Name: Leo
Age: 11 years old
Sex: Male, Castrated
Breed: Domestic Long Hair
Weight: 4.6 kg (10.2 lbs)
Reason for Visit: Adopted as an adult cat 12 months previously. He is reportedly asymptomatic at home. He seems to have some difficulty eating and a dental procedure was recommended. Physical examination revealed a heart murmur and Leo was referred for evaluation prior to his dental procedure.
Medications: None

Please review Leo’s clinical history.

Attitude/Demeanor: Quiet, alert, responsive
Coughing: No coughing
Abnormal Respirations: None
Exercise Intolerance: Normal
Sleep Patterns: Normal
Weight Change (loss or gain): Weight loss is reported over the past 12 months
Appetite: Reduced possibly related to dental disease
Usual Diet: Science Diet® Adult Maintenance, kibble
Vomiting: Uncommonly vomits hairballs
Diarrhea: None
Syncope: None
Change in Urinary Habits: None
Change in Drinking Habits: None
Other Symptoms or Signs: None

Please review the results of Leo’s physical exam.

Body Condition: Thin – BCS 4/9
Attitude: Quiet, alert, responsive
Mobility | Gait: Normal
Posture: Normal
Hydration: Normal
Body Temperature: 100.2 F
Arterial pulse – rate, regularity, intensity: 180 bpm, infrequent arrhythmia detected with pulse deficits
Rate & Respiratory Effort: 24 breaths per minute, normal
Mucous Membranes – Color & CRT: Normal color and CRT
Jugular Venous Pulse & Pressure: Normal, no evidence of jugular venous distension
Abdominal Palpatation: Normal
Lymph Nodes: Normal
Oral Cavity: Diffuse periodontal disease is identified
Other abnormalities: None

Let’s auscult Leo’s heart

Listen to Leo’s heart

The following are potential diagnoses for you to consider at this time. Based on the history and the physical examination, please indicate the likelihood of each as:

• High (could explain most or all of the signs)
• Possible (less likely to explain most of the signs)
• Unlikely

Systolic Blood Pressure: 155 mmHg, #2 cuff, right rear
Diastolic Blood Pressure: Not available for this case
Mean Blood Pressure: Not available for this caseConsensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provides the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. In 2018, ACVIM published guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats in the the Journal of Veterinary Internal Medicine.Click here to view and download a PDF of the ACVIM Consensus Statement, Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats.

Please review Leo’s radiographs

Click here for Leo’s radiograph viewer (measure VHS and VLAS here) View the right lateral radiograph View the ventral dorsal radiograph  

Please review Leo’s lab results

SERUM CHEMISTRIES

BUN: 36 mg/dL Normal: 15-33 mg/dL
Creatinine: 1.5 mg/dL Normal: 0.9 – 2.1 mg/dL
Sodium: 153 mm0l/L Normal:146 – 158 mm0l/L
Potassium: 4.9 mm0l/L Normal: 3.4 – 5.2 mm0l/L
Chloride: 120 mm0l/L Normal: 110 – 125 mm0l/L
ALT: 33 IU/L Normal: 25 – 145 IU/L
ALP: 28 IU/L Normal: 10 – 79 IU/L

HEARTWORM

Heartworm Test Results: Not performed

URINALYSIS

Urinalysis – USG: 1.018
Urinalysis – Protein: Negative
Urinalysis – Biochemical: Not Done
Urinalysis – Sediment Evaluation: Negative

CBC

White Blood Cells: 11.3 K/microL
Red Blood Cells: 8.12 M/microL
Platelets: 144 K/microL, scanning reveals clumping with adequate platelet numbers.
Thyroid Level: 2.5 mg/dL

Please review the results of Leo’s echo.

Please view the videos and interpretations that follow.

Click here to watch Leo's LV right sided short axis view Click here to watch Leo's LA/Ao right sided short axis view Click here to watch Leo's right sided short axis color flow Click here to view Leo's right ventricular outflow tract velocity Click here to watch Leo's 4-chamber right sided long axis view Click here to watch Leo's right sided long axis color flow Click here to view Leo's left ventricular outflow tract velocity Subjective – lesions of valves, myocardium, pericardial space: Systolic anterior motion of the mitral valve is present.
LV chamber size and thickness Symmetrical left ventricular concentric hypertrophy, left ventricular papillary muscle thickening and normal systolic function.
Left atrial size Normal left atrial size.
LVIDd & LVIDs Diastole (1.61 cm); Systole (0.70 cm).
LV shortening fraction 56.5%.
RA, RV and Pulmonary Artery Subjectively normal.
Effusions No effusions visualized.
Color Flow Results Systolic anterior motion of the mitral valve was present producing left ventricular outflow tract obstruction and mitral insufficiency. There was no visible right ventricular outflow tract obstruction.
Spectral Doppler Results The right ventricular outflow tract velocity was normal at 1.2 m/s (120 cm/s). the left ventricular outflow tract velocity was elevated at approximately 5 m/s (500 cm/s). This velocity is converted to a pressure gradient using the modified Bernoulli equation (4v2). So Leo’s velocity of 5 m/s translates to a left ventricular outflow tract gradient of 100 mmHg.

Please review Leo’s ECG

Click here for Leo's ECG results

You’re ready to form a diagnosis and treatment plan for Leo! Please select your answer to each question below.

Follow Up Treatment: Because of the identified myocardial changes and ventricular arrhythmia the CEG recommended re-evaluation of Leo’s cardiac status in 3 months. A recheck echocardiogram enables evaluation of the efficacy of the atenolol and to determine whether the myocardial changes and atrial size were stable, progressive or possibly improved. The owners were instructed to have Leo re-evaluated quickly if he developed clinical signs of increased respiratory rate or effort, changes in his attitude or appetite, development of syncope, or acute hindlimb weakness or paralysis.

Please answer the following questions.