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Signalment, presentation, history and clinical examination
A 10- year-old neutered female Cavalier King Charles Spaniel (CKCS) was presented for further investigation of intermittent collapse. The dog had been medicated with 0·4 mg/kg benazepril every 24 hours since a murmur had been detected at four years of age. One month previously, the dog had presented with intermittent collapse and signs suggestive of left-sided congestive heart failure (CHF), and a diagnosis of chronic valvular heart disease (CVHD) and CHF was made. Furosemide (1·6 mg/kg every 12 hours) and spironolactone (2·4 mg/kg every 24 hours) had been added to the treatment regimen, which resulted in resolution of the cough and tachypnoea but not the collapsing episodes.
At the time of investigation, the dog had suffered five episodes of collapse; on each occasion it woke up, stood up and then fell down into lateral recumbency with rigid limbs. During the episodes, the dog appeared unaware of its surroundings and it recovered spontaneously after less than 30 seconds. There was no change in behaviour before or after these events and there was no jaw movement or hypersalivation. The owners reported that the dog was mildly exercise intolerant, had a resting respiratory rate of 16 breaths per minute and had always suffered stertorous breathing when asleep.
Physical examination found the dog to be bright, alert and responsive, with a body condition score of 7/9. Clinical examination identified pale pink mucous membranes, a normal capillary refill time and normal femoral pulses bilaterally. Thoracic auscultation detected a grade V/VI systolic murmur that was loudest over the left cardiac apex and a grade IV/VI systolic murmur audible over the apex of the heart on the right.
Problems to consider
▪ Collapsing episodes
▪ Exercise intolerance
Cardiac and …
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