– 7 year old, MN shelter cat with a grade 3/6 systolic heart murmur which needs a COHAT with extractions
– looks like he has HCM but really hard to get a decent m-mode
– there also appears to be LAE and an elevated aortic max velocity at about 4m/s (therefore moderate aortic stenosis)
– I am not seeing a huge MR jet, but maybe a little one? does this look like SAM – I would think it has to be present with the high aortic flow?
– risk for anesthesia with this one? (I would avoid ketamine and be very careful with fluids)
– 7 year old, MN shelter cat with a grade 3/6 systolic heart murmur which needs a COHAT with extractions
– looks like he has HCM but really hard to get a decent m-mode
– there also appears to be LAE and an elevated aortic max velocity at about 4m/s (therefore moderate aortic stenosis)
– I am not seeing a huge MR jet, but maybe a little one? does this look like SAM – I would think it has to be present with the high aortic flow?
– risk for anesthesia with this one? (I would avoid ketamine and be very careful with fluids)
Comments
In your second video you were
In your second video you were in the best position for mmode and sam assessment I think I am seeing some. LA is bordeline normal and lv hypertrophy isnt bad. As long as bp and t4 are fine I would use torb premed, propofol induction iso maintenance and see little anesthetic risk. The key to these guys in my oppinon is keep them from tach-ing out so ease on down and ease on up avoiding excitement phase.
In your second video you were
In your second video you were in the best position for mmode and sam assessment I think I am seeing some. LA is bordeline normal and lv hypertrophy isnt bad. As long as bp and t4 are fine I would use torb premed, propofol induction iso maintenance and see little anesthetic risk. The key to these guys in my oppinon is keep them from tach-ing out so ease on down and ease on up avoiding excitement phase.
I have inserted another
I have inserted another m-mode taken from the long axis which does make the LV walls measure thick but I find it really easy to over estimate the walls in these guys. The EPSS m-mode – not sure about SAM?
Would you do anything about the high aortic velocity in this case med-wise ie: amlodipine?
Will be checking bloodwork and BP today.
Thanks for your help!
I have inserted another
I have inserted another m-mode taken from the long axis which does make the LV walls measure thick but I find it really easy to over estimate the walls in these guys. The EPSS m-mode – not sure about SAM?
Would you do anything about the high aortic velocity in this case med-wise ie: amlodipine?
Will be checking bloodwork and BP today.
Thanks for your help!
Would look at T4 as well.
Would look at T4 as well.
Would look at T4 as well.
Would look at T4 as well.
Hi!
Since your Spectral shows
Hi!
Since your Spectral shows LATE SYSTOLIC ACCELERATION (dagger shape), this is not aortic stenosis but dynamic obstruction of the left ventricular outflow tract. This can be treated with Atenolol. Amlodipine is contraindicated, if the patient is not hypertensive. Amlodipine would increased the pressure gradient.
Re-check after 2 months (pressure gradient)
Yes, wall thickness can be over-estimated with M-Mode, I usually prefer 2D measurements.
LA is borderline.
I would reduce your TGC in the depth.
Hyperthyroidism and hypertension should be ruled out. Be aware that this cat has a very high heart rate and is likely very exited. Systolic blood pressures >180 in a dark room and relaxed cat is indicative of hypertension.
Re anesthesia: In my personal opinion, ketamine is not a problem. I would avoid alpha-2-agonists even though some anesthesiologists recommend these in such patients…
Dormicum, low dose Ketamine (better Ketamine -S) , Butorphanol are ok, Induction with propofole and sevoflurane as maintanance are appropriate.
Avoid too much i.v. fluids as you said.
Best regards!
Peter
Hi!
Since your Spectral shows
Hi!
Since your Spectral shows LATE SYSTOLIC ACCELERATION (dagger shape), this is not aortic stenosis but dynamic obstruction of the left ventricular outflow tract. This can be treated with Atenolol. Amlodipine is contraindicated, if the patient is not hypertensive. Amlodipine would increased the pressure gradient.
Re-check after 2 months (pressure gradient)
Yes, wall thickness can be over-estimated with M-Mode, I usually prefer 2D measurements.
LA is borderline.
I would reduce your TGC in the depth.
Hyperthyroidism and hypertension should be ruled out. Be aware that this cat has a very high heart rate and is likely very exited. Systolic blood pressures >180 in a dark room and relaxed cat is indicative of hypertension.
Re anesthesia: In my personal opinion, ketamine is not a problem. I would avoid alpha-2-agonists even though some anesthesiologists recommend these in such patients…
Dormicum, low dose Ketamine (better Ketamine -S) , Butorphanol are ok, Induction with propofole and sevoflurane as maintanance are appropriate.
Avoid too much i.v. fluids as you said.
Best regards!
Peter
Thanks Peter
I think I got
Thanks Peter
I think I got the amlodipine and atenolol mixed up! T4 and biochem is normal. Will be checking BP before surgery.
So is the murmur from the dynamic obstruction of the LVOT?
Thanks Peter
I think I got
Thanks Peter
I think I got the amlodipine and atenolol mixed up! T4 and biochem is normal. Will be checking BP before surgery.
So is the murmur from the dynamic obstruction of the LVOT?
Yes these cat murmurs usually
Yes these cat murmurs usually come from the lvot turbulence +/- mr… in this case the lvot is likely the overriding sound.
Yes these cat murmurs usually
Yes these cat murmurs usually come from the lvot turbulence +/- mr… in this case the lvot is likely the overriding sound.
I agree
Peter
I agree
Peter
I agree
Peter
I agree
Peter
Hi Ladies and Gents
I have
Hi Ladies and Gents
I have recently been taught to measure Feline hearts in 2D (just scroll through video and measure peak sys/diastole in the sagital view. Best legal shortcut for my cardiac scans this year, cats are very difficult to scan IMHO and there is a reason some cardiologist dont waste their time measuring because we all know it doesn’t matter no meds unless emerging or clinical CHF.
Anesthesia funny European Ketamine ok
North America anti ketamine
All ways loved propofol, induced probably couple thousand of cats pre-echo days
Learned my anesthesia from a human cardiac anesthesiast md and if propofol was used for human bypass surgery is was certainly indicated for all my patients.
Bottom line from a clinical standpoint (vsag.org) use the anesthetic protocol you are most comfortable with
Peter Thoughts on Feline 2D measurements instead of m mode
Hi Ladies and Gents
I have
Hi Ladies and Gents
I have recently been taught to measure Feline hearts in 2D (just scroll through video and measure peak sys/diastole in the sagital view. Best legal shortcut for my cardiac scans this year, cats are very difficult to scan IMHO and there is a reason some cardiologist dont waste their time measuring because we all know it doesn’t matter no meds unless emerging or clinical CHF.
Anesthesia funny European Ketamine ok
North America anti ketamine
All ways loved propofol, induced probably couple thousand of cats pre-echo days
Learned my anesthesia from a human cardiac anesthesiast md and if propofol was used for human bypass surgery is was certainly indicated for all my patients.
Bottom line from a clinical standpoint (vsag.org) use the anesthetic protocol you are most comfortable with
Peter Thoughts on Feline 2D measurements instead of m mode