Liz Bode
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Replying to Janet Lewis 06/01/2026 - 15:39
Hi Janet,
this could be a number of things. I have never seen endocarditis of the pulmonic valve in a dog/ cat, but that doesn’t mean it can’t happen!
A few questions:
– what is the signalment?
– what is the clinical history, is it compatible with endocarditis?
– Is the mass attached to the leaflets and mobile?This could be a neoplastic lesion/ thrombus (sterile)/ infectious from that image – it looks pretty big and I guess clopidogrel wouldn’t go amiss just in case!!
Looking forward to your reply, it is an interesting one!
Liz
Replying to Roland R. 05/01/2026 - 11:01
Hi Roland,
I don’t have one I am afraid, but let’s see if Sid does. He finished his residency at Liverpool not so many years ago and I am pretty sure they had a sheet there with some reference ranges on etc. We will get back to you π
Liz
Hi Scott,
Some cardiologists are using this product, and I have seen one or two UK cardiologists talk about it on forums. The experience over here will be limited due to the financial implications, I have not used it. However, it has some very positive data in people and I think it could be beneficial in dogs. Would be interested to hear how your case goes!
Liz
Replying to Annet Krabbenborg 27/12/2025 - 15:01
Hi Annet,
I will do my best to answer the questions so that you can visualise what I mean:
β measuring ivs i know you said leading edge to trailing edge.. ? Do you measure the full ivs (? I assume thereβs a left and right side?) or if you can see the divide just the left side of the ivs? Maybe this is not a thing but am sure iβve heard something re this before)
Yes, there is often a difference in echo texture between the right and left side of the septumn However, there is no consensus on where to measure and as we don’t see this divide on all patients we measure the whole of the septum, leading edge to trailing edge on 2D.β mapse& tapse ? What are normal measurements for cats?
Here is Illaria’s paper on MAPSE and TAPSE in cats (open access) it has all the measurements in there including ref ranges.
https://onlinelibrary.wiley.com/doi/10.1111/jvim.14697β i often struggle to get a really nice la/ao view in a cat ( i often get it more like on a dog echo so la more on left side of the screen in stead of underneath the ao) ? Any tips to improve this?
I think cats atria often do look the same as dogs? Perhaps as they get bigger then they become more ‘underneath’ the aorta. As long as you are seeing a symmetrical looking aorta with the 3 cusps and the body and auricle of the LA in entirety then I think you are doing a good job π
β how do you get the left crannview for the measurement of the lau velocity?
This is tricky in cats with normal left atria, it is much easier when the atria is dilated. You start at the left cranial view with the aorta running horizontally across the screen and then angle your probe slightly caudally so it’s pointing towards the spine near where the last rib inserts. This should bring the auricle to the top oof the screen. In cats with normal LA you will struggle to get it. In those cases I don’t measure it, just LA fractional shortening.Happy New Year π
Liz
Replying to Caroline T. 24/12/2025 - 16:27
Hi Caroline,
This is a good question, what we mean by ‘normal’ velocity is the velocity we would expect to be generated by the right or left ventricle. Trivial MR or TR, in isolation (without valve changes) could be normal but if you are able to interrogate MR and TR and get a good profile then you probably have more than trivial regurgitation and that isn’t ‘normal’.
The RV is a low pressure system normally, so you would anticipate velocity of TR to reflect that, so a normal value for this is <3.0m/s. It is elevated in Pulmonic stenosis and pulmonary hypertension, amongst other more weird congenital abnormalities.
The LV is a high pressure system, so at normal blood pressure you would expect to see an MR velocity of 5-6m/s, reflecting a blood pressure of 100-120mmHg. MR velocity will be higher than this if there is aortic stenosis or systemic hypertension. It will be lower than this if there is increased left atrial pressure/ poor systolic function. However, in order to interpret the velocity of any jet accurately you must be critical of the profiles on Doppler you get, if you don't get a full profile then you can't interpret the image accordingly.
Hope that makes sense.
Liz
Replying to Caroline T. 24/12/2025 - 16:27
Hi Caroline,
This is a good question, what we mean by ‘normal’ velocity is the velocity we would expect to be generated by the right or left ventricle. Trivial MR or TR, in isolation (without valve changes) could be normal but if you are able to interrogate MR and TR and get a good profile then you probably have more than trivial regurgitation and that isn’t ‘normal’.
The RV is a low pressure system normally, so you would anticipate velocity of TR to reflect that, so a normal value for this is <3.0m/s. It is elevated in Pulmonic stenosis and pulmonary hypertension, amongst other more weird congenital abnormalities.
The LV is a high pressure system, so at normal blood pressure you would expect to see an MR velocity of 5-6m/s, reflecting a blood pressure of 100-120mmHg. MR velocity will be higher than this if there is aortic stenosis or systemic hypertension. It will be lower than this if there is increased left atrial pressure/ poor systolic function. However, in order to interpret the velocity of any jet accurately you must be critical of the profiles on Doppler you get, if you don't get a full profile then you can't interpret the image accordingly.
