Ping Phil and Nomen: Just received HCM echo printout

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yngver - 22 May 2007 19:27 GMT

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

I just brought her in for her one week re-check and talked 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? No one ever mentioned the gallop. Which of
these measurements are the most important to watch?

Thanks again for all your help!
-yngver

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Nomen Nescio - 23 May 2007 06:20 GMT

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From: yngver <yngver@aol.com>

>Thanks both Phil and Nomen for your expertise and advice regarding our
>newly diagnosed HCM cat.
[quoted text clipped - 5 lines]
>really was a relief to hear. Also, the heart murmur is gone and her
>heart rate was 140.

Sounds like GREAT news.

I'd be very interested in Phil's opinion. But as I look at the numbers,
I'm having a tough time seeing the HCM.

>LVIDd 1.44 cm
>LVIDs .60 cm

(LV internal dimension)
These both look a bit on the low side. Those are the numbers that
jump out at me as the area of concern. And that may be related to
the "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)."

Nothing else looks all that bad. And the key word, here, is MILD.
To give you a reference point, TK's first report had a lot of
"extreme" and "moderate" in it.

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

>No one ever mentioned the gallop.

The gallop is probably due to the LV outflow obstruction. I don't think
that the gallop, in and of itself, is anything to be concerned about. It's
not a separate issue.

All in all, it's a good thing that you're kinda fond of your cat. 'Cause
it looks, to me, like you may be stuck with her for many more years. :)

That's the layman's view of the report.
For the expert view, we'll both have to see what Phil has to say.
I'm really glad Phil checked the group and saw your post. The best
I can do is a somewhat educated guess.

Best of luck

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look at us we're beautiful - 23 May 2007 13:45 GMT

> All in all, it's a good thing that you're kinda fond of your cat. 'Cause
> it looks, to me, like you may be stuck with her for many more years. :)

You should have taken her to the vet years ago!

there's no need to feel ashamed because you love your cat!

nomen loves his caat
nomen loves his caat

haha

haha!

grown man co-dependent on... a cat

nice Nomen! they teach you that in college? how does your wife feel
about your little addiction?

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Nomen Nescio - 24 May 2007 07:11 GMT

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From: look at us we're beautiful <brryprrsh@yahoo.com>

>You should have taken her to the vet years ago!
>
[quoted text clipped - 11 lines]
>nice Nomen! they teach you that in college? how does your wife feel
>about your little addiction?

Didn't your mother ever tell you not to drink and post?
Save the inane BS for cybercat.
This is the "adult" table.

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yngver - 23 May 2007 22:15 GMT

> -----BEGIN PGP SIGNED MESSAGE-----
>
[quoted text clipped - 11 lines]
>
> Sounds like GREAT news.

Yes, I was really surprised that the atenolol would eliminate the
heart murmur in just a week. I asked the vet about diltiazem and he
said it's mainly a matter of what a cardiologist's experience has
been. He said this cardiologist prescribes diltiazem too sometimes but
not so frequently as atenolol. He told me diltiazem is 3x a day
dosing--that would be tough for us, since we are gone all day. I
thought there was a time release version but he said the 3x was the
most effective.

Of course, I also just a read a Web site that mentioned a current
study (I think it is still going on) that seems to indicate the best
outcome for cats with hcm treated with an ACE inhibitor, and the worst
outcome with beta blockers. But since the study is apparently still
ongoing, I don't think I can use that to convince a cardiologist.

> I'd be very interested in Phil's opinion. But as I look at the numbers,
> I'm having a tough time seeing the HCM.

I hope Phil sees this. The only think I can think of is that I read
that some cardiologists now consider the cutoff to be .5 cm instead
of .6 cm for left ventricle wall thickness or septal wall thickness.

> >LVIDd 1.44 cm
> >LVIDs .60 cm
[quoted text clipped - 5 lines]
> bulge of basal IVS into the LV outflow tract. Mild SAM with mild LV
> outflow tract obstruction (<50 mm hg)."

Okay, if the numbers are low, that means the walls must be a little
too thick, reducing the interior dimension? Something is causing the
SAM and outflow obstruction, so I guess that would have to be it.

