Here's his report if anyone is interested:
1. Mild biatrial enlarged of unknown etiology.
2. Mild pulmonary insufficiency - suspect pulmonic valve dysplasia. 3. Normal cardiac function.
4. No obvious intra-cardiac shunts.
Milo is a 7 week old, male intact American domestic shorthair red tabby cat that presented on 7/21/16 to AUVTH Cardiology Services for evaluation of an enlarged heart previously diagnosed on radiographs by the referring veterinarian. Milo was taken in two weeks ago by Steel City Cat Rescue at which time it was noted he had a distended abdomen and an upper respiratory tract infection. He was diagnosed and treated for Calicivirus (treated with Amoxicillin and Teramycin) which has since improved a great deal. His distended abdomen has not gotten bigger, though it has not been reported to have changed much. Two fecals have been run and both tested negative, two sets of radiographs were taken at the veterinarian's clinic, revealing an enlarged cardiac silhouette, and routine labwork was done with results in normal limits. Milo's guardian reports that he is eating and drinking well, urinates more than her other rescue cats, and has exercise intolerance.
On physical examination today, Milo was bright, alert and responsive with his TPR within normal limits. His weight was 0.77 kg and his temperature was 100.1 F. Milo's heart rate was 164 beats per minute with no murmurs or arrhythmias noted. Milo's respiratory rate was 60 bpm and his lung fields were normal on auscultation. Mucous membranes were pink with CRT <2 seconds. Pupillary light response and menace response were normal for both eyes; both ears had mild wax build up. Limbs ambulated normally and no pain was elicited on palpation. No masses were found on abdominal palpation, though his abdomen did visually appear distended.
1. Thoracic Radiographs:
The cardiac silhouette is enlarged. The pulmonary arteries and veins appear subjectively mildly dilated. No evidence of pericardial hernias of any type. The pulmonary parenchyma appears within normal limits. Final radiology report is pending.
The left ventricular internal dimensions are within normal limits at end-systole and end-diastole. Normal left ventricular systolic function based on the LVIDs and the calculated fractional shortening. Normal left ventricular wall thickness. The mitral valve appears structurally normal. The left atrium is mildly enlarged. The right atrium is subjectively mildly enlarged compared to the left atrium. The right ventricle is subjectively within normal limits for size and wall thickness. The basilar aspect of the interatrial septum is irregular and appears to have redundant tissue, but no intracardiac shunts are noted based on color and spectral Doppler interrogation. Mild pulmonary insufficiency is noted, but the velocities are not consistent with pulmonary hypertension. Trans-pulmonic velocities are within normal limits. The main, right, and proximal left pulmonary arteries are within normal limits for size. There is no echocardiographic evidence of pulmonary hypertension. The aortic valve appears structurally normal with normal trans-aortic velocities. On certain right parasternal short axis views at the level of the left ventricular papillary muscles, the parenchyma adjacent to the pericardium appears hyperechoic with focal, small anechoic regions. This abnormality was first thought to be invasion of the pericardial space by extra-pericardial tissue (PPDH, etc.), but the abnormality could not be reproduced on other views by other ultrasonographers. Thoracic radiographs do not support PPDH either, so this finding is most likely artifact and of clinical insignificance.
Milo's echocardiogram and thoracic radiographs were not indicative of any type of congenital or acquired cardiac pathology. His physical exam parameters were within normal limits with the exception of his distended abdomen. The abdominal distension is not from fluid in the abdomen based on evaluation via ultrasound probe, nor can the distension be definitively attributed to any form of cardiac disease. On echocardiogram, no significant findings were observed that would explain Milo's distended abdomen or exercise intolerance. The left atrium appeared mildly enlarged, mild pulmonary insufficiency was noted, and the right atrium was subjectively mildly enlarged. However, none of these changes seem to be affecting Milo clinically since signs of pulmonary hypertension or heart failure are not present.
Differentials for Milo's abdominal distension currently include peritoneal inflammation, certain viruses, parasites, PPDH, or normal kitten presentation. For now, the best plan for Milo would be to continue monitoring progression of his exercise intolerance and abdominal distension and look for signs of improvement or worsening. Milo appears clinically healthy and his quality of life is good, so we currently recommend monitoring for any changes in health and scheduling a recheck in 2-3 months if necessary.
Recommendations/Plan for Re-evaluation:
1. Although we did not find evidence of cardiac pathology or congenital abnormalities today on radiographs or echocardiogram, we cannot rule out the possibility of structural defects that were too small to be seen. We recommend scheduling a recheck appointment with AUVTH Cardiology Services around 4-5 months of age to reassess cardiac structure and function if you are still concerned with Milo's temperament or physical signs. If you notice any changes in Milo's health or behavior before then, please make an appointment with AUVTH so that he can be seen by a veterinarian. Any sudden, dramatic increases in respiratory rate or effort should be watched for along with lethargy and signs of GI changes like vomiting, anorexia, or diarrhea.