Quiz: Hypertrophic Cardiomyopathy in Cats

Amara Estrada, DVM, DACVIM (Cardiology), University of Florida

Matthew Boothe, DVM, Blue Pearl Veterinary Partners

April 2018|Cardiology|Peer Reviewed

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Quiz: Hypertrophic Cardiomyopathy in Cats

6  Questions
Multiple Choice Questions
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Quiz: Hypertrophic Cardiomyopathy in Cats

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Bagheera, a 7-year-old neutered male ragdoll cat is presented for a wellness visit and vaccinations. He was previously part of a breeding program, and the owner reports no abnormalities at home. Bagheera weighs 11.9 lb (5.4 kg) on presentation with a BCS of 5/9. Other than a grade II-III/VI left parasternal systolic heart murmur, physical examination is unremarkable. Heart rhythm is normal but fast at 220 bpm, and femoral pulses are strong and synchronous.

Which of the following is not a common cause for a heart murmur in a cat?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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The owner asks the following question when trying to decide whether she can afford more advanced diagnostics. What is the most appropriate response?

What percentage of cats with an ausculted heart murmur have heart disease?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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Several cats in the owner’s breeding colony have been diagnosed with HCM in the past. Although Bagheera is no longer part of the breeding colony, the owner would like more information about what diagnostic tests she should pursue for Bagheera.

Which of the following would not be a diagnostic modality that the owner should consider?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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A complete echocardiogram was performed on Bagheera, and based on the images obtained, there was evidence of mild LVH (diastolic LV wall thickness of free wall and interventricular septum 6 mm, with normal being <5.5 mm), and systolic anterior motion (SAM) of the mitral valve was present. Left atrial size was within normal limits and systolic function was also normal. All other causes of LV hypertrophy (eg, hyperthyroidism, hypertension) were ruled out and hypertrophic obstructive cardiomyopathy (HOCM) was diagnosed.

Assuming all else is normal, which of the following might be an appropriate treatment plan for Bagheera?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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Bagheera was treated with atenolol that was eventually titrated to 1 mg/kg q12h. Heart rate, measured at home with an inexpensive stethoscope, was reported by the owner to be 120-130 bpm. When Bagheera returns for a scheduled recheck evaluation 8 months later, he is clinically normal and pill administration at home is easy.

On recheck echocardiography, his left ventricle is slightly thicker than previous recorded images; diastolic LV wall thickness of free wall and interventricular septum now measuring approximately 6.5 mm, and left atrial size is now increased (LA:Ao of 2:1 [Left atrial to aortic root ratio; range, >1.5-1.6). Spontaneous echogenic contrast (SEC, or smoke) is noted in the LA chamber and raises concern for development of an aortic thromboembolism (ATE).

Assuming all other diagnostics are still normal and the owner is easily able to administer medication to Bagheera, which of the following would be an appropriate therapy to initiate for primary prevention of ATE?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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What can the owner be told regarding Bagheera’s prognosis?

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Quiz: Hypertrophic Cardiomyopathy in Cats
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Quiz: Hypertrophic Cardiomyopathy in Cats

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ATE = aortic thromboembolism, CHF = congestive heart failure, DLVOTO = dynamic left ventricular outflow tract obstruction, DRVOTO = dynamic right ventricular outflow tract obstruction

HCM = hypertrophic cardiomyopathy, HOCM = hypertrophic obstructive cardiomyopathy, LA:Ao = left atrial to aortic root ratio, LVH = left ventricular hypertrophy, SAM = systolic anterior motion, SEC = spontaneous echogenic contrast

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