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HCM Heart In A 10-Year-Old FS DSH Cat: Our Case of the Month October 2016

Patient Information

Age
10 Years
Gender
Female, Spayed
Species
Feline

Images

Concentric left ventricular hypertrophy in 5 chamber right parasternal long axis with bidirectional turbulence through the LVOT and mitral regurgitation typical for feline HCM.
Sectorial LV hypertrophy demonstrated in right parasternal short axis.
LVOT turbulence in right parasternal 5 chamber long axis.

Sam-I-Am! Ever want to know how to dissect out an HCM heart sonographically regarding hypertrophy, dynamic outflow obstruction (SAM), bidirectional turbulence and decide if clinical or not? Our SonoPath Cardiologist Maggie Machen DACVIM (Cardiology) demonstrates Educational TelemedicineTM artistry in her evaluation of the cat heart imaged by Andi Parkinson RDMS of Intrapet Imaging, Baltimore, MD, USA in the October, 2016 SonoPath Educational TelemedicineTM case of the month. Want to start or improve your echocardiogram game? We have made it step by step simple for you with our program taught successfully to hundreds of veterinary sonographers over the years; with a simple twist or a tilt or a push you can get the views you need every day.

Check out our educational products for rock star echocardiogram imaging with the SDEP downloadable cardiac program https://sonopath.com/products/downloadable

SDEP Poster:

https://sonopath.com/products/poster

Normals DVD abdomen and Cardiac with efficiency clips to obtain the rapid normal images in a short amount of time with 3 second maneuvers:

https://sonopath.com/products/cd

& of course our SDEP echo seminar this November 18-20, 2016 in Sarasota, Florida with Mandi Klemen DACVIM (Cardiology)

http://sonopath.com/events/2016-sdep-ce-events/nov-18-20-sdep-echo-sarasota-fl

History

A 10-year-old, FS, DSH cat was presented for assessment of murmur and anesthetic risk prior to dental prophylaxis. An exam 1-month prior revealed a grade III/VI murmur. NT-proBNP was >1500pmol/L. The patient was on no medications at the time of ultrasound. CBC/Chem/UA were all WNL. Radiographs showed cardiomegaly.

Image Interpretation

The left ventricular wall is moderate to severely asymmetrically hypertrophied. There is a diffusely hyperechoic endocardium consistent with fibrosis and ventricular remodeling. Asymmetric papillary muscle hypertrophy and atrophy. The right ventricle is subjectively normal in size and morphology. There is mild left atrial enlargement present. No right atrial enlargement present. Elevated RVOT velocity consistent with a dynamic obstruction. There is mild to moderate systolic anterior motion (SAM) of the mitral valve present, with a mildly elevated LVOT velocity. There is moderate eccentric mitral regurgitation present secondary to SAM. No other obvious valvular regurgitation is present. There is no pericardial effusion noted. No pleural effusion appreciated.

DX

Hypertrophic obstructive cardiomyopathy.

Outcome

This indicates LV hypertrophy with a dynamic LVOT obstruction (SAM). There is mild left atrial dilation, indicating the risk of a future spontaneous CHF and/or a thrombotic event may be elevated. There is also a benign RV outflow obstruction (DRVOTO). If able, administer titrating dose of atenolol: 2.5mg tablets; Give tab once daily. Recheck heart rate in 1-2 weeks with target stressed rate of 140-160bpm 12-24 hours post administration. Increase as needed until target reached. Screening blood pressure is recommended. Recommend recheck echocardiogram in 6 months to assess for progression, sooner if clinical issues arise.

Videos

Concentric left ventricular hypertrophy with both fixed LVOT obstruction by the IV septum prior to the aortic outflow as well as dynamic systolic anterior motion of the mitral valve. No volume overload is noted in the LV or LA hence this HCM is currently compensated.
Sectorial LV hypertrophy demonstrated in right parasternal short axis as well as normal LA/AO heart base. This is an example of the sonopath short axis 3 second efficiency clip used to capture as many key image positions as possible in a 3 second sweep. More on this technique for abdomen and thorax may be found on our Normals DVD Cardiac and Abdomen with lots of efficiency clip maneuvers to save time and obtain rock star views that may be post processed. https://sonopath.com/products/cd
Sectorial LV hypertrophy demonstrated in right parasternal short axis.
Concentric left ventricular hypertrophy in 5 chamber right parasternal long axis with bidirectional turbulence through the LVOT and mitral regurgitation typical for feline HCM.