> Nothing else looks all that bad. And the key word, here, is MILD.
> To give you a reference point, TK's first report had a lot of
> "extreme" and "moderate" in it.

Thanks. I didn't quite believe it when the vet told me it was very
mild; that's why I wanted to see the report myself. Although I can't
really interpret the numbers, it sure seems mild compared to what I've
read online. I'm really glad that TK is doing so well!

> >Grade 2/6 systolic murmur L apex, gallop; mm pink; normal pulses.
> >No one ever mentioned the gallop.
>
> The gallop is probably due to the LV outflow obstruction. I don't think
> that the gallop, in and of itself, is anything to be concerned about. It's
> not a separate issue.

Apparently only the cardiologist heard it. I realize it's related to
the cause of the heart murmur, and common in HCM cats.

> All in all, it's a good thing that you're kinda fond of your cat. 'Cause
> it looks, to me, like you may be stuck with her for many more years. :)

Thanks!!! I sure hope so. I guess the next echo is the key. But my vet
said that just because he thought the murmur was a little louder this
spring than what he heard last fall doesn't mean the condition
progressed. I thought that's what it meant. He said in very early HCM
heart murmurs can come and go and maybe he just didn't hear it all
that well.

We have three cats and although this naturally wasn't the way we
planned it, one cat chose my husband and this cat chose me. Our third
one just showed up on our doorstep a couple years ago, so she chose
both of us. The other two are very healthy, but this one cat I think
has had more than her share of problems. She has asthma, and last year
was diagnosed with degenerative joint disease in her back knees. I was
so hoping she wouldn't also have a heart problem on top of all this--
she is only 9. But she has done amazingly well with both problems so I
hope the HCM doesn't faze her either.

> That's the layman's view of the report.
> For the expert view, we'll both have to see what Phil has to say.
> I'm really glad Phil checked the group and saw your post. The best
> I can do is a somewhat educated guess.
>
> Best of luck

Thanks so much. You have been a big help and made me feel better. I
wish you the best of luck with TK and I hope his heart condition
continues to improve.
-yngver

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Nomen Nescio - 24 May 2007 06:20 GMT

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From: yngver <yngver@aol.com>

>Yes, I was really surprised that the atenolol would eliminate the
>heart murmur in just a week.

That's good! But you will probably find that the murmur will come and
go. Three months after TK started the diltiazem, our regular vet had to
go get her electronic stethoscope to hear the murmur. Three months
after that, it was a level 3 at Tufts. Just don't get disheartened if it
seems to come back.

>I asked the vet about diltiazem and he
>said it's mainly a matter of what a cardiologist's experience has
[quoted text clipped - 3 lines]
>thought there was a time release version but he said the 3x was the
>most effective.

TK gets 30 mg of diltiazem ER (extended release) once a day.

>Of course, I also just a read a Web site that mentioned a current
>study (I think it is still going on) that seems to indicate the best
>outcome for cats with hcm treated with an ACE inhibitor, and the worst
>outcome with beta blockers. But since the study is apparently still
>ongoing, I don't think I can use that to convince a cardiologist.

I've never trusted ONE study. You could probably find a "study" that
proves that pigs can fly.

>I hope Phil sees this. The only think I can think of is that I read
>that some cardiologists now consider the cutoff to be .5 cm instead
>of .6 cm for left ventricle wall thickness or septal wall thickness.

Phil, I believe, uses .6 cm. TK was .69 when diagnosed.

>Okay, if the numbers are low, that means the walls must be a little
>too thick, reducing the interior dimension? Something is causing the
>SAM and outflow obstruction, so I guess that would have to be it.

The " bulge of basal IVS into the LV outflow tract" throws me, a little.
I'm visualizing the effect as being similar to squeezing a garden hose
a small amount. But I could be way off.

>Apparently only the cardiologist heard it. I realize it's related to
>the cause of the heart murmur, and common in HCM cats.

It's his job to hear it. It's probably so slight that it takes the well trained
ear of a cardiologist to hear it.

