Solution to “What's Your Diagnosis?”
(1) Thoracic radiographs, ECG, and ECHO.
Thoracic radiographs: Mild cardiomegaly, Mild bronchial-interstitial pattern at dorsal lung field and increased radio-opaque area at cranial mediastinum.
ECHO assessment: MR/TR. ASD (bidirectional). Mild AS and PS with AI PI.
ECG: Provided above.
(2) 3rd-degree AV block.
(3) Start or continue with Furosemide at 1mg/lb, 1/4th nitrol paste, oxygen therapy, and Terbutaline. After the congestive heart failure is resolved, the treatment of choice is pacemaker implantation. If owner declines, the recommended treatment anticholonergic treatment or sympathomimetic treatment (Terbutaline or Theophylline) should be considered. Needless to say, 3rd- degree AV blocks have a medium-to-high risk of sudden death once the congestive heart failure has developed.
Sadly, Juliet went into cardiopulmonary arrest 24 hours post treatment. CPR was attempted without any improvement. Certainly her death was a combination of all of her heart problems and not necessarily due to her severe 3rd- degree AV block. However, we can say that it was one of the major factors that caused her death.