Case 31 — Discharge

Urinalysis

URINALYSIS PARAMETER        RESULT              METHOD/UNITS
Collection method           Cystocentesis
Color                       Dark brown
Turbidity                   Hazy
Specific gravity            1.035               Refractometer
pH                          6.5
Protein                     Negative
Glucose                     Negative
Ketones                     Negative
Bilirubin                   Negative
Hemoprotein                 3+
WBC                         0–1                 /hpf
RBC                         0–1                 /hpf
Epithelial cells            Rare squamous       /hpf
Casts                       None seen           /lpf
Bacteria                    None seen

Clinical diagnoses

  • Heartworm disease

Comments

  • Thoracic radiographs: Enlarged caudal vena cava with possible caudal lobar branch pulmonary artery enlargement. Focal interstitial pulmonary patterns.
  • Echocardiography: A heartworm is present in the right ventricle. More heartworms are also present in the pulmonary artery. Marked RA and RV chamber dilation are present and the RV free wall is mildly to moderately thickened. The left ventricle is mildly underloaded. Mild tricuspid regurgitation is present. The transvalvular pressure gradient is within normal limits. This is not consistent with the diastolic septal flattening and the enlarged vena cava since one would expect pulmonary hypertension to be the cause of right heart failure in this cat. The tricuspid regurgitation jet will be reassessed at the next visit.
  • ECG: Normal
  • CBC: PCV 25%, MCV 40, MCHC 31.
  • The presence of hemoglobin in his urine is most likely due to mild caval syndrome where the RBCs are being lysed as they pass through the tricuspid valve and the entwined heartworm during systole.

Discharge instructions

  • Boris has moderate signs of right heart disease secondary to his heartworm infection. Several worms are present in his heart chambers and pulmonary arteries. The worms in his pulmonary arteries cannot be removed mechanically.
  • Removing worms from his heart may be possible in the future if more worms are present in his right heart.
  • Please give Boris prednisone 5 mg twice daily for 7 days, then once daily for 14 days, then once every second day for 14 days.
  • Please bring Boris back for a recheck in 4–6 weeks, or earlier if problems occur.
  • Thanks for bringing Boris to the VMTH. He is a great cat.

Note

Although this cat did not have all of the classic signs of caval syndrome, he did have dark brown colored urine, hemoglobinuria on urinalysis, and an anemia.

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