Case Study

15-00118 Cali M HCM—–NO IMAGES——

A 12-year-old SF DSH was present for evaluation of an arrhythmia and recent onset diabetes. CBC, blood chemistry, and systolic BP were all within normal limits. BNP was elevated (629, with >270 suggestive of cardiac disease). Thoracic radiographs showed no evidence of pulmonary edema but the heart was valentine shaped.

A 12-year-old SF DSH was present for evaluation of an arrhythmia and recent onset diabetes. CBC, blood chemistry, and systolic BP were all within normal limits. BNP was elevated (629, with >270 suggestive of cardiac disease). Thoracic radiographs showed no evidence of pulmonary edema but the heart was valentine shaped.

DX

HCM

Sonographic Differential Diagnosis

The segmental hypertrophy and the enlarged papillary muscles are – given that hyperthyroidism has already been ruled out – consistent with HCM even though the suspected subendocardial/endocardial fibrosis can be a sign of concomitant RCM. A clear differentiation between these two types of cardiomyopathy cannot be made in this case. Based on the moderately enlarged left atrium I would start with low dose furosemide and ACEI. In my opinion anticoagulation is not necessary at the moment. I would recheck the patient after three months. Regarding the ECG: VPCs are frequently observed in feline patients suffering from cardiomyopathy. I would perform a Holter-ECG to look for dangerous arrhythmia since based on this short rhythm strip itВґs not necessary to introduce antiarrhythmic therapy. I would suggest to record another ECG after three months.

Image Interpretation

Moderate segmental concentric hypertrophy of the left ventricle involving mainly the free wall was noted. The papillary muscles are enlarged and hyperechoic. Across the left ventricular lumen a false tendon is noted (on short axis views). The subendocardial layer of the left ventricular myocardium shows increased echogenicity. The left atrium is moderately enlarged but thereВґs no “smoke” (spontaneous echo contrast) to be seen. I cannot see any SAM or fluttering of the aortic valve due to turbulence. The right ventricle is normal except some hyperechoic trabeculae, the right atrium seems to be enlarged too. Flow profiles across the RVOT and LVOT are normal in terms of shape and maximum velocity. On the ECG I can see a ventricular bigeminus.

Clinical Differential Diagnosis

Cardiomyopathy – dilated/hypertrophic/restrictive, myocarditis Arrhythmia – cardiac disease, secondary to diabetic metabolic changes

Sampling

None

Patient Information

Gender : Female, Spayed

Species : Feline

Type of Imaging : Ultrasound

Status : For Review

History

Diabetes, controlled

Exam Finding

Arrhythmia

Blood Chemistry

ALT (SGPT), High

Special Testing

BNP high