Case Studies In Small Animal

Cardiovascular Medicine

Home Up 1    Pleural Fluid 2              Cough 3   Heart Murmur 4           Syncope 5       Tachypnea 6           Cyanosis 7   Heart Murmur 8   Heart Murmur 9              Cough 10    Heart Failure 11              Ascites 12    Pleural Fluid 13           Syncope 14     Bradycardia 15     Tachycardia 16                Blind 17   Heart Murmur 18   Resp. Distress 19        Collapsing 20    Heart Failure 21          Paralysis 22    New Murmur 23              Cough 24          Vomiting 25       Tachypnea 26   Heart Murmur 27      Hemoptysis 28  Limb Swelling 29  Heart Murmur 30 Acute Collapse 31 Enlarged Heart 32               Blind 33             Cough 34         Collapse 35         Collapse 36 Thromboembolus 37  Heart Murmur 38  Heart Murmur

Diagnostic Studies

Case 34

Primary clinicians: Sarah Miller, DVM and Gerhard Wess, DVM

Supervising clinicians: Mark D. Kittleson, DVM, PhD, DipACVIM (Cardiology) and William P. Thomas, DVM, DipACVIM (Cardiology)

Signalment

bulletTen-year-old MC DLH cat weighing 6.1 kg ("Christopher")

Presenting Complaints

bulletCollapsing Episodes

Pertinent History

bulletChristopher presents to the VMTH Neurology Service for a 4 month history of collapsing episodes.
bulletThe episodes last approximately 5 seconds after which he is normal. The episodes normally consist of falling to one side and reaching/clutching with his forelimbs.
bulletYesterday he had an unusual episode where he went rigid, stuck one forelimb out, fell over against a wall and then fell down. Afterward he got up and was normal. Three minutes later as he was walking into the house the owner noticed that he was staggering like he was drunk. This quickly passed and he became normal again.
bulletHe does not appear to know when an episode is going to happen. He does not urinate, defecate or salivate during an episode. There is no particular time of day that they occur although they may occur at feeding time or when he is picked up. He appears to lose consciousness during the episodes although the clients have never tried to rouse him.
bulletWhen he first began having the episodes the clients would see 4-6/day, but he was an outdoor cat and was often away from home. He has begun staying closer to home and the clients estimate that he experiences 10 episodes a day. They do believe that the number of episodes he has in a day has been progressively increasing and that this increase is not due to an increase in time spent at home. He also has begun hiding in a cubby in the bedroom. Between episodes he is normal.
bulletAt one point the referring veterinarian noted a systolic BP of 120mmHg, a heart rate of 80-90 beats/minute, and a gallop rhythm.
bulletHe has had two cardiology consults, one 4 months ago and one 3 days ago.
bulletUltrasound images and an ECG from January are available for review. One undated record is available and indicates a 1-2/6 systolic murmur with regular rhythm and a heart rate of 132 beats/minute.
bulletEchocardiogram revealed changes consistent with idiopathic hypertrophy of the basilar septum, mild mitral valve thickening, mild regurgitation, and mild left atrial enlargement. No obvious cause of syncope was noted.
bulletOne record dated from 3 days ago indicates a 1-2/6 systolic murmur with intermittent premature beats with an overall slow rate. An ECG showed occasional junctional premature beats and an intermittent conduction abnormality but little change in heart rate (per record). His echocardiogram was similar to his previous exam showing mildly enlarged left ventricular and atrial chambers. At this time he was prescribed aminophylline 25mg PO BID.
bulletHe is on no other medications at this time. Prior to being started on aminophylline he may have been feeling a little ill which may have improved on this medication, but it has not changed the frequency of his episodes.
bulletHe has a good appetite and energy level, although he may not be cleaning himself as well.
bulletHe is an indoor/outdoor cat who lives on an acre with two dogs and one other cat.
bulletHe has had no C/V/D/Pu/Pd/Pp although he sneezes occasionally.
bulletHe eats a handful of Science Diet kibble BID and a can of Fancy Feast/day.
bulletHe is vaccinated annually at a vaccine clinic and is up to date.
bulletHe is often exposed to ticks, has not traveled, and was hit by a car 7 years ago, but suffered no ill effects.
bulletThe clients do not put pesticides or rodenticides out in their property, but he does have access to other people's property.
bulletHe has previously been tested for FIV/FeLV and feline heartworm, all of which were negative.

Physical Examination

bulletGen: BARH, T: 102.5F
bulletInteg: slightly unkempt hair coat; no masses palpated; shaved under tail base and over the right jugular vein.
bulletEyes: corneas clear; sclera white, pupils of equal size; no discharge
bulletEars: ceruminous discharge AS; clean AD
bulletNose: no discharge
bulletThroat: resists oral exam, no masses visualized
bulletMS: BCS 4-5/9, ambulates well
bulletCV: 2-3/6 systolic murmur heard best over the mid-sternum (left apex); no gallop rhythm noted; mm pink; CRT 1-2 sec; HR 110 beats/minute
bulletR: lungs auscult clear all fields; RR 40 (purring)
bulletGI/GU: moderate sized bladder; kidneys smooth and of normal size; no masses or organomegaly palpated
bulletNS: Mentation: BAR; Gait/Posture: normal; CrN: within normal limits; Postural reactions: wheelbarrow and hemiwalking normal; spinal reflexes: biceps, gastrocnemius, patellar, triceps, and withdrawal intact in all limbs; panniculus and perineal reflexes normal; spinal palpation normal
bulletLN: mandibular, prescapular and popliteal < 1cm

Problems

bulletEpisodes of Collapse
bullet2-3/6 Systolic Murmur
bulletBradycardia

Diagnostic Plan

bulletCardiology consult
bulletCBC
bulletSerum Chemistry Panel
bulletAbdominal Ultrasound
bulletThoracic Radiographs
bulletUrinalysis

 

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