 2021 11 Article capillary refill time of 2 seconds. Jugular venous distension was observed. Cardiac auscultation revealed tachycardia with a regular rhythm and a grade II/VI left apical systolic heart murmur. Harsh bronchovesicular sounds and crackles were auscultated. Because of concern for congestive heart failure (CHF), furosemide (2 mg/kg IV) was administered, the patient was placed in an oxygen cage, and a cardiac consultation was conducted. Diagnosis Initial CBC and serum chemistry results were normal, with the exception of hyperlactatemia (blood lactate, 3.8 mmol/L; reference range, 0.20-1.44 mmol/L). Blood lactate concentration is a measure of anaerobic metabolism. Hyperlactatemia can occur secondary to decreased oxygen delivery (e.g., volume depletion, blood loss, cardiogenic or septic shock), increased oxygen demand (e.g., seizures, exercise), inadequate oxygen utilisation (e.g., systemic inflammatory response syndrome, sepsis), and/or drugs or toxins. 1 Hyperlactatemia in this patient was suspected to be due to hypoperfusion secondary to active CHF and systolic dysfunction. Nora was hypotensive and had a systolic blood pressure of 85 mm Hg obtained via Doppler from the left dorsal metatarsal with the patient in right lateral recumbency. ECG revealed sinus tachycardia with a heart rate ranging from 186 to 210 bpm. No ectopic beats were visualised on 6-lead ECG or telemetry. An echocardiogram and thoracic radiographs were obtained. The echocardiogram revealed decreased left ventricular (LV) wall thickness, severe dilation of the LV chamber (i.e., eccentric hypertrophy), and severely reduced LV systolic function. Severe left atrial enlargement with a moderate degree of centrally directed left atrioventricular valve regurgitation (suspected functional) was observed. The left atrioventricular valve leaflets appeared normal in thickness with poor coaptation due to annular stretch. In addition, there was mild dilation of the right atrium and ventricle with a mild degree of right atrioventricular valve regurgitation. Results of echocardiography were consistent with dilated cardiomyopathy (DCM; Figures 1-4). 2,3 FIGURE 1: 2D echocardiographic image of the left ventricle from the right parasternal short axis view. There is decreased thickness of the LV walls and severe dilation of the LV cavity consistent with DCM. FIGURE 2: M-mode echocardiographic image from the right parasternal short axis view at the level of the mitral valve leaflets showing severely increased E-point-to-septal separation consistent with DCM FIGURE 3: 2D echocardiographic image from the right parasternal long axis view. The left atrium and left ventricle are severely dilated. The mitral valve leaflets are normal in thickness and have no evidence of degenerative mitral valve disease. >>> 12