Hypertrophic cardiomyopathy?

Re: Hypertrophic cardiomyopathy?

Rob Loxley — Tue, 10 May 2011 21:39:34 GMT

[quote user="Kate Richardson"]what does YMMV mean?[/quote]

Your mileage may vary

Re: Hypertrophic cardiomyopathy?

Kate Richardson — Mon, 09 May 2011 23:30:21 GMT

[quote user="robloxley"]

Hmm, I'm not sure I agree entirely. Getting to grips with the basic right parasternal long and short axis views doesn't take long, and being able to measure atrial size is pretty simple, cheap and useful in symptomatic cases.
If the CKCS with a cough doesn't have a big LA then I'm thinking maybe it's not left-sided CHF. With the dyspnoeic cat in sat in sternal on the consulting room table I can have detected a large LA and pleural effusion before anyone's even warmed the xray processor up, and I would happily describe my ultrasound skills as somewhat lacking. I would however agree that detailed measurements, wall thicknesses etc. take more skill and are easy to get wrong. YMMV etc.

[/quote]

I agree and disagree. The basic views are easy enough if and I repeat if you do them regularly and if you don't then caution, but interpreting them can still be difficult. Re measuring atrial size, sure, once you've looked at several you can subjectively say it appears enlarged or not if it appears massive, but I would still urge caution. I have seen a lot of animals, mainly dogs admittedly, but then these should be easier to echo, diagnosed with cardiac disease as a cause of their cough which following an echo with a cardiologist have a perfectly functioning heart but have lung disease. Atrial diameter needs a comparison, ideally to aortic size and both need to be measured at the right locations which is often harder than you think, particularly in a dyspnoeic cat which doesn't want to lie happily and relaxed in right lateral recumbency. Re pleural effusion, yes, anyone with basic us skills should be able to detect a moderate to marked effusion and I agree it is the diagnostic tool of choice- quick, instant results and minimal stress to patient. And if a pleural effusion is seen it can then be tapped etc etc and as I said earlier, I think cats with CHF present with pleural effusion more than pulmonary oedema IME. But this case doesn't have an effusion and these are the ones that can be tricky to diagnose.

PS what does YMMV mean?

PPS I am not knocking your us skills, just warning for inexperienced users to be cautious.

Re: Hypertrophic cardiomyopathy?

Rob Loxley — Mon, 09 May 2011 23:14:21 GMT

[quote user="Kate Richardson"]

[quote user="Andrew Kent"]

Have you got access to ultrasound? Even with a basic scanner it is usually fairly simple to have a look at atrial size and see if any dilation.

[/quote]

Good idea but not as easy in practice, especially in cats. I am pretty confident with abdominal ultrasonography and am slowly getting to grips with basic thoracic ultrasound, but I would caution anyone not familiar with using ultrasound and particularly not familair with echo to be very cautious about diagnosing cardiac changes.

[/quote]

Re: Hypertrophic cardiomyopathy?

Kate Richardson — Mon, 09 May 2011 14:18:11 GMT

[quote user="Andrew Kent"]

Have you got access to ultrasound? Even with a basic scanner it is usually fairly simple to have a look at atrial size and see if any dilation.

[/quote]

Re: Hypertrophic cardiomyopathy?

Andrew Kent — Sat, 07 May 2011 11:17:51 GMT

Have you got access to ultrasound? Even with a basic scanner it is usually fairly simple to have a look at atrial size and see if any dilation.

Andy

Re: Hypertrophic cardiomyopathy?

Richard Carter — Thu, 05 May 2011 11:45:05 GMT

would second need to investigate asthma/ tracheobronchitis - bronchi look fairly packed with gunk.

Re: Hypertrophic cardiomyopathy?

Kate Richardson — Thu, 05 May 2011 09:12:08 GMT

Posting this quickly...

Need to determine if dyspnoea is respiratory or cardiac in origin and this can be quite hard in some cases. Not imposs to have HCM with no murmur and HR doesn't always do what you expect it to do in cats. Heart appears more globular on lateral view but echo only way to be certain. Lung pattern hard to tell from xray posted uinfortunately- can you see any donuts to suggest bronchial pattern. IME cats w dyspnoea due to cardiac disease tend to get pleural effusion causing the dyspnoea, no evidence of that from these xrays. Main differential in a cat of this age would be asthma, any history of coughing, if so would be thinking asthma more likely. Simple test if you can is to give the cat some inhaled salbutamol or injectable if you don't have inhaler (terbutaline inj). If dyspnoea quickly resolves, highly likely asthma. Then can discuss BALs etc.

Re: Hypertrophic cardiomyopathy?

Julie Innes — Wed, 04 May 2011 23:51:43 GMT

Hi Catherine!

I seem to remember being told when doing my cardiology cert (that I never finished!) that the DV was the more informative view for HCM, and as you say, no definitive signs on that.

In a cat this age without a murmur etc, I might consider felv/fiv testing, as mediastinal LN enlargement can cause some oedema, and the cranial trachea does look slightly higher on the lateral view (but this could be artefact!)

If the cat is insured, could be worth referring if symptoms persist, as echo would rule HCM out or in?

Let us know!

Re: Hypertrophic cardiomyopathy?

Rob Loxley — Wed, 04 May 2011 20:24:36 GMT

I guess the big question is whether it,s cardiac or respiratory. Bnp can be useful if the xrays aren't clear. Also left atrial size on echo can be a helpful pointer for chf

Re: Hypertrophic cardiomyopathy?

Martin Atkinson — Wed, 04 May 2011 17:19:04 GMT

Send an NTproBNP to Idexx, if you don't have the transport tubes phone them for a supply. Very useful test which in my experience exactly mimics the degree of heart disease. The VHS of this heart in lateral is 7.5 which is normal but that doesn't stop it being HCM if the walls are thickened and the chambers are decreased in size. Not all HCM cases have murmurs or tachycardia. Echo is obvously the gold standard but proBNP is a lot cheaper and easier.

Re: Hypertrophic cardiomyopathy?

Mark Hedberg — Wed, 04 May 2011 16:57:00 GMT

Why not go for GA? 100% O2 and no stress from physical restraint is better for the cat and makes a better xray.