-Adult cat with murmur, unknown how long present.
-Asymptomatic
I struggled with these images and am trying to figure out and learn what I can from them. The 2D measurements were basicaly normal.
-The CW views actually only show 2 positions, just with the baseline moved to show the entire portion of it.
-In the Color Doppler clip, the turbulence appears to be associated with the right ventricle but not necessarily the tricuspid valve.
Can you help me sort out what I’m seeing?
Thanks.
-Adult cat with murmur, unknown how long present.
-Asymptomatic
I struggled with these images and am trying to figure out and learn what I can from them. The 2D measurements were basicaly normal.
-The CW views actually only show 2 positions, just with the baseline moved to show the entire portion of it.
-In the Color Doppler clip, the turbulence appears to be associated with the right ventricle but not necessarily the tricuspid valve.
Can you help me sort out what I’m seeing?
Thanks.
(Sorry the images are a bit dark, it’s an issue with image transfer)
Comments
Hey!
That’s a bit difficult:
Hey!
That’s a bit difficult: The color clips shows some tricuspid regurgitation, but the CWs are likely aligned with the right ventriular outflow tract.
Murmur hunts in cats can be challenging this is something we’re all struggling with sometimes.
Basically, what I see here doesn’t look like sth relly harmful. Possible explanations are pulmonic stenosis or an outflow oriented VSD. Dynamic obstruction is unlikely based on the shape of the CW profile (no late systolic acceleration) Color Doppler views of the same imaging planes you used for the CW interrogations would be very helpful here.
So, based on these views, no therapy required. If there’s a chance to get more views (also including color), pls feel free to post them! We are happy to help!
Peter
Thanks for you response. And
Thanks for you response. And for being kind about my attempts
I usually feel fairly confident but this case was definitely an exception. My response when it’s something unusual is to refer to a cardiologist anyway but I wanted to learn what I could from it.
I wondered about DRVOTO and PS so good to know you don’t think DRVOTO is likely.
Thanks!
Side note at ecvim this year
Side note at ecvim this year nice abstract on DRVOTO murmurs often being iatrogenic with stethoscope or probe pressure induction in cats. Ferrasin and crew with Rishniew behind the scenes.
Lots of good cardio blips this year if you have access to ecvim proceedings VIN or elsewhere.
Gives another plausible explanation for not finding these cat flow murmurs anyway:)
I always think i have better things to do than chase these insignificant flow murmurs in otherwise nsf hearts that are keeping Starling happy.
Iatrogenic Heart Murmur: A New Cause of Systolic Murmurs in Cats
29th ECVIM-CA Congress, 2019
L. Ferasin1; E. Kilkenny2; H. Ferasin1
1Specialist Veterinary Cardiology Consultancy Ltd, Alton, UK; 2Lumbry Park Veterinary Specialists, Alton, UK
Heart murmurs are commonly detected in apparently healthy cats, and Doppler echocardiographic evaluation is ultimately required to identify the cause of blood flow turbulence
responsible for this clinical finding. However, even Doppler echocardiography can occasionally fail to demonstrate the origin of murmurs in cats. Nevertheless, over the years, we have
observed that applying gentle pressure to the right side of the chest wall of a cat with the ultrasound probe (“provocative testing”) can induce temporary narrowing of the right ventricular
infundibulum and dynamic right ventricular outflow obstruction, subsequently causing blood flow turbulence. We have also observed that a similar phenomenon can be reproduced by
gently pressing the stethoscope head against the right wall of the chest, inducing an audible murmur during auscultation. The aim of this study was to evaluate the effect of increased
pressure of the ultrasound probe against the chest wall of cats undergoing echocardiographic examination in increasing right ventricular outflow velocity and evoking blood flow
turbulence in this anatomical area.
Clinical records of apparently healthy cats with dynamic right-sided systolic heart murmurs that underwent echocardiography between 2010 and 2018 were retrospectively reviewed. Only
cats that had blood flow turbulence in the infundibular tract induced by provocative testing during image acquisition of the right parasternal short-axis view at the level of the heart base
and did not have functional or structural abnormalities during echocardiographic examination were included in this study (n=61). Their median age was 8.0 (6.0 to 9.3) years, and mean
body weight was 4.5±1.22 kg. The median murmur grade was 2/6.
All cats included in the study presented a laminar blood flow on colour Doppler assessment of the right infundibular tract; however, turbulence could subsequently be visualised
following provocative testing. Similarly, the provocative test caused increased peak systolic velocity and a late-peaking “scimitar-like” profile, characteristic of dynamic mid-systolic
obstruction.
Outflow peak systolic velocities were normally distributed both pre-testing (1.05±0.26 m/s) and post-testing (1.94±0.51 m/s), and their difference (0.89±0.40 m/s) was statistically
significant on paired samples t test (p<0.0001).
The result of this study confirms that some murmurs in cats can be of iatrogenic origin, being caused