Case Studies In Small Animal

Cardiovascular Medicine

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Second Recheck

Case 32

Two months later

Pertinent History

bulletMickey was diagnosed with dilated cardiomyopathy two months ago. At that time, he had neurologic signs, and central retinal degeneration as well. His shortening fraction at that time was around 18%. He was severely taurine deficient with a whole blood taurine concentration of 24 nmol/ml and a plasma taurine concentration of <2nmol/ml. The owner reports that Mickey is doing well at home. His neurologic signs appear to have resolved. The owner thinks his vision may be slightly improved. His activity level is greatly increased and no weakness or lethargy are present. There has been no dyspnea, tachypnea, or coughing seen. His appetite is good, and he is currently eating baked chicken, Iams dry food, and chicken baby food. He continues to vomit more than is normal for him, but doesn't vomit every day. He has had some diarrhea which resolved with decreasing his enalapril dose to SID. Renal parameters have remained in the normal range at the referring veterinarian's as of mid-September. He is currently on enalapril, 1.25 mg PO SID, 6.25 mg furosemide SID, and 500mg taurine crystals PO SID-BID.

Physical Examination

bulletBAR. Approximately 5% dehydrated based on skin turgor and mucous membrane moistness. T=101.6, P=220, RR=40. St=4.55 kg BCS 5/9. Very nervous in exam room. Widely dilated pupils, bilaterally unresponsive to light. Menace absent OU. Moderate gingivitis and calculus present. No ataxia seen, ambulates well. No murmur ausculted. Regular cardiac rhythm. Soft gallop noted on auscultation. Fair femoral pulses. No jugular pulses or pulse deficits. Eupneic, but slightly tachypneic. Lungs auscult clear. Cranial abdomen palpated full. No head tilt, falling, or leaning seen. The rest of the physical exam was within normal limits.

Problems

bulletDilated cardiomyopathy
bulletCentral retinal degeneration

Comments

bulletPE: No murmur ausculted. Regular rhythm. Soft gallop ausculted. Fair femoral pulses. No jugular pulses or pulse deficits appreciated. Eupneic with mild tachypnea. Lungs auscult clear.
bulletEcho: IVS(d)=0.4 cm, IVS(s)=0.6 cm, LVEDD=1.9 cm, LVESD=1.4 cm, Ao:LA =0.7, LVFW(d)=0.4 cm, LVFW(s)=0.5 cm, SF=26%.
bulletAssessment: The ventricular end-systolic diameter has decreased from 19 to 14 mm, which means myocardial function has improved. The left ventricular end-diastolic diameter has also decreased, from 23 to 19 mm. Shortening fraction has increased from 18% to 26%. All of these indicate that taurine supplementation is improving the cardiovascular portion of his disease. Central retinal degeneration due to taurine deficiency is known to be irreversible, so improvement in vision is unlikely. Continuing taurine may further reverse the dilated cardiomyopathy in this cat.
bulletPlan: Continue with current therapy. Recheck in 6 weeks to assess his condition. Educate owner about continued progress.

Two weeks later

bulletTaurine levels:
Taurine 304 Plasma NMOL/ML  
Taurine 717 Whole Blood NMOL/ML  
bulletAssessment: The taurine concentrations are well above the normal range. The owner is successfully supplementing Mickey with taurine.

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