Nutritional dilated cardiomyopathy in a 5 year-old mixed-breed dog
Kelleher, Tyler M.
A 5 year-old spayed female mixed breed dog presented to the Cornell University Hospital for Animals’ Cardiology Service for a recent onset of coughing. The patient was presented to her primary care veterinarian two days previously, and after being evaluated was started on Lasix (furosemide, 37.5 mg three times a day) and was referred to the Cardiology Service at Cornell for further evaluation. She had been fed a home-cooked vegan diet, consisting of brown rice and lentils, since the owner adopted her a few years ago. On presentation, the patient was bright, alert, and responsive, but nervous, with a body condition score of 3/9 (5 being ideal). On physical examination the following abnormalities were noted: tachycardia (164 beats/minute), tachypnea (36 breaths/minute), mild to moderately increased respiratory effort, gallop rhythm over the left heart base, grade III/VI systolic murmur with point of maximal intensity over left 5th intercostal space, and mild abdominal distention. All other findings on a general physical examination were within normal limits. A complete blood count (CBC) and chemistry were submitted which revealed a mature neutrophilia (18.3 thou/ul; normal = 2.7 – 9.4) with a left shift (0.2 thou/ul; normal = 0 – 0.1 thou/ul), panhypoproteinemia (4.4 g/dL; normal = 5.3 – 7.0 g/dL) with albumin = 2.7 g/dL (normal = 3.1 – 4.2 g/dL) and globulins = 1.7 g/dL (normal = 1.9 – 3.6 g/dL), hypokalemia (3.5 mEq/L; normal = 3.8 – 5.4 mEq/L), and hypochloremia (98 mEq/L; normal = 105 – 116 mEq/L). Two-view thoracic radiographs (right lateral and dorsovental) were performed which revealed mild to moderate pleural fluid, mild pulmonary edema, moderate to severe generalized cardiomegaly, and questionable peritoneal fluid. An echocardiogram revealed evidence of severe systolic dysfunction (fractional shortening = 12%), enlargement of the pulmonary veins and both atria, severe mitral regurgitation, and moderate tricuspid regurgitation. With the patient’s history of eating a home-cooked vegan diet for a prolonged period of time coupled with physical, radiographic, and echocardiographic indications of congestive heart failure due to dilated cardiomyopathy, the presumptive diagnosis of a nutritional dilated cardiomyopathy was made. However, a primary cause for the dilated cardiomyopathy could not be ruled out. The patient was started on enalapril, furosemide, spironolactone, and pimobendan. A dietary change was made to Hill’s Prescription Diet j/d and oral supplementation with taurine and carnitine was started after consulting with the Nutrition Service. This presentation will focus on the diagnostics, differentials, and treatments to consider when a dog presents in congestive heart failure with dilated cardiomyopathy while having a known history that puts the individual at risk for having developed the disease secondary to their nutrition. A brief overview of the veterinary profession’s current understanding of how deficiencies in taurine and/or carnitine play a role in the development of dilated cardiomyopathy in dogs will also be discussed.
Dogs; DCM; Cardiomyopathy; Taurine; Deficiency; Canine; Nutrition; Case Studies
dissertation or thesis