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Heart Murmur

The patient was presented for a pre-surgical cardiac evaluation. The patient was suffering from a rapidly progressing degenerative mitral valve. At the time of presentation the patient was on a regimen of Furosemide (8mg/kg/SID), Pimobendan (0.25 mg/kg/BID), Benazepril (0.25 mg/kg/SID), and Spironolactone (2mg/kg/SID). Despite her treatments, she was still experiencing exercise intolerance, mildly increased resting respiratory rate, and was coughing. Thoracic radiographs showed severe cardiomegaly, an increased lung opacity due to a bronchio-interstitial pattern, elevation of the trachea with possible left mainstem compression (possible airway collapse) and mildly dilated pulmonary veins.

A 1.5-year-old, FS, Boxer was presented for an initial puppy wellness visit and a grade 1/6 cardiac murmur was detected; noted PMI (point of maximal impulse) right cranial. A grade 1-2/6 cardiac murmur was detected at several follow-up visits. The patient underwent ovariohysterectomy without event. More recently the patient was presented for further cardiac evaluations. PE found the patient with a heartrate of 140, panting but with no increased respiratory effort, and synchronous pulses. BP: 111/51, 95/53 MAP 67, 119/66 MAP 78. 2 ECG strips were submitted. The first strip (taken under sedation with butorphanol) showed periods of sinus rhythym and periods that appeared to be a high grade second degree AV block (ventricular rate 40-100 bpm). The second strip showed a sinus rhythm (rate 114 bpm) with intermittent single premature ventricular complexes (RBBB morphology) once sedation had worn off and patient was stimulated. 

An 8-year-old F Maltese was presented for examination.  A grade 5/6 systolic heart murmur was noted. Radiographs revealed severe generalized cardiomegaly and an unremarkable pulmonary parenchyma. Moderate hepatomegaly and ascites was additionally noted.