Liz Bode

Hi all,

I, obviously, love a heart worm case – although I have only ever seen one case of it in the UK. I have had advice calls about them and seen some cases when I was doing an externship in US. The case I saw was also a rescue from Romania and presented to me OOH as a resident in Edinburgh (where you’d least expect heart worm to be) with 3rd degree AV block. When we imaged it there was endocarditis (unrelated to heart worm, but probably myocarditis as an extension of the endocarditis was the cause of the AV block – the aortic valve is anatomically very close to the AV node). We took bloods and, routinely, did blood smears which a student looked at first for me – they came back to say they could see worms!!! We were so surprised – there were loads of microfilaria squirming around in the dog’s blood! We treated the heart worm, endocarditis and the dog did much better than we thought. The 3rd degree AV block even resolved and so we did not need to place a pacemaker.

Just thought I’d share a case with a more positive outcome ?

Liz

Hi Kerida,

Thanks for uploading the history and the radiographs to the discussion forum, what an interesting case!

I think there is evidence of some cardiomegaly, particularly at the base on the laterals. You can’t really see the right atrium on these as it is buried in the middle of the cardiac silhouette (unless v severe tricuspid dysplasia, which cats do not often get and this is the wrong age). It is hard to confirm specific chamber enlargement on the DV as the silhouette is effaced by the lung pattern. I see what you mean on the left lateral, there looks like there is some sort of mass cranio-dorsal to the heart. I can’t see this on the Dv, but the slight rotation makes it hard to look at the right-cranial thorax. The heart is rounder on the left lateral, but I think we tend to see this so can’t read too much into that.
The lung pattern is diffuse broncho-interstitial with a greater interstitial component in the caudo-dorsal lung fields.
You don’t mention any murmur/ arrhythmia/ gallop so I assume that these are not present?

My DDx would be:

Oedema – cardiogenic vs non-cardiogenic superimposed on feline asthma type pathology
Infection – bronchopneumonia
Possible mass in cranial thorax

Is there any way this cat could have a FAST scan of the thorax to rule in/out cardiomegaly and a mass? I think that would be the single most useful test here?

What did you decide to do with the cat in the end? Interesting that the brother died of resp issues too…

I would be very interested to see what others thought 🙂

Liz

No problem 🙂 That sounds like a cool case. I always think comparing what you find to the human literature is super interesting, so you would want to do that. If there are any case reports/ case series of similar things in the veterinary literature you would want to compare your case to those too (if there aren’t you might consider writing this up!). If there was anything unusual about this case or things you didn’t do due to financial limitations then talk about this in the discussion too.

Hope that helps.

Liz

Well done Scott, definitely something to be proud of. Danielle is a legend and I learnt so much from her as a resident.

Liz

I think both theories are in their infancy, but there appears to be growing evidence for a role of both these theories. The cardioprotective theory involves the intralipid being able to improve myocardial metabolic function, even reversing some of the effects of ischaemia, which will provide more energy for the heart. It also enhances some calcium handling within the heart which improves inotropy and repairs any lost function present that may have been caused by cardiotoxic drugs. Most evidence appears to be in the use of anaesthetics in people.

Hi Ashley,

Poor little guy. This is quite an unusual condition, especially the severe cases when it can cause exercise intolerance and respiratory difficulty. I’ve only ever really seen milder forms in brachycephalic dogs, who seem to have this condition slightly more commonly. I have seen a Pug with this condition when it was more severe, but he exercised fine, the only thing that was unusual with him was that his apex beat was shifted to the right and the mean electrical axis of his ECG also showed R deviation – I think we investigated an asymptomatic murmur that was not related. There is a surgical option – external splinting, and there are a few published reports where this has been successful for certain forms of the condition. It also seems to be more successful the younger the animal as their sternum is still soft/ cartilaginous. However, I have no experience of patients having this procedure – not sure if Scott or anyone else do.

Sorry I can’t be more helpful.

Liz

I might give it some butorphanol if anxious.
I would perform a thoracic POCUS examination – looking for pleural effusion, evidence of B-lines and to check cardiac structure and function. You might also be able to see any evidence of herniation.
Check BP
Check an ECG
Bloods inc electrolytes
More imaging if stable enough and nothing obvious on POCUS examination

(the cardiologist’s perspective)

Hi both,

Feline VHS could be useful if it is increased, which it will be in cases of HF.
However, pre-clinical HCM may have a normal VHS which can complicate the picture.

In terms of further assessment post stabilisation, I think this is indicated. Different types of heart disease have vastly different prognosis and so from that point of view further investigations would be indicated.

Liz 🙂