22yo MI cat with peripheral edema (four leg swelling)
What do you think of this heart?
Has mild mitral regurgitation, severe aortic regurgitation (7m/s) and mild to moderate stenosis (3,6m/s), no LV hypertrophy, huge LA, restrictive LV filling pattern, and mild decreased systolic function.
Also mild to moderate azotemia (creatinine 2,4) – mild dehydration noted.
I don’t have the BP yet, albumin is at 3,5. Normal K+, mild increase in Na+/CL-.
How would you treat it? It is quite a challenge…
22yo MI cat with peripheral edema (four leg swelling)
What do you think of this heart?
Has mild mitral regurgitation, severe aortic regurgitation (7m/s) and mild to moderate stenosis (3,6m/s), no LV hypertrophy, huge LA, restrictive LV filling pattern, and mild decreased systolic function.
Also mild to moderate azotemia (creatinine 2,4) – mild dehydration noted.
I don’t have the BP yet, albumin is at 3,5. Normal K+, mild increase in Na+/CL-.
How would you treat it? It is quite a challenge…
Started lasix IM and clopidogrel, but I am not sure about ACEI, spiro and pimo.
Thank you!
Comments
Hi
Thanks for
Hi
Thanks for posting!
Endocarditis is also an possible cause here. If the aortic regurge had been there for the past 22 yrs (congenital aortic stenosis), the cat would not be alive any more. Heart failure is very likely here, so Furosemide is indicated. I would likely leave out ACEIs because of azotemia. Clopidogrel is correct. Re Pimo: It’s not licensed and outflow tract obstructions are usually a contra-indication. If the cat does not respond to Furosemide, then Pimo can be an option, but the owner has to be informed, that this is off-lable-use.
Re suspected endocarditis: Take blood for culture (Staphylococcus? Streptococcus? E coli? Pseudomonas? …) and check for Bartonella.
Heart failure in dogs and cats usually does not cause limb swelling – Limb swelling is extremely unlikely to be caused by heart failure. Maybe vasculitis?
Prognosis is grave…
Peter
Hi Peter,
The cat has been
Hi Peter,
The cat has been doing fine with furosemide and clopidogrel, the ascites and limb edema have resolved, he is eating well. We already have BP (mean SysP=162mmHg) and T4 (normal). I started yesterday 0,5mg/kg ACEI and will recheck azotemia every other day. The edema puzzles me, since he is clearly not hypoalbuminemic and is doing fine (CBC ok, liver enzymes ok), but I’ll advise a blood culture.
Even with these findings, do you think this cat could have restrictive CM, or is this only a consequence of the ao valve disease?
I’ll keep you updated on the outcome!
Thank you!
Hi
Given the changes here, I
Hi
Given the changes here, I wouldn’t call it RCM. RCM is defined by normal diastolic dimensions, relatively normal or slightly thickened walls and normal or mildly decreased systolic function in the absence of concurrent diseases that could explain the ventricular changes, In this case, I think, the aortic insufficiency and stenosis seem to be responsible for the change in ventricular dimensions/function.
Peter
Great thread guys and nice
Great thread guys and nice images jobrag!
Peter i know its often just semantics and things change as the heart evolves pathologically but can you bullet point the difference between RCM and unclassified CMY?
Is UCM defined similarly to RCM but with increased diastolic dimensions and usually left and right atrial overload?
Or is it more complicated than that??? I’ve heard differing opinions so would be cool to have it in print on this thread.