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

.    Radiographs 2D Echo .    More Echoes .    Angiograms .    Cardiac Cath Diagnosis

Case 6

Primary clinician: Darcy Adin, DVM

Supervising clinician: Mark D. Kittleson, DVM, PhD, DipACVIM (Cardiology)


Signalment

bulletSeven-year-old FS domestic shorthair weighing 4.4 kg ("Nastasia")

Presenting Complaint

bulletCyanosis

Pertinent History

bulletNastasia was first seen at the VMTH seven years ago and a tentative diagnosis of ventricular septal defect with pulmonic stenosis or pulmonary hypertension was made. Thoracic radiographs showed cardiomegaly with enlargement of the main pulmonary artery. Color flow Doppler was not available at that time and a definitive diagnosis could not be made.
bulletNastasia presented today as the owner has moved and can no longer keep the cat and was not able to locate another owner and so brought her here as a last resort.
bulletShe was hit by a car when 1 year of age, and the owner believes she may have had broken facial bones. She completely recovered from the incident.
bulletNastasia is an indoor/outdoor cat and is not on any medications at this time.
bulletShe has almost daily episodes of dyspnea which last 3-5 minutes, after which she is normal. The episodes appear to be initiated by excessive attention from the owner. The owner states that she has always had these episodes and they have not gotten worse.
bulletNo syncope. No other problems, except for occasional hairball associated vomiting every 1-2 months.
bulletDiet is kibble and canned "fishy" foods.
bulletShe is a "nervous" cat and is not good with children or dogs.
bulletHowever, she is very photogenic and has learned to pose for the camera (see above).
bulletVaccines are current.

Physical Examination

bulletT=102.4, P=180, R=48.
bulletBARH. Clean skin with full hair coat.
bulletEyes- incomplete PLR (nervous), anterior chambers clear, no scleral injection.
bulletEars-clean.
bulletMouth- mm pale pink, mild calculus on PM and M's, no oral masses.
bulletNose appears faintly cyanotic (see above picture). CRT 1 sec.
bulletBCS 5/9, symmetrical musculature.
bulletGrade 2/6 left sided sternal systolic murmur (difficult to auscult due to constant purring).
bulletTachypneic, slight abdominal effort upon breathing, "cooing like sound" audible. Breath sounds ausculted bilaterally.
bulletSmooth gut loops, left kidney smooth. No abdominal masses or organomegaly. Small bladder palpated.

Problems

bulletGrade 2/6 left sided systolic murmur with history of congenital heart disease
bulletGeneralized cyanosis

ECG

bulletECG revealed occasional PVCs and a right-axis shift.

Lab work

bulletPCV-49%,
bulletTP- 8.2 gm/dl

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