Page 264 - Feline Cardiology

Chapter 19: Congestive Heart Failure 271

cyanosis and should be quickly triaged for emergency
care. Muffled lung and heart sounds are commonly
present with significant pleural effusion, and often
patients have shallow, rapid respirations. Palpation of a
noncompliant cranioventral thorax may raise the suspi-
cion of a cranial mediastinal mass as the cause of pleural
effusion. Adventitious lung sounds may be present in
cats with pulmonary edema and may overshadow detec-
tion of a murmur.
Abnormal cardiac auscultation including a murmur,
gallop heart sound, or arrhythmia is variably present.
Only 20% of cats dying of heart failure in one study
had an abnormal cardiac auscultation (Liu et al. 1970).
Factors involved with such a low occurrence of abnor-
mal cardiac auscultation may include muffled heart
sounds from pleural effusion, adventitious lung sounds
masking a murmur, or at the time of that publication
in the 1960s the high prevalence of dilated cardiomy-
opathy, which less commonly causes a murmur. A sys-
tolic murmur may be more commonly present in cats
with HCM (64–72%) than in cats with restrictive car- A Congestive Heart Failure
diomyopathy (36%) or dilated cardiomyopathy (9%)
(Rush et al. 2002; Ferasin et al. 2003). Likewise, the
murmur intensity is typically loudest in cats with
hypertrophic obstructive cardiomyopathy compared to
other cardiac diseases. A gallop heart sound (i.e., extra
S 3 or S 4 heart sound) is more common in cats with
DCM (45%) compared to HCM (12–33%) and RCM
(23%) (see Chapter 1) (Rush et al. 2002; Ferasin et al.
2003). Tachycardia is commonly present and is a result
of sympathetic activation (i.e., sinus tachycardia) or a
tachyarrhythmia (i.e., supraventricular tachycardia,
ventricular tachycardia, or atrial fibrillation).
Lethargy, weakness, collapse, or poor femoral arterial
pulse quality may be present in cats with low output
heart failure, which is more common in cats with DCM
than other cardiac diseases. Slow capillary refill time and
pale mucous membranes occur when there is low cardiac
output and peripheral hypoperfusion. Absence of B
femoral arterial pulses, cold extremeties, and cyanotic
nail beds may be present in cats with arterial thrombo- Figure 19.8. Physical examination abnormalities seen in a cat
embolism. Cats may have poor body condition and with right heart failure. This Sphynx suffers from right-sided con-
cachexia, especially if they have suffered from chronic gestive heart failure secondary to severe tricuspid regurgitation
congestive heart failure. One study confirmed this obser- and tricuspid valve dysplasia. Examination of the jugular veins
vation and found that cats with congestive heart failure reveals severe jugular venous distension and pulsation (A), and
there is obvious abdominal distension and a ballotable fluid wave
had significantly lower body condition score (4 ± 1) indicative of ascites (B).
compared to cats with compensated heart disease
(6 ± 1), and cats with congenital heart disease had lower
body condition score than cats with acquired heart distension is often overlooked in the physical examina-
disease (Torin et al. 2007). tion, but it is a key tool for evaluation of elevated right
Clinical abnormalities seen with right heart failure atrial pressure. Unlike large animals and people, cats do
include jugular venous distension, ascites, hepatomeg- not develop peripheral subcutaneous edema with right
aly, and pleural effusion (Figure 19.8). Jugular venous heart failure.