Radiograph of a poodle with enlarged heart, ¾ murmur on left side, dyspneic, what do you treat with?

• A. Furosemide and digoxin
• B. Atropine and epinephrine
• C. Cefazolin and fluids
• D. Prednisone

Answer: (A)

When a small dog shows an enlarged heart on radiographs, a left-sided systolic murmur typical of mitral valve disease, and dyspnea, the scenario points to congestive heart failure from valve degeneration. The treatment goal is to reduce fluid buildup in the lungs and support the heart’s pumping ability. Furosemide is a diuretic that lowers preload and pulls fluid out of the lungs, rapidly easing breathing. Digoxin provides a positive inotropic effect, helping the heart pump more effectively and can help with rate control to improve overall cardiac output. This combination targets both the fluid overload and the reduced pumping function seen in this condition.

The other options aren’t appropriate for this situation: atropine and epinephrine are used for emergency rhythm issues or arrest, not for treating heart failure; cefazolin and fluids would add fluid load and worsen pulmonary edema; prednisone is not a treatment for heart failure and can worsen fluid retention.