>We have three cats and although this naturally wasn't the way we
>planned it, one cat chose my husband and this cat chose me.

TK is a mama's boy. I'm his buddy......but my wife is HIS girl.

>She has asthma, and last year
>was diagnosed with degenerative joint disease in her back knees. I was
>so hoping she wouldn't also have a heart problem on top of all this--
>she is only 9. But she has done amazingly well with both problems so I
>hope the HCM doesn't faze her either.

It sounds like you're doing the best you can for her. You can do nothing
more and should do nothing less.
She's got a loving, caring, person looking after her. She's a lucky kitty.

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yngver - 25 May 2007 21:04 GMT

> -----BEGIN PGP SIGNED MESSAGE-----

That's good! But you will probably find that the murmur will come and

> go. Three months after TK started the diltiazem, our regular vet had to
> go get her electronic stethoscope to hear the murmur. Three months
> after that, it was a level 3 at Tufts. Just don't get disheartened if it
> seems to come back.

Thanks for letting me know that. It was a pretty faint murmur anyway.
I didn't know it could come back.

> TK gets 30 mg of diltiazem ER (extended release) once a day.

I thought there was a once a day dose. If TK does okay with it, I
don't see why some vets prefer the 3x dosing. Well, since our cat is
doing so well on atenolol and I am not a cardologist, I guess we'll
stick with the atenolol for now. I am thinking when she goes for her
recheck in three months we might make an appt. with a different
cardiologist, but from what I've read about him he tends to prefer
atenolol too.

> I've never trusted ONE study. You could probably find a "study" that
> proves that pigs can fly.

I know, and the article stressed that the study hasn't concluded yet.
It is a shame that there has not been a study previously to see which
heart meds are most effective in treating feline HCM. It seems to me,
after the reading I've done, that a lot of it is guesswork.

> Phil, I believe, uses .6 cm. TK was .69 when diagnosed.

Okay, so that is pretty definite. But even if someone uses .5 cm as a
cutoff, her IVSd is only .51 cm. I guess that would be "slightly
thickened". In a way it seems a little arbitrary. One mm difference
between a cat that has HCM and one that doesn't?

> The " bulge of basal IVS into the LV outflow tract" throws me, a little.
> I'm visualizing the effect as being similar to squeezing a garden hose
> a small amount. But I could be way off.

I don't quite know what she means by "bulge", but I think LV outflow
tract obstruction is usally caused by thickening of the septal wall,
so I guess that's what it is. I think some cardiologists diagnose HCM
if they see SAM even without any thickening.

> >Apparently only the cardiologist heard it. I realize it's related to
> >the cause of the heart murmur, and common in HCM cats.
>
> It's his job to hear it. It's probably so slight that it takes the well trained
> ear of a cardiologist to hear it.

Yes, I figured as much.

> >We have three cats and although this naturally wasn't the way we
> >planned it, one cat chose my husband and this cat chose me.
>
> TK is a mama's boy. I'm his buddy......but my wife is HIS girl.

It's funny, we chose this cat and our other cat as kittens. I chose
the older one (they are six months apart in age) and my husband chose
this one. But the one I chose turned out to adore my husband, and the
one he chose is "my" cat.

> >She has asthma, and last year
> >was diagnosed with degenerative joint disease in her back knees. I was
[quoted text clipped - 5 lines]
> more and should do nothing less.
> She's got a loving, caring, person looking after her. She's a lucky kitty.

Thanks. I know they are all special kitties but of all the cats I've
had, I guess you could say she is the most special. I think we are
finally getting over the shock and fear that she is just going to drop
dead any minute. She seems perfectly fine.

Sounds like TK is going to be with you a long, long time too!
-yngver

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yngver - 04 Jun 2007 16:17 GMT

> On May 24, 12:20 am, Nomen Nescio <nob...@dizum.com> wrote:> -----BEGIN PGP SIGNED MESSAGE-----
>
[quoted text clipped - 77 lines]
> Sounds like TK is going to be with you a long, long time too!
> -yngver

I am still hoping Phil sees the echo results and can comment!
Thanks--
yngver

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