What is your diagnosis? Tetralogy of Fallot.
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Biomedical subjects
Publications and source records attributed to Etienne Côté.
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The well recognized cardiac effects of severe hyperkalemia include progressive rhythm and conduction disturbances such as bradycardia, spiked and narrow T waves, widening QRS complex, widening and flattening P wave, disappearance of the P wave, and cardiac arrest. Paradoxically, a heart rate greater than 200 beats/min may coexist with hyperkalemia in some cats. This report describes three cats with moderate to severe hyperkalemia and concurrent rapid heart rate. In each cat, the serum potassium (K(+)) concentration was > or =7.5 mEq/dl with a concurrent heart rate > 200 beats/min. In each cat, nine-lead electrocardiograms demonstrate an absence of P waves and a wide-complex tachycardia. Hyperkalemia should be considered in the differential diagnosis when a feline electrocardiogram demonstrates a wide-complex tachycardia without identifiable P waves.
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The asymmetric shape of the heart, small acoustic window, and range of interindividual variation in normal and abnormal states all can limit the extent of echocardiographic studies in small animal medicine. Beyond these uncontrollable variables, however, there are a number of additional potentially complicating factors that the echocardiogapher controls. Understanding and handling this second category of variables is critical for optimizing the quality and diagnostic value of echocardiographic studies. These variables range from such simple issues as proper restraint and an indissociable association between echocardiographic findings and clinical information, to specific points relating to simultaneous electrocardiogram display, good visualization of cardiac structures using multiple overlapping imaging planes, and avoidance of oblique or tangential views. The basic overview presented here aims to describe these commonly encountered, clinically relevant points in a way that helps veterinarians improve the quality of echocardiograms they perform.
OBJECTIVE: To assess the frequency of heart murmurs in overtly healthy cats. DESIGN: Prospective study. SAMPLE POPULATION: 103 healthy domestic cats. PROCEDURE: Background information and physical characteristics were assessed in cats that were candidates for blood donation during an 8-month period. For cats with heart murmurs, additional information collected included murmur timing, grade, point of maximal intensity, and presence of additional heart sounds. RESULTS: Heart murmurs were detected in 22 of the 103 (21%) cats. Echocardiography was performed in 7 of those 22 cats. The echocardiogram was considered normal in 1 cat; in the other 6 cats, diagnoses included hypertrophic cardiomyopathy (interventricular septal hypertrophic form [IVSH]; n = 4), left ventricular concentric hypertrophy with valvular disease (1), and equivocal IVSH (1). Thirteen cats had more than 1 examination during the study; 3 of them developed heart murmurs. There were no significant differences in age, sex, breed, coat color, eye color, or heart rate between cats with and without murmurs. Among the 103 cats, there were 6 pairs of siblings from 6 multiple-cat households and 16 cats from 7 multiple-cat households in which the cats were not related; the proportion of cats with murmurs was higher in the related cats (5/12) than in the unrelated cats (3/16), but the difference was not significant. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that heart murmurs are detectable in a large proportion of overtly healthy cats and that many murmurs appear to be caused by structural heart disease that is in a clinically latent state.
OBJECTIVE: To determine signalment, clinical signs, diagnostic findings, treatment, and outcome for cats with atrial fibrillation (AF). DESIGN: Retrospective study. ANIMALS: 50 cats. PROCEDURE: Medical records of cats that met criteria for a diagnosis of AF (ECG consisting of at least 2 leads, clear absence of P waves, supraventricular rhythm, and convincingly irregularly irregular rhythm) and had undergone echocardiography were reviewed. RESULTS: There were 41 males (37 castrated) and 9 females (7 spayed). Forty-one were of mixed breeding; 9 were purebred. Mean +/- SD age was 10.2 +/- 3.7 years. The most common chief complaints were dyspnea, aortic thromboembolism, and lethargy. In 11 cats, AF was an incidental finding. Mean +/- SD ventricular rate was 223 +/- 36 beats/min. The most common echocardiographic abnormalities were restrictive or unclassified cardiomyopathy (n = 19), concentric left ventricular hypertrophy (18), and dilated cardiomyopathy (6). Mean +/- SD left atrial-to-aortic diameter ratio (n = 39) was 2.55 +/- 0.80. The most common thoracic radiographic findings were cardiomegaly, pleural effusion, and pulmonary edema. Median survival time (n = 24) was 165 days (range, 0 to 1,095 days). Eight of 24 cats lived for > or = 1 year after a diagnosis of AF was made. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that AF occurs primarily in older adult male cats with structural heart disease severe enough to lead to atrial enlargement. Atrial fibrillation in these cats was most commonly first detected when signs of decompensated cardiac disease were evident, but also was commonly identified as an incidental finding.
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Because urinary bladder rupture can be life threatening, a simple, safe technique for evaluating patients is desirable. Current diagnostic protocols involve radiographic imaging, but ultrasound-based contrast techniques have not been methodically evaluated in veterinary patients with urologic trauma. Ultrasound contrast cystography (contrast cystosonography) involves infusion of microbubbled saline solution through a urinary catheter. It was performed in an in vitro model and in 2 dogs with naturally occurring urinary bladder rupture. A positive result consisted of visualizing microbubbles sonographically in fluid surrounding the bladder immediately after infusion of contrast into the urinary catheter. A positive result was obtained both in the in vitro model and in the 2 dogs, with radiographic and surgical confirmation of naturally occurring intraperitoneal urinary bladder rupture in the dogs. Based on the results of this study, ultrasound contrast cystography appears to be more sensitive than two-dimensional (2D) abdominal sonography for detecting naturally occurring urinary bladder rupture in dogs.
An 11-month-old, female Scottish terrier was presented with a history of a heart murmur. The electrocardiogram showed signs of left ventricular enlargement, and radiography confirmed generalized cardiomegaly. Echocardiography revealed four equally sized aortic valve cusps. A ventricular septal defect, with systolic left-to-right shunting, and aortic regurgitation into both ventricles were also present. The dog was free of clinical signs 1 year after diagnosis.