Ever want to know how to dissect out a HCM heart sonographically regarding hypertrophy, dynamic outflow obstruction (SAM), bi-directional turbulence and decide if it’s clinical or not?
Our SonoPath Cardiologist, Maggie Machen DACVIM, demonstrates Educational Telemedicine™ artistry in her evaluation of the cat heart; imaged by Andi Parkinson, RDMS of Intrapet Imaging, Baltimore, MD, in October, 2016 SonoPath case of the month.
Patient Information:
Age: 10 Years
Gender: Female, Spayed
Species: Feline
Breed: Domestic Short-Haired |
Symptoms:
- Presented to Assess Murmur and Anesthetic Risk Prior to Dental Prophylaxis
- An Exam 1-Month Prior Revealed a Grade III/VI Murmur
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Imaging/Sampling:
- Echocardiogram
- Radiographs
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Image Interpretation:
- The left ventricular wall is moderate to severely asymmetrically hypertrophied
- There is a diffusely hyperechoic endocardium consistent with fibrosis and ventricular remodeling
- Asymmetric papillary muscle hypertrophy and atrophy
- The right ventricle is subjectively normal in size and morphology
- Mild left atrial enlargement present
- No right atrial enlargement present
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- Elevated RVOT velocity consistent with a dynamic obstruction
- Mild to moderate systolic anterior motion (SAM) of the mitral valve present, with a mildly elevated LVOT velocity
- Moderate eccentric mitral regurgitation present secondary to SAM
- No other obvious valvular regurgitation is present
- No pericardial effusion noted
- No pleural effusion appreciated
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Outcome
This indicates LV hypertrophy with a dynamic LVOT obstruction (SAM). There is mild left atrial dilation, indicating the risk of a future spontaneous CHF and/or a thrombotic event may be elevated. There is also a benign RV outflow obstruction (DRVOTO). If able, administer titrating dose of atenolol: 2.5mg tablets; Give tab once daily. Recheck heart rate in 1-2 weeks with target stressed rate of 140-160bpm 12-24 hours post administration. Increase as needed until target reached. Screening blood pressure is recommended. Recommend recheck echocardiogram in 6 months to assess for progression, sooner if clinical issues arise.
