Ping Phil: Echo results for HCM diagnosis

Repost--

Thanks both Phil and Nomen for your expertise and advice regarding our
newly diagnosed HCM cat.

When I brought her in for her one week re-check last week I was able
to talk to my
regular vet. He is great--he told me that he sees a lot of cats that
if diagnosed early as my cat was, and if she stabilizes on atenolol
(and he said most cats do), then he predicts a normal lifespan. That
really was a relief to hear. Also, the heart murmur is gone and her
heart rate was 140.

Here is the summary:
Overall left ventricle systolic function is normal with FS% greater
than 35%. The left ventricle size is normal. Left ventricular free
wall thickness is normal. Mild asymmetric septal hypertrophy with
bulge of basal IVS into the LV outflow tract. Mild SAM with mild LV
outflow tract obstruction (50 mm hg).

The left atrium, right ventricle, right atrium all normal in size and
function. Aortic valve normal. No aortic stenosis or regurgitation.
Tricuspid valve, pulmonic valve, pericardium, aorta, pulmonary aorta
all normal.

Mild thickening of the anterior mitral valve leaflet. Mild mitral
regurgitation present, predominately a posteriorly directed jet.

Values:
2D
IVSd .55 cm
LVPWd .54 cm
(aren't these normal values? They are less than .6 cm.)
Ao diam 1.05 cm
LA diam 1.25 cm
LA/Ao 1.19

M-Mode
IVSd .51 cm
LVIDd 1.44 cm
LVPWd .47 cm
IVSs .71 cm
LVIDs .60 cm
LVPWs .90 cm
EDV(Teich) 5.46 ml
ESV (Teich) .51 ml
EF (Teich) 90.67%
%FS 58.23%
SV (Teich) 4.95 ml

Doppler
AV Vmax 2.67 m/s
AV maxPG 28.47mmHg
PV Vmax 1.27 m/s
PV maxPG 6.48 mmHG

Grade 2/6 systolic murmur L apex, gallop; mm pink; normal pulses.

ECG rhythm: Sinus rhythm.
*****************************************

So what does this mean? Which of
these measurements are the most important to watch?

Nomen said he is having a hard time seeing the HCM in this report
other than the mild SAM so I'm hoping you can comment, Phil! I'm not
sure which of the measurements are not normal.

Thanks again for all your help!
-yngver

"yngver" wrote in message
ups.com...
Repost--


Sorry I took so long to respond- I've been really busy.



Thanks both Phil and Nomen for your expertise and advice regarding our
newly diagnosed HCM cat.

When I brought her in for her one week re-check last week I was able
to talk to my
regular vet. He is great--he told me that he sees a lot of cats that
if diagnosed early as my cat was, and if she stabilizes on atenolol
(and he said most cats do), then he predicts a normal lifespan. That
really was a relief to hear. Also, the heart murmur is gone and her
heart rate was 140.

Here is the summary:
Overall left ventricle systolic function is normal with FS% greater
than 35%. The left ventricle size is normal. Left ventricular free
wall thickness is normal.

Mild asymmetric septal hypertrophy with
bulge of basal IVS into the LV outflow tract. Mild SAM with mild LV
outflow tract obstruction (50 mm hg).

The left atrium, right ventricle, right atrium all normal in size and
function. Aortic valve normal. No aortic stenosis or regurgitation.
Tricuspid valve, pulmonic valve, pericardium, aorta, pulmonary aorta
all normal.

Mild thickening of the anterior mitral valve leaflet. Mild mitral
regurgitation present, predominately a posteriorly directed jet.

Values:
2D
IVSd .55 cm
LVPWd .54 cm
(aren't these normal values? They are less than .6 cm.)
Ao diam 1.05 cm
LA diam 1.25 cm
LA/Ao 1.19

M-Mode
IVSd .51 cm
LVIDd 1.44 cm
LVPWd .47 cm
IVSs .71 cm
LVIDs .60 cm
LVPWs .90 cm
EDV(Teich) 5.46 ml
ESV (Teich) .51 ml
EF (Teich) 90.67%
%FS 58.23%
SV (Teich) 4.95 ml

Doppler
AV Vmax 2.67 m/s
AV maxPG 28.47mmHg
PV Vmax 1.27 m/s
PV maxPG 6.48 mmHG

Grade 2/6 systolic murmur L apex, gallop; mm pink; normal pulses.

ECG rhythm: Sinus rhythm.
*****************************************

So what does this mean?


It means she has very mild heart disease that probably won't affect her
lifespan.


Which of
these measurements are the most important to watch?


