Clinical Cases Focus on Respiratory and Cardiology

Clinical CasesFocus on Respiratory and Cardiology

Dusty W. Nagy, DVM, MS, PhD DACVIMUniversity of Missouri

Food Animal Medicine, Surgery, and Production Medicine

Case Workup

Signalment HistoryPhysical ExaminationProblem ListDifferential Diagnoses– Prioritized list– Avoid zebras

particularly the pink and chartreuse ones

Case Workup

Initial diagnostic and treatment plan– Prioritize tests

Utility – rule in or rule out differentialsNeed to know info for treatment

– Analyze test resultsChanges to the planOutcomeReflection

Case 1

Chief complaint: weak, appears drunkSignalment: 9-year-old black crossbred cowHistory: Cow was seen off by herself this morning. They assumed that she was trying to calve. When no calf was noted by noon they went to check on her. She rushed the owner and rammed several farm vehicles while taking her to the barn.Environment: August in central Missouri. Cow is one of 32 in a cow calf herd. They are housed on 80 acres of mostly fescue grass subdivided into 3 pastures.

University of Missouri #

Physical Examination

AppearanceBody condition score 5/9Normal abdominal contour

BehaviorBelligerentAggressive

Gait and postureWeakStands base wide on all 4Sways while walking

Urine analysisyellow/orange colorNo analysis done

TPRTemperature – 104.2 ºFPulse – 92 bpmRespiratory rate – 52 bpm

Physical Examination – left side

RumenDecreased contentPoor stratification

PingsNo pings

Lymph Nodesprefemoral – normalprescapular - normal

Lung auscultationnormal breath sounds

Heart auscultationRhythm – regular, fastIntensity – normalSounds – no murmurs or

arrhythmiasJugular veinNormal

Cervical skin tent< 2 seconds

Physical Examination – right side

PingsNo pings

SeccussionNo fluid sloshing

Ballotmentnormal

Lymph nodesPrefemoral – normalPrescapular - normal

Lung auscultationNormal breath sounds

Heart auscultationRhythm – regular, fastIntensity – normalSounds – no murmurs or




Abdominal painNone present

Skinnormal

Extremitiesnormal

Musculoskeletalnormal

HeadOcular discharge - noneEye examination - normalNasal discharge - noneMucous membrane color -

yellowTeeth - normal


Mammary glandInflammation

none presentStrip cup

no abnormalitiesCalifornia mastitis test

Rectal palpationThird trimester fetus

FecesDry/firmLarge amount in rectum

Problem list

Problem list

TachycardiaTachypneaFeverJaundiceAbnormal behavior, posture and gaitAbnormal fecal consistency

Prioritized list of differentials

Differential diagnosisTachycardia/Tachypnea– Cardiac disease– Respiratory disease– Disease that affects oxygen carrying capacity – Pain– Stress

Jaundice– Liver failure– Hemolysis

IntravascularExtravascular

Differential diagnosis

Fever– Infection– Inflammation

Abnormal posture and gait– Neurologic disease– Musculoskeletal disease– Disease that affects oxygen carrying capacity

Abnormal fecal consistency– Gastrointestinal disease– Dehydration

Initial diagnostic and treatment plan

Diagnostic plan Treatment plan

CBC– PCV/TP

Arterial blood gasSerum biochemistryUrinalysisComplement fixation/PCR

Antibiotics– Oxytetracycline 9mg/lb

SQ EODLow stress environment

InterpretationCBCAnemia – lossAnisocytosisPolychromasia Erythrocyte basophilic stipplingPeripherally located erythrocyte parasites

Update – after 2 days the cow is picking at hay and drinking some water. She is sticking close to the barn, but is moving around the lot.

Do you want to do any additional diagnostics orchange treatments?

The rest of the bunch…..

Do you want to do anything for the rest of the herd? Does geography matter?Does herd type matter?Can you clear the carrier state?

What if’s………

What if the cow was down with a PCV of 8?– Would you transfuse her?– Would you treat her?– Would you euthanize her?

Any considerations before?

CASE 2

Problem: drooling, respiratory noiseSignalment: 6-month-old crossbred steerHistory: 10 calves (including patient) were weaned, vaccinated, castrated, and dehorned if necessary approximately 2 weeks prior. The calf did not eat as well as expected yesterday. Today it is anorexic and honks on inspiration.Environment: June in central Missouri. Herd composed of 50 cow/calf pairs on fescue pasture. Calves get some supplemental grain.



AppearanceBody condition score

4/9Normal abdominal

contourBehaviorMildly distressed

Gait and postureHead and neck

extended

Urine analysis– None caught

TPRTemperature – 104.8 ºFPulse – 80 bpmRespiratory rate – 56

bpm


RumenNormal stratification

PingsNo pings

Lymph Nodesprefemoral – normalprescapular – normal

Lung auscultationDifficult to auscultHonking on inspirationOpen mouth breathing

Heart auscultationRhythm - regularIntensity - normalSounds – no murmurs

or arrhythmiasJugular veinNormal



PingsNo pings


Ballotmentnormal


Lung auscultationDifficult to auscultHonking on inspirationOpen mouth breathing

Heart auscultationRhythm – regularIntensity – normalSounds – no murmurs or





Skinnormal

Extremitiesnormal


HeadOcular discharge - noneEye examination – mild

scleral injectionNasal discharge –

whitish/yellow, fetidMucous membrane color -

paleMouth

Teeth – normalHypersalivation

Neck – large, painful larynx



NAStrip cup

NACalifornia mastitis

testNA

Rectal palpationNA

Fecesnormal

Problem list

Problem list

Fever TachypneaInspiratory noiseHead and neck extendedOpen mouth breathingFetid breathNasal and oral dischargeScleral injection


