Mausi - Hypertrophic cardiomyopathy
Mausi was absolutely adorable, her favorite pastime was to hang around in the yard and play with kids. But one day she simply preferred to stay at home. She just didn't want to leave the house and slept almost the entire day. She even ignored her favorite food and was beginning to loose weight. The next day while sitting in front of the television (she loved watching Dr. House) she simply fell from the couch. Even though she recovered quickly it was obvious that something was wrong. She needed urgent medical attention.
Well, the doctor heard a loud systolic murmur. He had a suspicion and immediately performed an echocardiogram. Mausi was pretty restless during the exam but the doctor saw what he suspected. But, do YOU know which medical condition Mausi has?
Certainly, there is severe left ventricular hypertrophy. The ventricle also appears rather small.Note that there is complete cavity obliteration during systole. Left ventricular function is hyperdynamic and there is tachycardia.
Take a look at the motion of the anterior mitral valve leaflet - it moves towards the septum during systole causing left ventricular outflow tract obstruction. Clearly, the diagnosis is obstructive hypertrophic cardiomyopathy. But there is more to see in this echo:
The parasternal short axis view shows a very narrow right ventricular outflow tract with systolic obstruction here as well. Right ventricular outflow tract obstruction is a fairly rare additional finding in HOCMP but it can occur especially if right ventricular hypertrophy is also present.
In clinical context
The diagnosis of hypertrophic cardiomyopathy explains Mausi‘s symptoms of fatigue and also the syncope she had experienced. Possibly, she also had an episode of ventricular tachycardia. The findings, you see are quite typical, however the pattern of hypertrophy is rather concentric and not asymmetric with a prominent septum as one finds in most patients.
How can we help?
But what now? Which treatment would you consider? Myectomy? Alcohol ablation? Both are valid treatment options. But not in Mausi's case. Why not? Well, Mausi is a middle aged cat and was eventually treated conservatively with a beta blocker. Unfortunately she did not make it for long and died only 4 weeks later suffering from difficulties in breathing and heart failure. Sad, but let us not forget cats have seven lives. Just a note on the side, HOCMP is one of the most common heart conditions in cats!
If you want to learn more about hypertrophic cardiomyopathy, then our Echo Complete course is perfect for you. After attending the course, you will be able to diagnose HOCMP without the help of anyone else. Moreover, we will teach you the criteria for identifying those patients who are suitable for alcohol ablation. So come and check it out.
Thanks to Dr. Mato Markovic of the Veterinary University of Vienna for providing the images of Mausi.
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Where is Waldo (Part 1)?