Mend Monroe: Help Protect Her Heart

Estimate for Monroe

In the last couple of months, Monroe has been having unexplained swelling in her leg joints. We've tried steroids, two antibiotics and loads of testing. While we were in the process of all the testing, a Grade two heart murmur was suspected. That halted doing any probable surgery until investigated. Below is a loose summary of medical notes from Newtown Vet. 

There are two separate issues being evaluated: her widespread joint swelling/infection and some abnormalities in the electrical conduction of her heart. The reassuring part is that her heart is pumping normally, she is not in heart failure, and the cardiologist says there is no immediate cardiac contraindication to anesthesia as long as special precautions are taken.

Monroe has swelling involving all four limbs/joints, particularly the carpal (wrist) joints. Fluid taken from a joint grew a bacterium called Streptococcus infantarius. THAT is significant. It means bacteria were actually cultured from joint fluid, rather than the swelling simply being presumed to be arthritis or inflammation. She's only two years old!

The organism was reported as susceptible to doxycycline, meaning that antibiotic should be capable of treating it. She has also been receiving prednisone and, at the time of this cardiology visit, Clavamox.

Because she has multiple swollen joints plus a documented bacterial culture, the doctors are understandably looking for a possible source of infection elsewhere in her body. That also explains why they were concerned about endocarditis—an infection involving the heart valves.

The good news: they did NOT find evidence of endocarditis

Her echocardiogram doesn’t describe the findings you’d expect from an obvious heart-valve infection. Her heart chambers are normal size, her heart’s pumping function is normal, and there is no fluid around her heart, lungs, or abdomen.

She does have mild abnormalities of the mitral and tricuspid valves called valve dysplasia. Essentially, those valves developed slightly abnormally. They allow a small amount of blood to leak backward. Right now, the cardiologist considers this mild. They specifically say it may never progress or cause her problems. They recommend rechecking her heart in 9–12 months.

Her ECG showed both first-degree AV block and episodes of second-degree AV block, Mobitz type II. Normally an electrical signal travels from the upper chambers of the heart to the lower chambers with every heartbeat. With second-degree AV block, sometimes the electrical signal doesn’t get through, so the ventricles don’t produce a beat in response. If that became severe, it could cause a very slow heart rate, weakness, collapse or exercise intolerance.

However, Monroe currently has none of those clinical signs.

The Cardiologist gave her atropine, and her heart rate increased appropriately to about 190 beats/minute and the AV block disappeared. That’s important because it shows her conduction abnormality is responsive to atropine. A pacemaker would be the treatment if the arrhythmia became clinically significant and didn’t respond to medication, but they are not recommending a pacemaker now.

They recommend a 48-hour Holter monitor, which is basically a portable ECG Monroe wears while going about her normal activities. That would show how often these blocked beats actually occur over two days. This is not practical in a shelter environment. Monroe would need to be in a long-term medical foster or a foster to adopt home, with no other pets, in order for us to test this. 

We are faced with a gargantuan task to raise this amount of money in a very short period of time. Once we raise at least two thirds of the gross estimate, we can schedule the surgery and work on getting her into a foster home. To apply to foster to adopt, please visit www.brasscityrescue.org