Hope that makes sense.
Liz
Replying to Annet Krabbenborg 14/12/2025 - 13:01
Hmmm, the noise around the baseline is possibly your wall filter? So you might want to increase that slightly to hide some of the noise.
Replying to Svetlana D. 12/12/2025 - 14:06
Hi Svetlana,
That looks good to me. You want to measure at the end of diastole, so the start of the QRS. Then leading edge to leading edge, so that is the top of the endocardium on the RV side of the septum and the top of the endocardium on the LV side of the septum and so on through the free wall, looks like your cursors are good here. Systole is the same but the smallest LV size, which is usually and of the T wave.
Liz
Replying to Svetlana D. 12/12/2025 - 14:06
Hi Svetlana,
That looks good to me. You want to measure at the end of diastole, so the start of the QRS. Then leading edge to leading edge, so that is the top of the endocardium on the RV side of the septum and the top of the endocardium on the LV side of the septum and so on through the free wall, looks like your cursors are good here. Systole is the same but the smallest LV size, which is usually and of the T wave.
Liz
Replying to Caroline T. 11/12/2025 - 08:22
Amazing! Welcome Caroline π
Answers to the above questions:
QUESTION 1 β Aortic Stenosis (Peak Gradient)
Doppler peak velocity across the aortic valve is 4.0 m/s. Calculate the peak pressure gradient between the left ventricle and the aorta.Solution
ΞP=4v^2= 4(4.0)^2= 4(16)= 64mmHgQUESTION 2 β Tricuspid Regurgitation (Estimating PA systolic pressure)
You measure TR jet velocity = 3.2 m/s. Right atrial pressure (estimated from CaVC) = 10 mmHg.
Calculate the pulmonary artery systolic pressure (PASP).
Solution
RVβRA gradient:
ΞP=4(3.2)^2=4(10.24)=40.96β 41 mmHgAdd RA pressure to estimate PASP:
PASP=41+10= 51 mmHgQUESTION 3 β Pulmonic Stenosis
The peak velocity across the pulmonary valve is 2.8 m/s. Find the peak systolic gradient.Solution
ΞP=4(2.8)^2=4(7.84)= 31.36 mmHgQUESTION 4 β Ventricular Septal Defect Gradient
You measure VSD jet velocity = 5.0 m/s. Calculate the pressure gradient between LV and RV.Solution
ΞP=4(5.0)^2=4(25)= 100 mmHgQUESTION 5 β A step further: Estimating RV Systolic pressure from VSD velocity
If systemic systolic BP = 100 mmHg and VSD jet velocity = 4.0 m/s, what is the RV systolic pressure?Solution
Gradient:
ΞP=4(4.0)^2= 64 mmHg
RVSP=SBP-ΞP=100-64= 36 mmHgReplying to Annet Krabbenborg 03/12/2025 - 19:45
Hi Annet,
Thanks for the questions, tissue Doppler is a little tricky! In terms of the annulus, yes this is where the valve attaches to the wall of the heart, it is also called the hinge point.
When setting up tissue Doppler, I narrow the sector width, then put the colour on to cover the whole window (you might also need to adjust the depth to get the frames per second above 200), you will also need to adjust the Nyquist limit so you don’t get any brown colour. Then I place the sample volume of the pulse wave Doppler (which is how I set it up on my machine, but it could be different on other machines) on the annulus. The sample volume is usually 2-3mm.
Hope that helps!
Liz
Hi Riley,
Thanks for posting this, it is a super interesting and exciting development in both people and animals. In people, they found that these drugs were of significant benefit to those with DM in terms of CV outcomes. They have then also found a significant benefit to people without DM but with CHF caused by both systolic and diastolic dysfunction. They survive for longer and have less hospitalised patients. There is a strong interest in veterinary medicine, not least because there is already a licensed product in cats. I am sure drug studies are already underway (in fact I know they are) so we are just waiting for the data…
Watch this space…
Liz
Replying to Emma Holt 24/11/2025 - 12:00
Hi Emma,
Frustrating isn’t it!!! Do you use the Vivid? We have the same problem. We find that attaching the ECG to the feet prevent this to some degree, we use crocodile clips (flattened ones) for environmental reasons mainly and the baseline does tend to wander quite a bit. Sometimes, if we attach them to the feet it does this less. Another problem is if one of the lead touches another, which happens commonly in cats. If you can keep them separated it tends to move about less. Otherwise, we just have to put up with it π
Liz
Replying to Emma Holt 24/11/2025 - 12:00
Hi Emma,
Frustrating isn’t it!!! Do you use the Vivid? We have the same problem. We find that attaching the ECG to the feet prevent this to some degree, we use crocodile clips (flattened ones) for environmental reasons mainly and the baseline does tend to wander quite a bit. Sometimes, if we attach them to the feet it does this less. Another problem is if one of the lead touches another, which happens commonly in cats. If you can keep them separated it tends to move about less. Otherwise, we just have to put up with it π
Liz
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