Tomorrow I have a cardiac ultrasound scheduled for a 3 month old shelter kitten that the shelter vet thought had the “loudest heart murmur he has ever heard”. I have not listened to the kitten yet so am not sure what type of murmur it is. The shelter is interested in knowing if this kitten has bad disease or not as they would like to adopt it out. (innocent vs congenital heart disease) I have very limited experience with congenital heart disease, esp. in cats so have a few questions before I proceed: 1. If this is congenital disease, what would be the top differentials in a kitten? 2.
Tomorrow I have a cardiac ultrasound scheduled for a 3 month old shelter kitten that the shelter vet thought had the “loudest heart murmur he has ever heard”. I have not listened to the kitten yet so am not sure what type of murmur it is. The shelter is interested in knowing if this kitten has bad disease or not as they would like to adopt it out. (innocent vs congenital heart disease) I have very limited experience with congenital heart disease, esp. in cats so have a few questions before I proceed: 1. If this is congenital disease, what would be the top differentials in a kitten? 2. If the patient is squirmy for the exam, what type of sedation would be safest if congenital disease may be present? 3. Are there any particular cardiac views that I should be paying more attention to? 4. Any other pearls of wisdom? Thanks Jacquie Update: March 2,2012 Here are some images. I was not able to pin down what was going on in this kitten. Looks like HCM but I don’t think it is that simple? (need lots more practice!) But whatever it is, there is significant LAE so I assume it is not good.
Comments
If that loud then likely not
If that loud then likely not a flow murmur and likely congental.
VSD is the most frequent in cats, PDA possible, tetralogy, pulmonic stenosis, buprenex or torbutrol is safe. Before you head into the exam i suggest going through peter’s folder and the congenitals there.
just follow the blue line top of screen after logging in to have member access to all his cases.
http://www.sonopath.com/specialists_modler.asp
Good luck
If that loud then likely not
If that loud then likely not a flow murmur and likely congental.
VSD is the most frequent in cats, PDA possible, tetralogy, pulmonic stenosis, buprenex or torbutrol is safe. Before you head into the exam i suggest going through peter’s folder and the congenitals there.
just follow the blue line top of screen after logging in to have member access to all his cases.
http://www.sonopath.com/specialists_modler.asp
Good luck
Please see update with stills
Please see update with stills and clips – thanks!
Jacquie
Please see update with stills
Please see update with stills and clips – thanks!
Jacquie
Based on what I see Jacquie I
Based on what I see Jacquie I am thinking HCM with fixed lvot obstruction. > 0.6 cm in a 3 month old cat is major thickening. The ventricular septum looks good but with LAE and that thickening and fixed lvot i am not too keen on long term survival here. Lets see what Peter says too when he gets a minute.
Based on what I see Jacquie I
Based on what I see Jacquie I am thinking HCM with fixed lvot obstruction. > 0.6 cm in a 3 month old cat is major thickening. The ventricular septum looks good but with LAE and that thickening and fixed lvot i am not too keen on long term survival here. Lets see what Peter says too when he gets a minute.
Just another quick question –
Just another quick question – there looks like there is a fuzzy hyperechoic density in the left atrium that is kind of bouncing around with each cardiac contraction. I did see this in several views. It is not well defined and doesn’t look like a thrombus that I have seen in the past.
Do you think this is just an artifact or does it have any significance? I have spoken to the shelter about starting this kitten on q72 low dose aspirin since it is fairly cheap but know there is no evidence either way that this will prevent FATE.
As always – thanks!
Jacquie
Just another quick question –
Just another quick question – there looks like there is a fuzzy hyperechoic density in the left atrium that is kind of bouncing around with each cardiac contraction. I did see this in several views. It is not well defined and doesn’t look like a thrombus that I have seen in the past.
Do you think this is just an artifact or does it have any significance? I have spoken to the shelter about starting this kitten on q72 low dose aspirin since it is fairly cheap but know there is no evidence either way that this will prevent FATE.
As always – thanks!
Jacquie
I totally agree with Eric: I
I totally agree with Eric: I see severe left ventricular hypertrophy, possibly due to fixed LVOT obstruction. But I cannot rule out SAM. The LA is significantly enlarged. Prognosis is bad for this kitten. If you mean what I see (bouncing density) then it´s most likely an artifact. But anyway, low dose aspirin would be a good idea. What about rads? Are there already signs of congestion?
I think congestive heart failure is imminent.
Btw: You asked about the P240 probe. If you send me your email address via email (Kelly can forward your addess to me) I could get in contact with the esaote company and ask them to supply you with a P240 probe for testing purposes. Since I´m, close to Italy, it might be easier for me than for you to organize that 🙂
Peter
I totally agree with Eric: I
I totally agree with Eric: I see severe left ventricular hypertrophy, possibly due to fixed LVOT obstruction. But I cannot rule out SAM. The LA is significantly enlarged. Prognosis is bad for this kitten. If you mean what I see (bouncing density) then it´s most likely an artifact. But anyway, low dose aspirin would be a good idea. What about rads? Are there already signs of congestion?
