Case Study

15_00066 Thom L Mild LVH, SAM

A 10-year-old MN DSH cat was presented for evaluation. Previous echocardiogram in 2008 showed SAM with mitral regurgitation. Current therapy is amlodipine, Benazepril, Diltiazem and CoQ10. CBC, serum biochemistry, and blood pressure are all within normal limits with a BNP of 386. According to the owner the patient is doing well.

A 10-year-old MN DSH cat was presented for evaluation. Previous echocardiogram in 2008 showed SAM with mitral regurgitation. Current therapy is amlodipine, Benazepril, Diltiazem and CoQ10. CBC, serum biochemistry, and blood pressure are all within normal limits with a BNP of 386. According to the owner the patient is doing well.

DX

Mild concentric hypertrophy, SAM, mild left atrial enlargement.

Sonographic Differential Diagnosis

Mild concentric hypertrophy, SAM, mild left atrial enlargement. Because of the fact that the cat has a normal BP under amlodipine and ACEI it’s possible that BP would be elevated without this medication. Thus it cannot be said whether this is mild HCM or hypertrophy because of hypertonia.

Image Interpretation

Mildly concentrically hypertrophied left ventricle, a very slightly enlarged left atrium, normal right ventricle and atrium. Systolic anterior motion of the anterior mitral valve is clearly displayed. This leads to turbulent flow across the LVOT with concomitant reflux into the left atrium originating from the same region of the LV. Flow across the LVOT shows the typical dagger shaped profile indicating dynamic obstruction. The flow profile across the RVOT has also this particular shape so that there is some dynamic outflow obstruction (a benign finding, considered normal in some cats).

Comments

Given that there is little evidence regarding therapy of compensated heart disease in cats, advised to continue current medication. Consider replacing Diltiazem by Atenolol (6,25 mg once daily) on order to address the high heart rate. Recheck the heart rate and echo in 6 months.