Case Study – Collaboration and Early Detection
In May 2017, we diagnosed an 8-year-old female Poodle mix with mild Degenerative Atrioventricular Valve Disease (DAVD). As she had no chamber enlargement, normal lungs, mild regurgitation, and a normal proBNP, no treatment was recommended at that time. As with most stable DAVD cases, it was recommended to have a six-month recheck with her primary care veterinarian, followed by a year recheck with us. At her primary care recheck, her murmur was found to have increased from a grade 2/6 to a 4-5/6, the proBNP was now elevated at 3516 pmol/L (normal <900 pmol/L), and significant left-sided heart enlargement was noted on radiographs. We contacted the primary care doctor and the owner with a written report and phone calls, and suggested an echocardiogram December 2017 instead of May 2018. The echocardiogram showed a flail mitral valve due to ruptured chordae tendineae as well as marked left atrial and ventricular enlargement. We prescribed benazepril and pimobendan, and the owner was educated about the signs of congestive heart failure.
This case is a great example of how collaborative medical management between primary care veterinarians and specialists can be beneficial, and potentially life-saving, for our mutual patients. Had this chordal rupture not been caught, it could have quickly decompensated into congestive heart failure. Early detection of this significant change allowed us to start medications, and hopefully improve both quantity and quality of life.