May's Case of the Month

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Sonographic Findings of Dilated
Cardiomyopathy in a Domestic Shorthair. 

Sonographer: Shadawn Salmond-Jimenez DVM

Patient Information:

Age: Unknown

Gender: Neutered Male

Species: Feline

 

History


Patient was adopted 5 years prior to presentation. Presented for significant lethargy and inappetence. Dull mentation noted on PE as well as a soft/nonpainful abdomen that was difficult to palpate due to obesity. Patient was significantly hypothermic. No murmur was ausculted. Severe azotemia, elevated lipase and ALT were noted on bloodwork. An abdominal ultrasound was scheduled for further evaluation.

Image Interpretation


Abdominal ultrasonographic findings include a moderate amount of free anechoic fluid with no masses. The hepatic veins and caudal vena cava were dilated with no respiratory collapse noted. Cursory heart evaluation revealed pleural effusion and dilation of the cardiac chambers. A complete echocardiogram was recommended and elected at that time.

Diagnosis and Sonographic Analysis:


Cardiology interpretation of the study demonstrated advanced underlying dilated cardiomyopathy (DCM) (characterized by severe left atrial enlargement, left ventricular eccentric hypertrophy and profound left ventricular dysfunction). Moderately-to-severely enlarged right-sided chambers were noted and secondary congestive heart failure characterized by pleural effusion were also diagnosed.

Case outcome


Due to the poor prognosis of feline DCM and accompanied severe azotemia, the owners elected to euthanize.

 

Brief Overview of Feline Dilated Cardiomyopathy


The most common cause of feline DCM was a dietary deficiency in taurine. Commercial cat foods have been supplemented with additional taurine and feline DCM is now rare. Most cats diagnosed with DCM have the idiopathic form and do not respond to taurine supplementation and thus have a poor prognosis.

Historically, most cats with DCM survive for less than a few months with medical management. The addition of pimobendan to the treatment protocol in recent years appears to allow some cats to do better than these historical averages suggest.

 

 Sonographic image   of left ventricular eccentric hypertrophy (red arrow), severe left atrial enlargement and moderate to severe right chamber enlargement.

Sonographic image of left ventricular eccentric hypertrophy (red arrow), severe left atrial enlargement and moderate to severe right chamber enlargement.

 Color flow image of the mitral regurgitation jet entering the left atrium.

Color flow image of the mitral regurgitation jet entering the left atrium.

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 M-mode measurement of left ventricular septal and posterior walls during systole and diastole. Severely increased ventricular dimension and profound left ventricular systolic dysfunction are noted in this patient (top). In comparison, an image of a cat with normal left ventricular dimensions and ventricular systolic function (bottom).     Sonographer: Shadawn Salmond-Jimenez, DVM

M-mode measurement of left ventricular septal and posterior walls during systole and diastole. Severely increased ventricular dimension and profound left ventricular systolic dysfunction are noted in this patient (top). In comparison, an image of a cat with normal left ventricular dimensions and ventricular systolic function (bottom).

 

Sonographer: Shadawn Salmond-Jimenez, DVM

A special thanks to the staff at Potomac Animal Wellness Services for this interesting case.

Echocardiogram findings and assessment courtesy of Idexx Telemedicine Cardiology.