"Something sounded strange when I tried to get a heartbeat", my technician recently told me as she described a patient in a room waiting to see me. The dog was an older pet, 9 years old, and had come in for not acting right that day. He had been seen a few weeks ago for similar signs but nothing was found that day on his labwork or exam. Today the owner said he didn't really want to get up and was not interested in eating. So when my skilled technician told me her findings, my interest was peeked. As soon as our techs tell us information regarding our patients, we immediately start running a list of possibilities in our minds - its how we are trained to think. We go over abnormalities, symptoms, differentials, possible explanations and so on and so on.
The combination of an older dog who didn't want to get up and eat, along with the strange thing my tech described made my inner ER doctor come to life. I asked her a little more about what she meant - she said it was hard to hear his heart and that his pulses on his back legs felt funny. Small alarm bells start ringing in my head because I immediately know what I need to do for this poor dog and owner. I go in and approach the concerned owner and let him know that based on what he has described at home and what my technician noted on her initial exam I am concerned that his dog may have some fluid developing around his heart - a condition called pericardial effusion. I do my physical exam and notice that this dog's gums do look a little pale and his heart rhythm is abnormal. I tell dad that our next step to confirm things is to do a quick ultrasound to look for fluid around the heart. If we see some I will come back and talk to him about our next steps.
Our ultrasound confirmed what I had suspected - this poor guy did indeed have pericardial effusion - fluid contained within the sac surrounding the heart. Imagine the heart sits inside a thin balloon - usually there is only a small amount of fluid in that balloon but in some instances we get a large amount of fluid there. This fluid fills up the balloon and puts pressure on the heart, preventing the heart from being able to contract and pump normally. This leads to symptoms such as we saw today - lethargy, pale gums, disinterest in food, and difficulty hearing the heart when listening to the dog with a stethoscope. Imagine trying to listen to music through a wall of water - it would all sound muffled right? That's what it sounded like when we listened to this dog - everything was muffled.
We were able to drain the fluid from around the heart using a long needle (a procedure called a pericardiocentesis). We removed almost 1/2 liter of blood from around his heart.
This instantly made him feel better and when his dad picked him up later that day he eagerly walked into the room, tail wagging the whole time. Often pericardial effusion is due to an underlying cancer somewhere and in this instance, a large tumor on this dog's spleen had metastasized to his heart which was causing the blood to accumulate around it. Unfortunately, the owners had to make the tough choice to say goodbye to their friend a week later.
I credit my great technical staff for noticing such a slight symptom and clinical sign - it was their keen awareness of what is normal and abnormal that tipped me off to know which direction to head in with this patient. I was glad we were able to provide some relief to this patient, even if only for a short amount of time.
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