Primary clinicians: Sarah Miller, DVM and Gerhard Wess, DVM
Supervising clinicians: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology) and William P. Thomas, DVM, DACVIM (Cardiology)
Signalment
Ten-year-old MC DLH cat weighing 6.1 kg ("Christopher")
Presenting Complaints
Collapsing Episodes
Pertinent History
Christopher presents to the VMTH Neurology Service for a 4 month history of collapsing episodes.
The episodes last approximately 5 seconds after which he is normal. The episodes normally consist of falling to one side and reaching/clutching with his forelimbs.
Yesterday he had an unusual episode where he went rigid, stuck one forelimb out, fell over against a wall and then fell down. Afterward he got up and was normal. Three minutes later as he was walking into the house the owner noticed that he was staggering like he was drunk. This quickly passed and he became normal again.
He does not appear to know when an episode is going to happen. He does not urinate, defecate or salivate during an episode. There is no particular time of day that they occur although they may occur at feeding time or when he is picked up. He appears to lose consciousness during the episodes although the clients have never tried to rouse him.
When he first began having the episodes the clients would see 4-6/day, but he was an outdoor cat and was often away from home. He has begun staying closer to home and the clients estimate that he experiences 10 episodes a day. They do believe that the number of episodes he has in a day has been progressively increasing and that this increase is not due to an increase in time spent at home. He also has begun hiding in a cubby in the bedroom. Between episodes he is normal.
At one point the referring veterinarian noted a systolic BP of 120mmHg, a heart rate of 80-90 beats/minute, and a gallop rhythm.
He has had two cardiology consults, one 4 months ago and one 3 days ago.
Ultrasound images and an ECG from January are available for review. One undated record is available and indicates a 1-2/6 systolic murmur with regular rhythm and a heart rate of 132 beats/minute.
Echocardiogram revealed changes consistent with idiopathic hypertrophy of the basilar septum, mild mitral valve thickening, mild regurgitation, and mild left atrial enlargement. No obvious cause of syncope was noted.
One record dated from 3 days ago indicates a 1-2/6 systolic murmur with intermittent premature beats with an overall slow rate. An ECG showed occasional junctional premature beats and an intermittent conduction abnormality but little change in heart rate (per record). His echocardiogram was similar to his previous exam showing mildly enlarged left ventricular and atrial chambers. At this time he was prescribed aminophylline 25mg PO BID.
He is on no other medications at this time. Prior to being started on aminophylline he may have been feeling a little ill which may have improved on this medication, but it has not changed the frequency of his episodes.
He has a good appetite and energy level, although he may not be cleaning himself as well.
He is an indoor/outdoor cat who lives on an acre with two dogs and one other cat.
He has had no C/V/D/Pu/Pd/Pp although he sneezes occasionally.
He eats a handful of Science Diet kibble BID and a can of Fancy Feast/day.
He is vaccinated annually at a vaccine clinic and is up to date.
He is often exposed to ticks, has not traveled, and was hit by a car 7 years ago, but suffered no ill effects.
The clients do not put pesticides or rodenticides out in their property, but he does have access to other people's property.
He has previously been tested for FIV/FeLV and feline heartworm, all of which were negative.
Physical Examination
Gen: BARH, T: 102.5°F
Integ: slightly unkempt hair coat; no masses palpated; shaved under tail base and over the right jugular vein.
Eyes: corneas clear; sclera white, pupils of equal size; no discharge
Ears: ceruminous discharge AS; clean AD
Nose: no discharge
Throat: resists oral exam, no masses visualized
MS: BCS 4-5/9, ambulates well
CV: 2-3/6 systolic murmur heard best over the mid-sternum (left apex); no gallop rhythm noted; mm pink; CRT 1-2 sec; HR 110 beats/minute
R: lungs auscult clear all fields; RR 40 (purring)
GI/GU: moderate sized bladder; kidneys smooth and of normal size; no masses or organomegaly palpated
NS: Mentation: BAR; Gait/Posture: normal; CrN: within normal limits; Postural reactions: wheelbarrow and hemiwalking normal; spinal reflexes: biceps, gastrocnemius, patellar, triceps, and withdrawal intact in all limbs; panniculus and perineal reflexes normal; spinal palpation normal
