A 9-year-old SF DMH with a history of hyperthyroidism that had been treated with I 131 was presented for evaluation of sudden onset posterior paresis.
A 9-year-old SF DMH with a history of hyperthyroidism that had been treated with I 131 was presented for evaluation of sudden onset posterior paresis.
The echocardiogram is consistent with a restrictive cardiomyopathy with moderate left atrial enlargement, an episode of early heart failure and a thromboembolic event. This condition is likely not related to the hyperthyroidism diagnosed earlier. It appears relatively advanced at this time and puts the cat at increased risk for a repeat thromboembolic event. A persistently elevated heart rate can also contribute to signs of decompensation.
The left atrium is moderately enlarged in size. There are hypoechoic structures seen in the left atrium on some views but this appears to represent tissue surrounding the overlying pulmonary artery rather than thrombi. The left ventricular cavity is mildly dilated in diastole (1.9 cm) and systole (1.4 cm) with a depressed fractional shortening (26 %) consistent with myocardial failure. The right ventricle papillary muscle is prominent, and the right atrium is normal to mildly enlarged in size. The main pulmonary artery appears prominent in comparison to the aorta. There is mild mitral regurgitation.
Heparin can be considered at 200 U/kg IV once followed by 100 U/kg SQ QID while the cat is hospitalized. Other supportive care such as pain medications can be considered as clinically warranted. Low dose Lasix such as 6.25 to 7.5 mg IV q 12 to 24 hours can be considered, particularly if the respiratory rate were elevated. This can be continued as a maintenance therapy, perhaps at 6.25 mg PO SID or whatever is the lowest dose that will control the clinical signs. Pimobendan is also recommended at 0.625 to 1.25 mg PO BID. Once the cat has improved, Benazepril can be added at 1.25 mg PO SID and increased to 2.5 mg PO SID after a week if it is well tolerated. If the heart rate were persistently elevated over 180 bpm, Atenolol would be recommended at 1/4 of a 25 mg tablet PO SID to BID to keep the heart rate in the normal range. Long-term anti-coagulation can be considered with aspirin or Ascriptin at 5 mg/kg or 5 mg total dose PO on a Monday, Wednesday, Friday schedule with Plavix at Вј of a 75 mg tablet PO SID. A renal profile is recommended a week after the final adjustments to the medications have been made to make sure they are well tolerated. The condition can be followed by thoracic radiographs every 2 to 5 months to monitor for signs of progression or decompensation. The echocardiogram can be repeated in 6 months to monitor for any further changes to the cardiac structure.
The heart rate is measured at 184 to 206 bpm and a regular sinus rhythm is seen on an ECG run during the exam. The ECG shows a regular sinus rhythm with a mildly elevated rate of 200 bpm. There are no arrhythmias on this recording. The QRS complexes are towards the upper limit of normal and the rest of the P-QRS-T complex appears normal.
Aortic thrombosis secondary to cardiac disease Spinal cord – trauma, disc prolapse, trauma, neoplasia Trauma
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