Case 6 — Cyanosis

Nastasia, a seven-year-old female spayed domestic shorthair cat with a visible bluish tinge to the nose consistent with cyanosis
Nastasia — 7-year-old female spayed domestic shorthair, 4.4 kg. Note the faint cyanosis of the nose.

Primary clinician: Darcy Adin, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Signalment

  • Species: Feline
  • Breed: Domestic shorthair
  • Age: 7 years
  • Sex: Female spayed
  • Weight: 4.4 kg
  • Name: Nastasia

Presenting Complaint

  • Cyanosis

Pertinent History

  • First seen at the VMTH seven years ago; tentative diagnosis of ventricular septal defect with pulmonic stenosis or pulmonary hypertension. Color flow Doppler was not available at that time and a definitive diagnosis could not be made.
  • Nastasia presented today because the owner has moved and can no longer keep the cat and brought her here as a last resort.
  • Hit by a car at 1 year of age; owner believes she may have had broken facial bones. She completely recovered.
  • Indoor/outdoor cat; not on any medications.
  • Almost daily episodes of dyspnea lasting 3–5 minutes; episodes appear to be triggered by excessive attention from the owner and have not worsened over time.
  • No syncope. Occasional hairball-associated vomiting every 1–2 months.
  • Diet: kibble and canned “fishy” foods.
  • “Nervous” cat; not good with children or dogs. Very photogenic and has learned to pose for the camera.
  • Vaccines current.

Physical Examination

  • T = 102.4°F; P = 180; R = 48
  • BARH; clean skin with full hair coat
  • Eyes: incomplete PLR (nervous), anterior chambers clear, no scleral injection
  • Ears: clean
  • Mouth: mucous membranes pale pink; mild calculus on premolars and molars; no oral masses
  • Nose faintly cyanotic (see photo above); CRT 1 sec
  • BCS 5/9; symmetrical musculature
  • Grade 2/6 left-sided sternal systolic murmur (difficult to auscultate due to constant purring)
  • Tachypneic with slight abdominal effort; “cooing-like sound” audible; breath sounds auscultated bilaterally
  • Smooth gut loops; left kidney smooth; no abdominal masses or organomegaly; small bladder palpated

Problem List

  • Grade 2/6 left-sided systolic murmur with history of congenital heart disease
  • Generalized cyanosis

ECG

  • Occasional PVCs and a right-axis shift

Lab Work

  • PCV 49%
  • Total protein 8.2 g/dl
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