Hypertension with systemic disease (Proceedings)

This session will deal with case examples where blood pressure measurement is indicated. This is meant to be an interactive session with participation of the attendees. Your diagnostic skills will be tested as will your knowledge on blood pressure issues.

CASE #1

Signalment: Bonnie, 10-year-old Cocker Spaniel mix, FS

History: Has had a murmur for 6 months, now mild exercise intolerance. Also has been noted to be PU/PD. A chemistry profile revealed a significant elevation in ALP and a mild increase in ALT. She was referred for further work up.

Physical Examination: On examination Bonnie is alert and active. She does cough once in the exam room. Body condition is abnormal with a potbelly and muscle wasting evident. The dorsum has widespread areas of crusting dermatitis. Nuclear sclerosis is present O.U. On auscultation the lungs are clear, however a Grade 4/6 holosytolic murmur with PMI over the mitral valve is heard. Pulses are good, heart rate is 180. Body temperature is normal, Bonnie is panting.

Differentials?

Diagnostic Plan?

Revised differential list

Therapeutic plan

Bottom line to this case:

CASE #2

Signalment: Bert, 7-year-old Labrador Retriever, M

History: The owner has noted that Bert seems to be getting a little bit skinnier and his hair coat is not as good as it could be.

Physical Examination: On examination Bert is a typical Labrador, activity level way too high. Physical examination does reveal a slightly dull hair coat. Other striking abnormalities are not noted. Prostate cannot be palpated since Bert would need sedation to be able to perform a rectal examination. Because of the owner's concerns a CBC, chemistry profile and UA are obtained.

Initial lab results: The CBC shows a moderate neutrophilia (19,000/ul). Chemistry profile shows mild hypoalbuminemia and hypercholesterolemia. Other values are normal on the profile. The UA shows a S.G. of 1.024 and a +++ protein reaction. The urinary sediment reveals 50 RBCs/hpf.

Differentials?

Diagnostic Plan?

Revised differential list

Therapeutic plan

Bottom line to this case:

CASE #3

Signalment: Sara, 7-year-old FS DSH, 6 kg

History: Renal insufficiency was detected in this cat at 2 years of age. She has remained fairly stable in that time frame. She had developed a murmur about 1 year before at which time hypertension and hypertrophic cardiomyopathy were diagnosed. She is currently being treated with Amlodipine 6.25 mg EOD, 150 ml s.c. fluids daily and an appropriate kidney diet. Within the last few days the owner has noticed that she is bumping into things.

Physical Examination: On examination Sara quiet but alert. Muscle mass is reduced; however body fat is still clearly evident. The kidneys feel small on abdominal palpation, bladder is full. A grade 3/6 holosystolic murmur can be heard with a PMI left parasternal. Heart rate is 200 BPM, lungs are clear. On ophthalmic examination partial detachment of the left retina is noted and complete detachment of the right retina. A Doppler blood pressure is taken and reveals a 150mmHg systolic value.

Differentials?

Diagnostic Plan?

Revised differential list

Therapeutic plan

Bottom line to this case:

Case #4

Signalment: Otis, 14-year-old DSH cat, MC

History: Weight loss has occurred in Otis, though he has been normally active and has a good appetite. The reason Otis is presented is vaccinations. The owner thinks he may be drinking more than usual; the litter box also needs to be changed more frequently.

Physical Examination: Otis is a normally active cat, though the exam does stress him out. Muscle mass loss is evident and is fairly severe. On palpation of the abdomen, kidneys feel small. On thoracic auscultation a gallop rhythm is evident as well as an intermittent murmur. A nodule can be felt at the thoracic inlet. Body temperature is normal; heart rate is approximately 240 BPM

Differentials?

Diagnostic Plan?

Revised differential list

Therapeutic plan

Bottom line to this case: