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Friday, January 23, 2009
Solution for case 12
Radiographic findings: Thoracic radiographs showed a valentine shaped heart with significant generalized cardiomegaly and enlarged pulmonary arteries and veins. Abdominal radiographs showed homogenous soft tissue opacities with little visceral details which strongly suggest the presence of a significant amount fluid in the abdomen.

Tentative diagnosis: Congestive heart failure (Hypertrophic cardiomyopathy).

Differentials:

  • Heartworm
  • Restrictive and Dilated cardiomyopathy
  • Hyperthyroidism
  • Feline infectious peritonitis (FIP)
  • Feline asthma

Hypertrophic cardiomyopathy is common in the cat and is characterized by concentric ventricular hypertrophy in which the ventricular walls become thickened. The heart pumps well but cannot relax well during diastole. In addition, the thickening of the ventricles results in malorientation of the AV valves so the cat may develop mitral regurgitation. The cat may also develop dynamic aortic outflow obstruction secondary to the systolic anterior motion of the mitral valve.

Cat was positive for heartworm, and can be further confirmed by ultrasound which is more reliable in cats.

This patient is suffering from ascites and dyspnea secondary to hypertrophic cardiomyopathy complicated by heartworm disease. Thorax radiograph showed enlarged pulmonary arteries and veins which may be supportive of heartworm disease.

Two possible differentials are dilated cardiomyopathy caused by a taurine deficiency and restrictive cardiomyopathy caused by fibrosis of the endocardium, myocardium, or subendocardial tissues. These can be differentiated from HCM because dilated cardiomyopathy is rare since most cat foods are supplemented with taurine and restrictive cardiomyopathy usually shows enlargement of one or both atria and not a generalized hypertrophy.

A T4 test was done to rule out hyperthyroidism.

In FIP we will see presence of an exudate aspirated from the abdomen as well as an inflammatory CBC.

There was no eosinophilia present in the CBC to support a diagnosis of feline asthma; however, eosinophils in a transtracheal lavage would be more diagnostic.

Treatment:

Due to the dyspnea, the patient was immediately started on oxygen therapy with a pulse oximeter and oxygen levels increased from 80% to 98% oxygen saturation. A catheter was placed, IV fluids were started.

The patient was placed on furosamide (10mg IV twice a day) and diltiazem (10 mg/kg PO q24h) (Ca channel blocker) to treat the hypertrophic cardiomyopathy, pulmonary edema, and ascites. Fluid therapy was continued at twice the maintenance dose (2-3ml/kg/h) for 4 days.

Client education: The patient needs to be on daily heart medications for the rest of its life. Heartworm preventative needs to be given monthly to help prevent the heartworm disease from getting worse.

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posted by Dr Banga's Websites @ 12:00 AM  
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