Hi guys,
Just wanted some advise on treatment for a 3y.o cat with HOCM and syncope episodes.
Cat presents with
Severe concentric hypertrophy of the LV,
Systolic Anterior motion of the MV
Mitral regurgitation
Severe enlargement of the LA.
I know we use atenolol to help with HOCM. however, my understanding is not to use beta blockers if cat has CHF. O has financial constraints hence thoracic rads were not done.
Questions:
1. Can you tell if cat is in Left sided CHF based on just Echo images?
Hi guys,
Just wanted some advise on treatment for a 3y.o cat with HOCM and syncope episodes.
Cat presents with
Severe concentric hypertrophy of the LV,
Systolic Anterior motion of the MV
Mitral regurgitation
Severe enlargement of the LA.
I know we use atenolol to help with HOCM. however, my understanding is not to use beta blockers if cat has CHF. O has financial constraints hence thoracic rads were not done.
Questions:
1. Can you tell if cat is in Left sided CHF based on just Echo images?
2. How do i know when it is safe to start on atenolol if O doesn’t want to take repeat X-rays
3. How do i know if a cat that is on atenolol develops CHF?
Comments
Do you have a good M Mode of
Do you have a good M Mode of the L ventricle. In the 3rd still picture
showing SAM the IVS and VFW did not look all that thickened to me.
If there is not concentric hypertrophy but rather eccentric hypertrophy or even no hypertrophy I would consider starting this cat on diuretics and +/- Pimobendan (off label)
I don’t know that you can diagnose CHF on Echo alone.
I know there are financial constraints- but a chest x-ray and EKG are indicated.
OK – I put my 2 cents in here. Wait and see what others have to say.
yeh he has a 2 cm left atrium
yeh he has a 2 cm left atrium which is kocking on the door to chf depends if wet lung or not from traditional definition of chf. In my opinion many would tx differently here. Correct you are not supposed ot use b blockade in chf because they need th elevated HR to stay alive basicly. So what I do with these is BID lasix and stat and acei 0.25-0.5 mg/kg and sit on it for about a week and then reecho. Im a proactive plavix user too so I would add that. If you reduce the volume overload and starlings laws come back home the HR may drop under 200 on its own but if the vlume overload reduces to say an LA of 1.6 or so and the HR is still > 200 then I would add atenolol. Again its just how I have managed these cats and many may do it differently but the key is minor adjustments… treat what you can see and here I see volume overload and have always lived by treat the volume issue first then see if the heart gets happier or not before trying to control the rate.
note the contractility is not elevated here even if the LV is thick… Im eyeballing a 35% fs or so which is a tendency toward restrictive cmy… but things change once volume issues are adjusted and fs% may go up to true hcm range > 45-50%.
Hope this helps
Thank you for the
Thank you for the feedback.
Here are the LV measurements. Based on the measurements for LVIDd, there is no evidence of volume overload but FS% is ~30%. Base on the ‘lowish’ FS%, so i still presumed volume overload is present due to the large atrium?
Thank you for the updated
Thank you for the updated images.
Below is Dr Chris Stauthammers take on treatment of HCM.
Congestive heart failure:
Acute Therapy:
Cats that present in respiratory distress secondary to CHF require prompt and aggressive
therapy. The primary treatment is parenteral furosemide. Most cats also benefit from
supplemental oxygen (e.g., oxygen cage). Topical nitroglycerine may also be applied, but
its efficacy in cats is unknown. Cats with significant pleural effusion require
thoracocentesis. It is important remember that cats with severe heart failure are usually in
severe respiratory distress, and must be managed with the utmost care and with minimal
stress. Stress and excessive handling exacerbate dyspnea, and this can prove fatal.
Chronic Therapy:
After resolution of the acute crisis, the therapeutic objective is to prevent a recurrence of
pulmonary edema. Furosemide is the most important and efficacious drug available to
achieve this objective. Most cats require life-long furosemide therapy. However,
furosemide can occasionally be discontinued, usually in those cats in which the heart
failure that was precipitated by a reversible event (e.g., fluid or corticosteroid
administration). Cats are more sensitive to furosemide than dogs, and are more likely to
develop azotemia or electrolyte abnormalities with overzealous administration. Cats with
pleural effusion may require periodic thoracocentesis.
Two classes of drugs have been advocated to improve left ventricular filling in feline
cardiomyopathy; calcium channel blockers and-blockers. Published information that
addresses this issue in an objective manner is scant. However, an abstract was presented
at the 2003 ACVIM Forum from a prospective, double-blinded, multicenter study
evaluating chronic therapies for CHF in cats with either HCM or restrictive/unclassified
cardiomyopathy. Cats were entered into the study after having survived an acute episode of
CHF. In addition to furosemide, the cats were randomly assigned to receive placebo, a
calcium channel blocker (extended-release diltiazem), a beta-blocker (atenolol), or an ACE
inhibitor (enalapril). Cats receiving atenolol did significantly worse than cats receiving
placebo (in terms of time to recurrence of CHF or death). The cats receiving diltiazem had
a similar outcome to cats receiving placebo, but there was a relatively high incidence of
side effects (predominately gastrointestinal signs). Cats receiving enalapril appeared to
have a better outcome than cats receiving placebo, but this difference did not achieve
statistical significance in this study.
Based on these results, we currently recommend that cats in CHF be treated with either
furosemide alone, or furosemide and an ACE inhibitor (e.g., enalapril or benazepril). The
ACE inhibitor is carefully added to a cat’s treatment protocol once it is eating well and is
not azotemic. In addition to furosemide and an ACE inhibitor, therapy aimed at
preventing systemic arterial thromboembolism (e.g., aspirin or clopidogrel) is
recommended in cats with HCM (see arterial thromboembolism lecture). Positive inotropic
medications (digoxin, pimobendan) are not recommended as myocardial contractility is
generally normal and these medications may exacerbate the diastolic dysfunction and
myocardial hypoxia. Positive inotropic