Laboratory work
Blood samples for haematology , biochemistry and measurement of electrolytes were taken to assess for any other underlying health conditions ( particularly renal disease , which could be worsened by aggressive diuretic therapy ) and to establish a baseline prior to initiation of aggressive furosemide therapy to treat the CHF .
The results were largely unremarkable , with an increase in blood glucose being the only abnormality . This was thought to be related to stress , but it was noted to reassess this on repeat blood work the following day .
Echocardiography
In cases of suspected heart failure , an echocardiogram is essential for assessing cardiac structure and function . The underlying cause of heart failure can then be diagnosed based on echocardiographic measurements . When the patient was deemed stable enough , echocardiography was performed to confirm the diagnosis of cardiac disease .
The echocardiogram revealed left ventricular wall hypertrophy with end-diastolic wall thickness measured at 7.11 mm ( normal is < 5 mm for an average-sized cat [ 3 ] ). The left atrium was enlarged ( Figure 1 ) with the left atrium to aorta ratio measured at 1:1.86 ( normal is considered to be no greater than 1:1.6 ).
Figure 2 . Right parasternal four-chamber long-axis view , demonstrating mitral regurgitation due to systolic anterior motion of the mitral valve on colour Doppler imaging .
Thoracic radiography
Dorsoventral radiographs revealed some residual mild pleural effusion and mild pulmonary oedema ( Figure 3 ). Lateral views were not taken , to minimise patient stress and respiratory compromise .
Thoracic radiographs are the gold standard for the diagnosis of pulmonary oedema , but the cardiac silhouette is not always a useful tool for grading the stage of heart disease in feline patients and cannot be used to diagnose cardiomyopathy phenotypes .
Figure 1 . Left atrial enlargement in the right parasternal short-axis view at the level of the aortic valve .
Spontaneous echo contrast was visible in the left auricle , indicating an increased risk of thrombus formation . Systolic anterior motion of the mitral valve was present , with the septal mitral valve leaflet being pulled into the left ventricular outflow tract in systole . This resulted in moderate mitral regurgitation and turbulence in the outflow tract in systole , which was visible on colour Doppler imaging ( Figure 2 ). A diagnosis of HCM was made based on these findings .
Figure 3 . Dorsoventral radiograph taken following thoracocentesis , showing pulmonary oedema and mild pleural effusion .
44 Veterinary Nursing Journal