– 15 yr old MN Himalayan presented for anorexia/vomiting and intermittent irregular heart beat on auscultation – when ECG was run, it came out normal
– pleural effusion on chest rads
– had been in renal failure for a few months and had history of elevated BP (systolic around 200)
– limited echo performed due to resp. distress when in lateral (should have tapped and then scanned); patient is going to be euthanized due to age and various disease processes
– 15 yr old MN Himalayan presented for anorexia/vomiting and intermittent irregular heart beat on auscultation – when ECG was run, it came out normal
– pleural effusion on chest rads
– had been in renal failure for a few months and had history of elevated BP (systolic around 200)
– limited echo performed due to resp. distress when in lateral (should have tapped and then scanned); patient is going to be euthanized due to age and various disease processes
I am curious on thoughts for the enlargement of the right heart? Pulmonary hypertension? Right heart failure? ARVC? Also looks like thick LV walls. I was not able to get a TR max velocity on this one. PA max velocity 0.8 m/s.
Comments
I think the right heart is
I think the right heart is just prominent because of emerging PHT from the thoracic disease…. The key here is that the LA is normal size (1.2 cmc eyeballed but there seems ot be an arrythmia too) with conceurrent pleural effusion = non cardiogenic pleural effusion (neoplasia, pleuritis, chyle, LLT, purulent causes….) i.e there is thoracic/pulmonary pathology and th eheart is effector organ = increased pulmonary pressures >> right heart enlargement +/- PHT. Chase the effusion with cytospin for neoplasia and chase the abomen for a primary. The heart is just there for the ride.
I thought the left atrium
I thought the left atrium looked big? More at the short-axis heart base but can be hard to tell from one clip and not a perfect view. I uploaded an apical view video where to me the LA looks big- patient really starting to struggle here. I attempted an E wave below but may be underestimated. The other clip I uploaded is going from the LV to the LA/Ao although not perfect where the LA looks bigger and the LV looks flattened.
In video one your la max is
In video one your la max is 1.3 cm which is very normal and the atrial septum is flat. The right atrium is bigger than the left which is th eoipposite of what is supposed to happen. So the pleural effusion cannot be cardiogenic without a big LA at least in the 1.6 cm and above and usually in the 2.0 range and beyond.
Got ya. The large RA is
Got ya. The large RA is disorienting and some of my measurements for LA/Ao were out of normal range but the scan was a struggle getting perfect planes!
Thanks!
To hard on yourself. The scan
To hard on yourself. The scan was VERY helful. You know the problem is not cardiogenic. Very useful information making neoplasia more likely in this cat.