I think congestive heart failure is imminent.
Btw: You asked about the P240 probe. If you send me your email address via email (Kelly can forward your addess to me) I could get in contact with the esaote company and ask them to supply you with a P240 probe for testing purposes. Since I´m, close to Italy, it might be easier for me than for you to organize that 🙂
Peter
Thanks Peter
I guess with
Thanks Peter
I guess with the age of this pet, I really did not think it could be as easy as HCM. I had congenital disease on the brain! Strangely enough, I did not find evidence of MR in this case? I thought the aortic valves looked a little thicker than usual and I could not get an aortic velocity greater than 1 m/s but did have a hard time getting a good alignment for spectral doppler on the left apical 5 chamber view. I have recommended chest rads – we will see what the shelter does? I have warned them about CHF.
I have found out a little bit more information about the PA240 probe. I have a MyLab50 which I purchased new about 5 years ago and is software version 8. They are telling me that the PA240 will not work on my machine unless I upgrade to at least version 10 which would also involve the installation of some new hardware. They have quoted me about $9000 CAN to do this. Have you heard anything about this in the past? Thanks so much for your offer! I guess Italy would be the place to get it as it is where the machines are made. I will try to get my e-mail address to you.
(Hey Eric – I’m surprised you are not a MyLab user – living in Italy and all (ha ha!))
Thanks Peter
I guess with
Thanks Peter
I guess with the age of this pet, I really did not think it could be as easy as HCM. I had congenital disease on the brain! Strangely enough, I did not find evidence of MR in this case? I thought the aortic valves looked a little thicker than usual and I could not get an aortic velocity greater than 1 m/s but did have a hard time getting a good alignment for spectral doppler on the left apical 5 chamber view. I have recommended chest rads – we will see what the shelter does? I have warned them about CHF.
I have found out a little bit more information about the PA240 probe. I have a MyLab50 which I purchased new about 5 years ago and is software version 8. They are telling me that the PA240 will not work on my machine unless I upgrade to at least version 10 which would also involve the installation of some new hardware. They have quoted me about $9000 CAN to do this. Have you heard anything about this in the past? Thanks so much for your offer! I guess Italy would be the place to get it as it is where the machines are made. I will try to get my e-mail address to you.
(Hey Eric – I’m surprised you are not a MyLab user – living in Italy and all (ha ha!))
Oh Jacquie I’m all over the
Oh Jacquie I’m all over the map geographically but I really like my Logic E and have 6 of them on my team in New Jersey. I have seen the logic series from the beginning as prototypes so tough to go away from with you know and expect. I think there are lots of good machines out there now its just which work flow works for you and what your eye relates to best. & of course its important to have a company behind it. For example GE in Europe has been shady in support in the veterinary field but Esaote is very solid and therefore has suceeded well. This is one reason why GE hasn’t done as well in Italy or in Europe. Much of the issue comes down to support. The product lines between GE and Esaote are comparable but with a different look and different workflow.
Eric
Oh Jacquie I’m all over the
Oh Jacquie I’m all over the map geographically but I really like my Logic E and have 6 of them on my team in New Jersey. I have seen the logic series from the beginning as prototypes so tough to go away from with you know and expect. I think there are lots of good machines out there now its just which work flow works for you and what your eye relates to best. & of course its important to have a company behind it. For example GE in Europe has been shady in support in the veterinary field but Esaote is very solid and therefore has suceeded well. This is one reason why GE hasn’t done as well in Italy or in Europe. Much of the issue comes down to support. The product lines between GE and Esaote are comparable but with a different look and different workflow.
Eric
Eric I totally agree with you
Eric I totally agree with you and was just poking fun! Maybe this discussion should be under a different thread but I agree it is what you become comfortable with is most important and of course the support. Esaote has had a real rocky road in the US and the Canadian support, well, has been a little questionable. The GE machines have a good reputation and Sound Eklin is a great company. I think their ultrasound CE is the best that is out there in North America!
Jacquie
Eric I totally agree with you
Eric I totally agree with you and was just poking fun! Maybe this discussion should be under a different thread but I agree it is what you become comfortable with is most important and of course the support. Esaote has had a real rocky road in the US and the Canadian support, well, has been a little questionable. The GE machines have a good reputation and Sound Eklin is a great company. I think their ultrasound CE is the best that is out there in North America!
Jacquie
Hi Jacquie!
I have already
Hi Jacquie!
I have already forwarded you email address to the esaote company. Hopefully, they will contact you. I really cannot imagine that the upgrade costs $9000! I will tell them that they should exert themselves to find an appropriate solution. But I cannot promise that my intervention will help…
Best Regards from the Old World!
Peter
Hi Jacquie!
I have already
Hi Jacquie!
I have already forwarded you email address to the esaote company. Hopefully, they will contact you. I really cannot imagine that the upgrade costs $9000! I will tell them that they should exert themselves to find an appropriate solution. But I cannot promise that my intervention will help…
Best Regards from the Old World!
Peter