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Case 5
Recheck Examinations
10/14/98
 | A telephone conversation with the owner revealed that Alice was doing very well (acting
like a kitten). She is drinking a lot according to the owner but she urinates outside so
she is unable to monitor this. Her Lasix dose was increased over the phone because of
persistent tachypnea. She is now on 1.5 of the 12.5 mg Lasix tablets morning and night and
1 tablet in the middle of the day (50 mg per day) along with 7.5 mg diltiazem q8 hours and
1 mg enalapril once a day. |
4/16/99
| Alice is still doing well! On a phone conversation her owner indicated that the doses
of the medications haven't changed at all in the last 6 months and that Alice still feels
like a kitten. At last report she was chasing her brother around the house! Hopefully we
won't hear anything from her for another 6 months. The general impression is that cats
with HCM are doing better since we started using an ACE inhibitor, such as enalapril, to
treat them. Alice may be living proof. |
1/15/00
| Alice's owner called today for a refill on her medications. We called her
back and she is still doing well! We told her that we should recheck Alice in
the near future to see if we can discover why she has done so well for so long.
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3/29/01
| Recheck HCM |
| 6/98- Alice presented to the VMTH Emergency
Service for dyspnea, and was diagnosed with hypertrophic
cardiomyopathy and severe congestive heart failure. She was hospitalized
and given intravenous Lasix. She was eventually sent home with diltiazem
7.5 mg PO TID, enalapril 1 mg PO q 24h, and Lasix 12.5 mg (1.5 tabs PO q
12h with 1 tab PO in the middle of the day). |
| Alice has not returned to the Cardiology Service
for a recheck in the past 2.5 years. She has been
eupneic with no episodes of distress. She has been on the same
medications at the same dosages for this entire time. The client reports
that Alice has been doing well and appears to be an active healthy cat.
Alice has not had any V/D/C/S but occasionally regurgitates after eating
too quickly. The client reports that a litter box had to be placed inside
the house this past winter since Alice would not bother to go outside to
urinate. She no longer has this problem. |
| General: BARH, BCS 5/9, P 192, R 52 |
| Integument: Healthy coat |
| EENT: Eyes- Clear anterior chamber, no discharge, mild episcleral
injection. Ears- Clean. Nose- Moist, lacks discharge. Throat- Pink mucus
membranes, no oral lesions. |
| MS: No lameness. |
| CV: IV/VI left apical systolic murmur. No
gallop or arrhythmia present. Strong femoral pulses. CRT < 1 sec.
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| Resp: All lung fields clear. |
| GI: No masses palpated. |
| GU: Smooth kidneys. |
| NS: No obvious deficits though not thoroughly examined. |
| LN: WNL |
| Hypertrophic cardiomyopathy (historical secondary pulmonary edema)
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| Severe hypertrophic cardiomyopathy |
| Echo: IVSd 6.9 mm, LVFWd 7.4 mm, LVIDd 16.3 mm, LVIDs 6.4
mm, Ao root diameter 9.3 mm, LA dimension 11.5
mm, FS 60 %. Severe progressive global left
ventricular hypertrophy and severe papillary hypertrophy. Left ventricular
myocardium is hyperechoic. Mild SAM seen on 2-D and color flow
Doppler; maximal aortic blood flow velocity is 3 m/s with pressure
gradient of 36 mmHg. Normal left atrial size. Conclusion: Severe
hypertrophic cardiomyopathy with mild SAM. The left ventricular
hypertrophy has progressed since 2.5 years ago, but most importantly the
left atrial size is now normal. She is a unique and fortunate patient to
have compensated for 2.5 years. The severe CHF may have been precipitated
by an acute stressor event, and with treatment she has compensated. She is
still at risk for recurrent CHF, but at this time probably does not need
to be on such high diuretic doses. We have recommended a slow decrease in
dose of Lasix to 12.5 mg PO BID over 2 weeks. We also recommend continuing
the diltiazem 30 mg, 1/4 tab PO TID and enalapril 1.25 mg PO SID (although
often we are prescribing enalapril BID now). |
| Recheck echocardiogram in a year or earlier if she has breathing
difficulties. |
4/25/01; 5/10/01; 7/03/01; 8/08/01;
10/16/01; 01/10/02
| Medication refills are recorded for each of the
above dates. |
| Three and one-half years and counting!! |
2/07/02
| Alice's owner called this morning to let us know
that Alice died. She didn't see her last night and this morning when she
didn't show up for her food she went looking and found her lying on the porch,
as if she was sunning herself there. Apparently she died suddenly in her
sleep. It was something that wasn't totally unexpected but the news still shocked all
of us to hear it. The owners offered to have a cosmetic necropsy performed.
This was done and Alice's body was returned to her owners, who buried her in
their back yard. |
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