C10003440 / invoice 10000

Here for checking PB

PB doppler: 140mmHg

Plan: normal BP for a stress cat 
will start on propranolol 2.5mg bid for HCM

Echo result:

Interpretation:
Echocardiography revealed the cause of the audible murmur to be a markedly increased velocity through the left ventricular
outflow tract, also a small volume mitral regurgitation. These are occurring due to a combination of Systolic Anterior Motion
(SAM) of the mitral valve and fixed obstruction at the base of the left ventricular outflow tract from septal hypertrophy.
The left ventricle walls were mildly thickened, most consistent with Hypertrophic Cardiomyopathy (HCM). Other causes of
hypertrophy include systemic hypertension, hyperthyroidism, acromegaly and infiltrative disease.
There was no left atrial enlargement, with the LA:Ao ratio being 1.3. This indicates stage B1 disease.
With no significant atrial enlargement, there is no concern for the development of congestive heart failure in the near future, &
no current indication for clopidogrel therapy.
The presence of ventricular outflow tract obstruction suggests a possible benefit of beta-blocker therapy with atenolol, with the
aim of therapy being to reduce the severity of the dynamic outflow obstruction (by reducing sympathetic tone) & therefore the
ventricular workload, also reduce the heart rate. However, there is no published data on the true effectiveness of atenolol
therapy. Therefore, currently, its use is considered optional, particularly in cats that are difficult to medicate.
Recommendations:
Measure blood pressure to assess/exclude the possibility of hypertension causing the ventricular hypertrophy. T4
measurement to assess/exclude the possibility of hyperthyroidism.
Consider commencing atenolol 6.25 mg PO twice daily, to slow the progression of the disease. Recheck
auscultation in 1 week, if tachycardic (HR>180) then increase atenolol to 12.5 mg PO q12hrs. Don't increase
further
A repeat echocardiogram could be performed in 12 months time, to monitor for further progression & to allow
prognostication.
This owner should be educated to monitor resting respiratory rate. If it increases to > 30/min, then reassessment
& thoracic imaging should be performed, to assess for the development of congestive heart failure.


PLAN: booked for next Monday to check PB, SPO2 and respiratory system