Case Studies

These case studies contain detailed information on the diagnostic and treatment process for each individual animal.

Leo Tutorial

Case Background

Name: Leo
Age: 11 years old
Sex: Male, Castrated
Breed: Domestic Long Hair
Weight: 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

Clinical History

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

Physical Exam - General

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

Physical Exam - Auscultation

Let’s auscult Leo’s heart

  Listen to Leo’s heart
WHAT DO YOU HEAR?
Direct HR: 200 beats/min
Heart Rhythm: Underlying rhythm is regular although there are premature complexes ausculted.
Intensity of Heart Sound: Normal
Extra Sounds – Clicks or Gallops: 2/6 systolic parasternal murmur is ausculted.
Precordial Palpation: Normal

Direct HR: 200 beats/min
Heart Rhythm: Underlying rhythm is regular although there are premature complexes ausculted.
Intensity of Heart Sound: Normal
Extra Sounds – Clicks or Gallops: 2/6 systolic parasternal murmur is ausculted.
Precordial Palpation: Normal

Physical Exam - Differential Diagnosis

The following are potential diagnosis 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
PRIMARY CARDIOMYOPATHY
LEFT VENTRICULAR HYPERTROPHY RELATED TO SYSTEMIC HYPERTENSION
LEFT VENTRICULAR HYPERTROPHY RELATED TO HYPERTHYROIDISM
ACQUIRED VALVULAR HEART DISEASE
CONGENITAL HEART DISEASE
PHYSIOLOGICAL MURMUR (E.G. HIGH OUTPUT STATE LIKE ANEMIA)
The CEG considers the following differential diagnosis as most likely (and why): Leo represents a common presentation, a heart murmur in an otherwise asymptomatic cat. Heart murmurs in cats are often produced by left or right ventricular outflow tract obstruction. Left ventricular hypertrophy (related to primary cardiomyopathies or diseases that secondarily alter the myocardium) is the most common etiology accompanying outflow tract obstruction. Acquired valvular heart disease is uncommon in cats but remains a possible explanation for the heart murmur. Because of Leo’s unknown history prior to adoption one year ago congenital heart disease remains on the differential list. The intermittent arrhythmia provides concern that either underlying myocardial changes are already present, or that atrial enlargement may be present producing supraventricular arrhythmias. Because of the heart murmur and intermittent arrhythmia the CEG considers left ventricular hypertrophy related to cardiomyopathy, systemic hypertension, or hyperthyroidism as the most likely.

Diagnostic Test Selection

The following are potential diagnosis 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

BLOOD PRESSURE

NON-INVASIVE BLOOD PRESSURE

Blood Pressure

BUN     13 mg/dL
Normal: <30 mg/dL
Creatinine 0.88 mg/dL, Normal: <2.1 mg/dL
Sodium 146 mEq/L, Normal:138 – 154 mEq/L
Potassium 3.8 mEq/L, Normal: 3.6 – 5.2 mEq/L
Chloride 113 mmol/L, Normal: 105 – 119 mEq/L
ALT 55 IU/L, Normal: <75 IU/L
ALP 28 IU/L, Normal: <100 IU/L
First question

Radiographs

Echo

Echocardiography

Echocardiographic Interpretation

ECG

ECG Interpretation

Diagnosis & Treatment

Diagnosis

Treatment

Follow Up

Follow Up

Follow-up Treatment

Clinical Labs

Referral

Summary of Current Test Results

Additional Diagnostic Test Selection

Additional Diagnostic Test Results

Post Test - CE

CE Certification

RACE Certification

RACE Certification

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    The CEG is funded through an educational grant from Boehringer Ingelheim Vetmedica, Inc., IDEXX Laboratories, Inc. and Nestle Purina PetCare.

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