– 2 year old overweight MN DSH diagnosed with a new heart murmur
– was not happy during echo so was given 0.2 mg/kg butorphanol IV which helped facilitate the exam
– I am seeing uneven thickening of the IVS measuring up to 8mm in diastole, hypertrophied papillary muscles that almost obliterate the LV cavity in systole, hyperechoic (fibrotic?) papillary muscles and possible thinning of the apical LV wall
– I believe there is SAM and an obstructive LVOT pattern on spectral Doppler with aortic max velocity at about 2.7 m/s
– no LAE at this time
Would you call this HOCM, unclassified cardiomyopathy with SAM?
Would you start atenolol?
Comments
This looks volume contracted to me and maybe pseudohypertrophy. I agree the ivs looks subjectively thick as do the papillaries but the lvidd looks like < 1 cm which suiggests volume contraction. I would not tx atenolol at this point and recheck in 6 months unless exercise intollerance is an issue. Im not seeing SAM but I usually dx it from m mode. Lets see what Peter says. Anything going on in the abdomen causing volume depletion?
Yes, there are some myocardial changes visible, the paps look a bit large and are hyperechoic. Also, there seems to be an accessory papillary muscle that makes the septum look very thick. I’m not entirely sure about HCM. It could also be mitral dysplasia causing SAM and secondary hypertrophy.
Given the relatively low vmax and the normal heart rate, I would possibly not start with atenolol at this point but just re-check the cat and see what happens/develops.
These cases can sometimes be challenging.
Peter