Case Studies In Small Animal

Cardiovascular Medicine

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Second Visit

Case 31



VISUAL INSPECTION                                           
   Turbidity           hazy              Visual
   Color               yellow            Visual
   Specific gravity    1.037             Refractometer

CHEMICAL REAGENT STRIP                           
   pH                  5.5               Reagent strip
   Protein             2+                Reagent strip
   Glucose             negative          Reagent strip
   Ketones             negative          Reagent strip
   Bilirubin           negative          Reagent strip
   Hemoprotein         4+                Reagent strip

SEDIMENT               <.1ml sediment/2ml           
   WBC                 0-1               #/hpf
   RBC                 <10               range/hpf
   EPITHELIAL CELLS                                         
     Transitional      rare              range/hpf
     Squamous          none seen         range/hpf
     Renal             none seen         range/hpf
   Casts               none seen         range & type/lpf
   Crystals            none seen         rare/few/mod/many
   Bacteria            none seen         rare/few/mod/many
   Lipid Droplets      none seen         rare/few/mod/many
   Sperm               none seen         rare/few/mod/many

Clinical Diagnoses

bulletHeartworm disease


bulletThoracic radiographs: Enlarged caudal vena cava with possible caudal lobar branch pulmonary artery enlargement. Focal interstitial pulmonary patterns.
bulletEchocardiography: A heartworm is present in the right ventricle. More heartworms are also present in the pulmonary artery. Marked RA and RV chamber dilation are present and the RV free wall is mildly to moderately thickened. The left ventricle is mildly underloaded. Mild tricuspid regurgitation is present. The transvalvular pressure gradient is within normal limits. This is not consistent with the diastolic septal flattening and the enlarged vena cava since one would expect pulmonary hypertension to be the cause of right heart failure in this cat. The tricuspid regurgitation jet will be reassessed at the next visit.
bulletECG: Normal
bulletCBC: PCV 25%, MCV 40, MCHC 31.
bulletThe presence of hemoglobin in his urine is most likely due to mild caval syndrome where the RBCs are being lysed as they pass through the tricuspid valve and the entwined heartworm during systole.

Discharge Instructions

bulletBoris has moderate signs of right heart disease secondary to his heart worm infection. Several worms are present in his heart chambers and pulmonary arteries. The worms in his pulmonary arteries cannot be removed mechanically.
bulletRemoving worms from his heart may be possible in the future if more worms are present in his right heart.
bulletPlease give Boris prednisone 5 mg twice daily for 7 days, then once daily for 14 days, then once every second day for 14 days.
bulletPlease bring Boris back for a recheck in 4-6 weeks, or earlier if problems occur.
bulletThanks for bringing Boris to the VMTH. He is a great cat.


Although this cat did not have all of the classic signs of caval syndrome, he did have dark brown colored urine, hemoglobinuria on urinalysis, and an anemia. A nice example of urine and serum from a dog with hemoglobinuria and hemoglobinemia due to caval syndrome can be seen at Caval Syndrome.

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