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Heart murmur case study

It’s all about loving hearts and a tiny Cavapoo is happily around for Valentine’s Day after a potentially lethal heart murmur was detected.

Nancy was just a few weeks old when the rare murmur was detected when she was taken to Vets Now in Gateshead for an unrelated problem.

After being checked at her own vets, she was seen at Moorview Referrals in Cramlington where a pronounced continuous “machinery” murmur was confirmed and a patent ductus arteriosus diagnosed.

Subsequent surgery at the IVC Evidensia practice was a complete success and she is back to living a full and active life.

The pup had been taken to Vets Now after picking up an infection and the murmur spotted there was detected again when she had her second vaccination.

“Nancy was completely asymptomatic and very playful when we first saw her at 16 weeks,” said cardiologist Antonio Moneva-Jordan from the Moorview team. “On physical examination she was bright and alert and weighed only 2.5kg, the smallest pup of a litter of seven.

“She had a grade IV/VI continuous “machinery” murmur over the left axillary region. On the basis of the cardiac investigations, we reached a diagnosis of patent ductus arteriosus, or PDA.

“Around three quarters of PDA patients will develop signs of congestive heart failure within the first year of life.

“It is quite rare, and we only see a handful of cases a year. It is something you would hope to detect during an initial puppy examination, but with small wriggly pups it can be missed.”

Early closure of a PDA is strongly recommended and, due to her small size, surgical closure was elected.

The Moorview soft tissue surgery team performed a left lateral thoracotomy to identify the PDA ventral to the descending aorta, dorsal to the pulmonary trunk and medial to the vagus nerve.

Double ligation of the vascular structure was performed, and a thoracic drain was placed. No heart murmur was detected following closure of the PDA.

“Happily, Nancy’s recovery was uneventful, and we were able to discharge her the following day on pain relief,” said Dr Moneva-Jordan.

“When we did a follow-up echocardiogram four weeks after the surgery, there was no evidence of residual PDA flow, and her long-term prognosis is excellent.”

Owner Mrs Lynne Robson, from Sunderland, says she is just happy that being poorly with something else helped save her dog.

“A couple of weeks before her second vaccination I had to take her to Vets Now with bacterial cystitis and the vet said she could hear a heart murmur,” said Mrs Robson.

“She advised getting it checked at her vaccination. Nancy was a bundle of energy and I look back now and wonder how she could have been so full of life with this.

“She’s still tiny, but she’s feisty and we’re just happy she came through it all.”