IVSd, LVPWd, LA diameter and keep a close watch on the SAM/mitral
regurgitation. Some cats develop SAM before the LVPW and/or IVS start to
thicken- and some cats only develop SAM-- without any wall thickening at
all. SAM leads to mitral regurgation that could lead to heart failure if it
becomes severe enough. But Atenolol should keep the SAM in check.



Nomen said he is having a hard time seeing the HCM in this report
other than the mild SAM so I'm hoping you can comment, Phil! I'm not
sure which of the measurements are not normal.


The vet might be using 5 mm as the threshold for hyperthrophy - or the
regional thickening of the IVS- or the mild thickening of the mitral valve
leaflet - or the mild LVOT obstruction.



Thanks again for all your help!
-yngver

I'm sorry I can't be more helpful. I'm not trying to blow you off-- its
just that her heart disease is so mild that there's really not much I can
comment on.

Let me know how her next exam goes, ok?

Best of luck,

Phil

On Jun 15, 3:21 am, "Phil P." wrote:
"yngver" wrote in message

ups.com...

Repost--

Sorry I took so long to respond- I've been really busy.





Thanks both Phil and Nomen for your expertise and advice regarding our
newly diagnosed HCM cat.

When I brought her in for her one week re-check last week I was able
to talk to my
regular vet. He is great--he told me that he sees a lot of cats that
if diagnosed early as my cat was, and if she stabilizes on atenolol
(and he said most cats do), then he predicts a normal lifespan. That
really was a relief to hear. Also, the heart murmur is gone and her
heart rate was 140.

Here is the summary:
Overall left ventricle systolic function is normal with FS% greater
than 35%. The left ventricle size is normal. Left ventricular free
wall thickness is normal.

Mild asymmetric septal hypertrophy with



bulge of basal IVS into the LV outflow tract. Mild SAM with mild LV
outflow tract obstruction (50 mm hg).

The left atrium, right ventricle, right atrium all normal in size and
function. Aortic valve normal. No aortic stenosis or regurgitation.
Tricuspid valve, pulmonic valve, pericardium, aorta, pulmonary aorta
all normal.

Mild thickening of the anterior mitral valve leaflet. Mild mitral
regurgitation present, predominately a posteriorly directed jet.

Values:
2D
IVSd .55 cm
LVPWd .54 cm
(aren't these normal values? They are less than .6 cm.)
Ao diam 1.05 cm
LA diam 1.25 cm
LA/Ao 1.19

M-Mode
IVSd .51 cm
LVIDd 1.44 cm
LVPWd .47 cm
IVSs .71 cm
LVIDs .60 cm
LVPWs .90 cm
EDV(Teich) 5.46 ml
ESV (Teich) .51 ml
EF (Teich) 90.67%
%FS 58.23%
SV (Teich) 4.95 ml

Doppler
AV Vmax 2.67 m/s
AV maxPG 28.47mmHg
PV Vmax 1.27 m/s
PV maxPG 6.48 mmHG

Grade 2/6 systolic murmur L apex, gallop; mm pink; normal pulses.

ECG rhythm: Sinus rhythm.
*****************************************

So what does this mean?

It means she has very mild heart disease that probably won't affect her
lifespan.

Which of

these measurements are the most important to watch?

IVSd, LVPWd, LA diameter and keep a close watch on the SAM/mitral
regurgitation. Some cats develop SAM before the LVPW and/or IVS start to
thicken- and some cats only develop SAM-- without any wall thickening at
all. SAM leads to mitral regurgation that could lead to heart failure if it
becomes severe enough. But Atenolol should keep the SAM in check.



Nomen said he is having a hard time seeing the HCM in this report
other than the mild SAM so I'm hoping you can comment, Phil! I'm not
sure which of the measurements are not normal.

The vet might be using 5 mm as the threshold for hyperthrophy - or the
regional thickening of the IVS- or the mild thickening of the mitral valve
leaflet - or the mild LVOT obstruction.



Thanks again for all your help!
-yngver

I'm sorry I can't be more helpful. I'm not trying to blow you off-- its
just that her heart disease is so mild that there's really not much I can
comment on.

Let me know how her next exam goes, ok?

Best of luck,

Phil

Thanks for your response, Phil. It seems it's very encouraging that
you have little to comment on--I'm glad to hear that in your
estimation her heart condition is very mild. She has a recheck in 3
months and another echo in six months. I realize the results of the
second echo are key--that will show whether there is any progression.
The vet said that in his experience, most cats are stabilized with
medication. So I'm hopeful that's the case with her. The vet did say
he could no longer hear the heart murmur so I assume that since it's
the mitral regurgitation causing that, the atenolol is controlling it.

Thanks again--I am very relieved. I'll post the results of her next
checkup and echo.
-yngver