Differential diagnosisTachypnea, inspiratory noise, head and neck extended, open mouth breathing, fetid breath, nasal discharge, salivation, swollen larynx with pain– Upper airway disease

Necrotic laryngitis – Fusobacterium necrophorumLaryngeal trauma – abscess or edemaViral laryngitis – IBRActinobacillosis

Fever, scleral injection– Inflammation, infection



No diagnostics– Save money for treatment

Endoscopy Radiographs CBC

Antibiotics– Florfenicol

9 mg/lb IM EOD

Anti inflammatory– Flunixin meglumine

1.1mg/kg IV SID – BID

Update – After 48 hours the steer is no longer honking and less dyspneic. The respiratory rate is still elevated and the breath is still somewhat foul smelling.


Drug Options

FlorfenicolCeftiofurTulathromycinTilmicosinDanofloxacinTetracycline PenicillinSulfonimides

Case 3

Problem: respiratory distressSignalment: Weaned crossbred beef steerHistory: Calf was purchased at a sale barn in northern Missouri with 49 other calves. It was transported to a small feedlot in west central MO where it was vaccinated on arrival. Previous health and vaccine information unknown. Calf pulled for treatment this morning. Environment: 1000 animal feedyard. No testing done. Calves are routinely purchased and combined into muti-source pens.


Dyspnea



5/9Gant

BehaviorDepressed

Gait and postureHead and neck

extended

Urine analysisNone caught


bpm


RumenNormal stratification

PingsNo pings

Lymph Nodesprefemoral – normalprescapular - normal

Lung auscultationLoud and harshCrackles and wheezesRapid, shallow breaths

Heart auscultationRhythm - regularIntensity - normalSounds – no murmurs or


Cervical skin tent4 seconds


PingsNo pings


Ballotmentnormal


Lung auscultationLoud and harshCrackles and wheezesRapid, shallow breaths

Heart auscultationRhythm – regularIntensity – normalSounds – no murmurs or





Skinnormal

Extremitiesnormal


HeadOcular discharge -

mucopurulentEye examination - normalNasal discharge -

mucopurulentMucous membrane color -

paleTeeth - normal



NAStrip cup


testNA

Rectal palpationNAFecesnormal

Problem list

Problem list

Fever Tachypnea Ocular and nasal dischargeHead and neck extended Rapid shallow breathingAbnormal lung sounds


Differential diagnosisTachypnea; ocular and nasal discharge; head and neck extension; rapid, shallow breathing; abnormal lung sounds– Pneumonia

Viral– BRSV, IBR, PI3

Bacterial– Manheimia haemolytica, Histophilus somnii, Pasturella

multocida

Fever– Inflammation, infection



None save money for treatment

Arterial blood gasCBCRadiographs

Antibiotics and Anti inflammatory– Resflor gold

Florfenicol– 40 mg/kg

Flunixin meglumine– 2.2 mg/kg IV

Dosed at 6ml/100 lbs SQ

Interpretationshould you so choose to run tests

CBCNeutrophilia – inflammatory diseaseNeutropenia – inflammatory disease, endotoxemiaLeft shiftToxic change in neutrophilsHyperfibrinogenemia – inflammatory disease

Update – six hours after the initial treatment the calf is noticeably improved. The calf’s temperature is 102.0 F, respiratory rate and effort are within normal limits. The calf is starting to eat and drink. Auscultation still reveals abnormal lung sounds.


Case 4

Problem: SickSignalment: 7-year-old Holstein bullHistory: ADR for approximately 2 weeks. Treated with antibiotics (several), flunixin meglumine, and several additional substances with no response.Environment: Bull resides on Amish farm. Used to breed cows for the owner and several neighbors.




3/5BehaviorQAR

Gait and postureSlight arch to back

Urine analysisNone caught


bpm


RumenDecreased fill

PingsNo pings

Lymph Nodesprefemoral – normalprescapular – sl. enlarged

Lung auscultationnormal breath sounds

Heart auscultationRhythm - UTDIntensity - UTDSounds – abnormal

Jugular veinDistended with pulses



PingsNo pings


Ballotmentnormal

Lymph nodesPrefemoral – normalPrescapular – sl. enlargement

Lung auscultationNormal breath

soundsHeart auscultationRhythm – UTDIntensity – UTDSounds – abnormal

Jugular veinDistended with

pulses Cervical skin tent5 seconds


Abdominal painElbows abducted

Skinnormal

Extremitiesnormal


HeadOcular discharge - noneEye examination - normalNasal discharge - noneMucous membrane color -

pinkTeeth - normal

Venous Distention

Jugular Pulses

Cardiac Auscultation new

Venous Pulsation



NAStrip cup


testNA

Rectal palpationweak aortic pulseFecesnormal

Problem list

Problem list

Increased pulse rateAbnormal cardiac auscultationDistended jugular veins with pulsesAbducted elbowsArched back


Differential diagnosisIncreased pulse rate, abnormal cardiac auscultation, distended jugular veins, jugular pulses– Heart failure

PericarditisValvular endocarditisLymphosarcoma

Abducted elbows, arched back– Pain

Cranial abdominal/caudal thoracic



Serious talk with owner

Echocardiogram ????CBCBLV serology/PCR– Cancer hunt

Euthanasia

Septic Pericarditis

Clinical Cases Focus on Respiratory and Cardiology

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