Case Studies In Small Animal

Cardiovascular Medicine

ECG From Similar Case

Signalment: One-year-old spayed female domestic shorthair cat (Lily)

Presenting complaint: Episodes of lethargy and weakness

ECG 1

September 18, 2006

bulletLilly is a 16 month old female spayed DSH cat. She presented to the VMTH Neurology Service with a history of intermittent lethargy and weakness.
bulletThe owners have had her since she was a very young kitten (they got her 15 months ago). She got sick a lot as a kitten with upper respiratory symptoms.
bulletThey report that she has had intermittent episodes of lethargy since last September (1 yr ago). The episodes almost always happen after she goes outside although sometimes she comes in and is normal and once she had an episode without going outside. The episodes involve a gradual onset (minutes) of lethargy and apparent weakness where she drops her head and some times rests it in her water bowl. She then leans against a wall or in a corner and goes to sleep but occasionally she doesn't close her eyes all the way during these periods of "sleep". The owners are unable to rouse her and describe that she seems like she is going to die. Her fur puffs up during the episodes. These episodes last for a few hours usually overnight (never more than a day) and then she wakes up and is fine. Recently the episodes happen every few days to every couple of weeks. The last episode she had was 2 days ago. The owner feels strongly that there is a correlation with going outside and reports that Lilly eats lots of plants while she is outside. She plays normally with the other cat in the house and does not seem to tire with exercise.
bulletIn between the episodes Lilly acts like a normal cat.
bulletPhysical and neurological exams were normal.

October 30, 2006

bullet
Lily was referred to the Emergency Service for lethargy and tachycardia.
bulletHPI: Cat goes outside approximately 4 x week and has subsequent episodes 2-3 x week. The episodes involve profound lethargy.
bulletEpisodes always follow time spent outdoors. Episode lasts from few hours to 12 hours and then returns to normal. When cat is outside, she spends most time eating grass and weeds. Owner unable to identify any specific weeds or garden plants. Weed killer has been sprayed intermittently and owners uncertain if gardener uses pesticides.
bulletToday's episode has been ongoing for past ~12 hours.
bulletOne seizure 4 1/2 months ago. Owner reports she slept for 12 hours that day then at midnight he was woken up by her thrashing, rolling, and flipping. This is the only time the owner has observed a seizure episode.
bulletVaccines current, rabies given last week.
bulletPhysical exam: QAR, MM - pink, HR>300bpm. No murmur is ausculted. Pulses are weak and synchronous.
bulletECG: HR 380bpm, supraventricular tachycardia (SVT), suspect alternative pathway, mea 120.
bulletEchocardiographic objective findings: IVSd= 4.3 mm, LVFWd= 6.4mm, EDD = 10.2mm, IVSs= 7.2mm, ESD= 6.5mm, LVPWs= 7.7mm, LA= 14.9 mm, Ao= 10.2 mm, LA/Ao= 1.5, FS~36%, RVOT vel. ~ 0.6m/s, LVOT vel.= 0.6.m/s.
bulletEchocardiographic subjective findings: The left ventricle and the papillary muscles have normal size and shape. There is mild to moderate left ventricular concentric hypertrophy and moderate papillary muscle hypertrophy. This finding may be consistent with pseudohypertrophy.
bulletLily was sent home on atenolol 6.25 mg q12 hours.

ECG 2

11/03/06

bulletLily returned today with a history of no additional episodes. However, she has been kept indoors since her last visit.

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Mark D. Kittleson, D.V.M., Ph.D. All rights reserved.