History

Patches is a 9.5 year old, neutered male Blue Merle Great Dane.  He came to Best Friends Animal Hospital due to being lethargic and coughing. Patches's brother had tested positive for heartworm disease and was treated. Patches had been tested twice before; one test was negative and the other was positive. The owners came in for a second opinion.

Presented

Patches was severely underweight. His heart seemed normal and lungs seemed slightly raspy. We did a preliminary workup:

• Heartworm test - positive
• Internal parasite check - negative

With the results from these tests, we decided to treat Patches for heartworms.

Workup

Before treatment could be started, we needed a baseline of his overall health.  We performed bloodwork and radiography for the following baseline:

• HCT - 50% (blood volume)
• Comprehensive bloodwork - Normal (this checks liver and kidney function)
• Chest radiograph - Patches's x-ray looked abnormal. The hazy white spots are thromboemlism (heartworms die and lodge in the lung field), not a good sign. In addition, the x-ray shows his crainal pulmonary arteries are enlarged.

Diagnosis

We diagnosed Patches with a grade III (out of IV) heartworm disease. A grade III is a severe and deadly case.

Treatment

Since the heartworm disease was severe, we decided to use Immiticide once a month for two treatments instead of 24 hours apart. Due to the thromboemlism, we started Patches on Prednisone. We kept Patches at the hospital for a week to keep a close eye on him. He did fine.

Patches came back after one month. He still had not gained his weight back. The owner mentioned that Patches was not eating well.  We associated this with the heartworm disease and administered the second heartworm treatment.

Follow-up

Patches returned one month after the last treatment because he was still not eating well. On physical examination, the abdomen seemed extended. We repeated bloodwork and radiographs. The bloodwork was normal, but the x-ray showed that his heart had increased in size. This condition tells us that Patches is now in congestive heart failure, due to the heartworms. Currently we are treating him for peripheral edema (fluid buildup) and congestive heart failure.

Past Cases of the Month

Case 1

Case 2