Case Study

15_00076 Barney K DRVOTO, SAM, HCM

A 13-year-old FS DSH cat was presented for evaluation prior to a dental procedure. On physical examination a grade 3/6 murmur was present and blood pressure was normal.

A 13-year-old FS DSH cat was presented for evaluation prior to a dental procedure. On physical examination a grade 3/6 murmur was present and blood pressure was normal.

Sonographic Differential Diagnosis

There are two sources for a heart murmur in this patient. While DRVOTO is considered normal in cats, SAM is clearly abnormal. The left ventricular hypertrophy could be due to HCM, but hyperthyroidism has to be excluded first.

Image Interpretation

Concentrically hypertrophied left ventricle (especially in the basal septal segment) and a slightly enlarged left atrium. The papillary muscles are hypertrophied. The mitral valve shows clear evidence of SAM (systolic anterior motion of the anterior leaflet). The flow profile across the LVOT appears dagger shaped, which is typical of dynamic obstruction of the left ventricular outflow tract (vmax 2.45 m/s, end systolic acceleration). The right ventricle and atrium are normal, but there is dynamic obstruction of the right ventricular outflow tract present (DRVOTO; indicated by the spectral Doppler flow profile).

DX

Hypertrophic cardiomyopathy with dynamic right ventricular outflow tract obstruction

Outcome

Since there is only minimal left atrial enlargement present, treatment is not indicated. Recheck every 6 months to evaluate the LA size would be recommended.

Comments

No further outcome provided.

Clinical Differential Diagnosis

Dilated/hypertrophic cardiomyopathy, vegetative endocarditis, mitral/tricuspid endocardiosis, ventricular hypertrophy secondary to hyperthyroidism, anemia.