Case 36

	Endomyocardial fibrosis
	Resolved partial saddle thrombus

	ECG: HR=190, sinus rhythm. Unremarkable ECG.
	Thoracic radiographs: Left atrium is enlarged and a large left auricular bulge is present. No evidence of pulmonary edema or pleural effusion.
	Echo (objective): Aortic velocity 1.5 m/s, pressure gradient 9 mmHg. Unable to take other measurements due to hyperechoic band across left ventricle (see below).
	Echo (subjective): Severe left atrial and auricular enlargement is present; no evidence of spontaneous contrast. Other chambers appeared to be of normal size. A hyperechoic and thickened band crossed the full width of the left ventricle. The ventricular wall thickness appeared normal. Two prominent and hyperechoic papillary masses were present. Mild pleural effusion and possibly pericardial effusion was present.
	Conclusion: Based on the echocardiogram, Newman has endomyocardial fibrosis and moderate to severe cardiac decompensation. The most likely cause of his saddle thromboembolus is decreased blood velocity in his enlarged left auricle and atrium causing a thrombus to form and then release into the aorta. Plan: 12.5mg Lasix PO SID, 2.5mg enalapril PO SID. The referring DVM can adjust these doses and check renal values in two weeks. Lovenox 6mg SQ BID is to be ordered from wwww.meds4mail.com and administered at 1 mg/kg subQ BID in an attempt to prevent another thrombus from forming.

	Newman presented to the VMTH to diagnose the cause of his heart murmur and saddle thromboembolus.
	Echocardiography of Newman's heart showed endomyocardial fibrosis causing impaired filling of the left ventricle resulting in severe left atrial enlargement. Newman has mild pleural effusion and possibly pericardial effusion, indicating that his ability to compensate for his heart disease is reaching its limit.
	MEDICATIONS:
	* Please give Newman one 2.5mg tablet of enalapril and one 12.5mg table of Lasix once a day, both by mouth.
	* Newman should also receive 0.02mL (6mg) of Lovenox (300mg/mL) subcutaneously twice a day. This can be ordered from the WebSite <www.med4mail.com>. Use insulin syringes to inject the Lovenox.
	MONITORING: Please count Newman's respiratory rate (number of breaths in one minute) while he is sleeping. His resting respiratory rate should stay under 30 breaths/min. Please call us in one week with his resting respiratory rate.
	RECHECK: Please make an appointment for a recheck in two months.
	Please call if you have questions or concerns. Call especially if you notice a decline in Newman's activity or any difficulty breathing or open-mouth breathing.
	Thank you for bringing Newman to the VMTH. He is a sweet and talkative cat, and we have enjoyed working with him.

Case Studies In Small Animal