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Signalment, presentation, history and clinical examination
A five-month-old entire female Shetland Sheepdog was referred for investigation of a loud heart murmur that had been incidentally detected at the time of primary vaccination. No exercise intolerance, tachypnoea, cough, syncope or other clinical signs of disease were reported. Its appetite, thirst, behaviour and growth were considered normal.
On presentation, the dog was bright and alert. It weighed 6·35 kg and had a body condition score of 5/9. The mucous membranes were pink and moist, with a vigorous capillary refill time of one second. The respiratory rate was 28 breaths per minute at rest and effort was normal. Thoracic palpation detected a palpable thrill in the region of the left heart base. Auscultation revealed a continuous grade V/VI heart murmur, with a point of maximum intensity dorsal to the left base, beneath the caudal aspect of the triceps muscle. It radiated widely but in places only the systolic component was audible. Pulmonary auscultation was unremarkable and the femoral and peripheral pulse character was hyperkinetic. The rectal temperature was normal at 38·2°C.
Problems to consider and differential diagnoses
▪ Continuous grade V/VI heart murmur, point of maximum intensity dorsal to the left heart base
Patent ductus arteriosus (PDA) (most likely)
Other aortic–pulmonary shunt (eg, aorticopulmonary window)
Sinus of Valsalva aneurysm
Coarctation of the aorta
Coronary arteriovenous shunt
▪ Hyperkinetic pulse character
PDA (most likely)
Severe aortic regurgitation
Echocardiography showed significant dilation of the left heart chamber. Left ventricular wall motion was subjectively normal and the mitral valve appeared normal. A trivial, central jet of mitral regurgitation was seen on …
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