- 17 year old FS DSH presented 2 months ago for a grade 1-2/6 cardiac murmur and weight loss. Echo was wnl except for high normal LV wall and septal measurements
- Cat presented to the E clinic last week for acute episode of vomiting and wobbly walk. PE showed a grade 4/6 cardiac murmur. E-clinic DVM reported weak femoral pulses with warm, pink toes. The cat was diagnosed with a probable partial saddle thrombus and was tx with hydromorphone and clopidogrel. The cat is doing well on clopidogrel, buprenex, and ondansetron.
- 17 year old FS DSH presented 2 months ago for a grade 1-2/6 cardiac murmur and weight loss. Echo was wnl except for high normal LV wall and septal measurements
- Cat presented to the E clinic last week for acute episode of vomiting and wobbly walk. PE showed a grade 4/6 cardiac murmur. E-clinic DVM reported weak femoral pulses with warm, pink toes. The cat was diagnosed with a probable partial saddle thrombus and was tx with hydromorphone and clopidogrel. The cat is doing well on clopidogrel, buprenex, and ondansetron.
- Echo done today shows an increased IVSd=7.2, LVIDd=8.3, LVPWd=5.3, IVSs=8.3, LVIDs=4.3, LVPWs=7.3, FS=48%, and HR=170bpm. There is a TVI of 2.75m/s. The left atrium is normal at 9.2mm and the LA:Ao is normal at 0.97. There is no visible smoke. Scan of the caudal aorta and external iliac arteries showed no evidence of any thrombi.
- While I do believe the cat has HCM, I am doubting the saddle thrombus dx. Don’t you need to have an enlarged LA for that to occur? I am also wondering about the TVI. Could this be a previously missed tricuspid valve dysplasia or should i be thinking pulmonary hypertension? Does the RA look enlarged?
- I do believe the cat is sick and losing weight, but she does not appear to be in heart failure and feel that something is being missed. BP measurements were normal at the E clinic. I have recommended chest rads.
Comments
This si not a primary cardiac
This si not a primary cardiac issue and th emurmur is likely benign. Many other causes of TED happen in cats… hyperthyroidism, infectious disease, neoplasia, sepsis… people get stuck on heart failure> TED but that is only the case about 50-60% of the time according to the studies I have seen and experience tells me the same and sudden death keeps them from getting to the office to be worked up anyway.
At the time of the event were there femoral pulses?? cyanotic nail beds? cold limbs? Hypothermia? How about maybe a cerebral event sounds more likely and may respond to the tx decsribed but also brian tumor in that old of a cat + cerebral thrombosis?? maybe a really thorough CNS exam to start. Heart isnt a player here in my book that looks pretty good for a 17 year old cat:)
Thanks Eric! The ER vet
Thanks Eric! The ER vet noted weak femoral pusles, warm pink toes, T=100 F, and painful upon examination of the rear legs. Looking at the patient’s record, she did have an episode of unilateral leg weakness in August. So is it correct to assume that you need to have LA enlargement before clots would start forming in the heart?
Regading this question:
“So
Regading this question:
“So is it correct to assume that you need to have LA enlargement before clots would start forming in the heart?”
No this is incorrect. All the conditions mentioned above that contribute to a hyperthrombotic state and I would add autoimmune disease which is big in dogs for TED, can create thrombosis despite the lack of cardiac disease. The heart is not a primary player here in these non cardiac hyperthrombotic cases. I have had many cases of TED without cardiac disease in cats and in fact this is the norm in dogs but also occurs readily in cats. So the visial of big LA and bouncing clot or smoke is great but its only part of the story…and rare in dogs.