Presentation

A 3 year old male neutered Shih Tzu presented for evaluation of lethargy, increased respiratory rate and effort, coughing as well as increasing murmur intensity. Patient was previously diagnosed with pulmonary hypertension secondary to acute pulmonary disease 6 months prior based on echocardiography and thoracic radiographs. Acute therapy with antibiotics and bronchodilators was initiated at that time with minimal response. Enalapril was also initiated and continued.

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Echocardiogram

Severe enlargement of the right atrium and right ventricle as well as severe thickening of the RVFW and IVS. Marked systolic flattening of the IVS. Severe leakages of the pulmonic and tricuspid valves. Severe elevation in pulmonary artery pressure (90 mm Hg / 30 mm Hg)

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Diagnosis

Idiopathic (primary) pulmonary artery hypertension with corresponding Cor Pulmonale

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Treatment

Viagra and Pimobendan were added to the enalapril.

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Initial Re-Evaluation

Marked clinical improvement as well as a reduction in pulmonary artery pressure to 50 mm Hg / 15 mm Hg. The Viagra dose was increased and Theophylline was added.

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Follow-Up

Patient continues to do well at home > 2 years since the initial evaluation. Pulmonary artery pressure has remained stable at 50 mmHg. Current Medications are Viagra, Pimobendan, Enalapril, Theophylline.