Page 162 - Problem-Based Feline Medicine

154 PART 3 CAT WITH SIGNS OF HEART DISEASE

Heterogeneous densities of the “cardiac” silhouette Surgical correction should be reserved for
due to varied contents of the pericardial cavity. cases with symptoms attributed to this condition.
● Post-operative care may be complicated in some
Abdominal radiographs may show an absent or smaller
cases. Consult with an experienced surgeon.
than normal liver.
Electrocardiographic findings Prognosis
Some patients have a normal ECG. Asymptomatic patients have a good prognosis in general.
The expected QRS complexes in a cat with a severely Surgically corrected patients have an excellent prognosis.
enlarged heart diagnosed by radiography are not pres-
ent in patients with peritoneopericardial diaphrag- DIAPHRAGMATIC HERNIA
matic hernia.
The mean electrical axis may be shifted (depending on Classical signs
the abnormal deviation of the heart by the viscera).
● Dyspnea/tachypnea.
Echocardiographic findings
See main reference page 57 (The Dyspneic or
The cardiac exam is commonly normal.
Tachypneic Cat).
In cases where primary cardiac disease is present, it is
difficult to obtain a true evaluation of the heart due to Clinical signs
compression by nearby organs.
Trauma associated with a motor vehicle accident or a
Abnormal blood flow patterns may be caused fall from several stories is the most common cause,
by compression forces of the viscera against the heart. although it can occasionally occur as a congenital
problem.
The liver and other organs can be visualized in direct
contact with the heart. Tachypnea and dyspnea are often evident, and may
begin at the time of trauma or a few hours later. In some
Cardiac catheterization findings
cats, the respiratory signs improve after a few days and
are most evident only after physical activity.
Non-selective angiography demonstrates that the peri-
cardial sac is filled with other organs. Typically there is a vague history of gastrointestinal
signs including vomiting, inappetance and weight loss,
Differential diagnosis usually beginning some time after a motor vehicle acci-
dent or fall.
Pericardial effusion is usually associated with clinical
signs of cardiac or infectious disease. Radiographically Physical examination may be normal. Often the heart
the cardiac silhouette lacks heterogeneous densities. sounds are muffled on one or both sides of the chest.
There may be an impression of an “empty” abdomen
Dilated cardiomyopathy is usually associated with
on abdominal palpation because of organ displacement.
signs indicative of heart disease. Radiographically the
heart never develops the degree of enlargement seen Diagnosis
with PPDH.
In a diaphragmatic hernia the heart, size is normal Radiographic findings
and displaced. There is loss of distinct diaphragmatic Abdominal viscera are identified within the thorax.
borders. A history of trauma is common. Stomach and small intestine can be easily identified as
gas-filled or fluid-filled structures.
Treatment
Displacement of abdominal and thoracic structures is
If the patient is asymptomatic and the diagnosis is inci- found due to shifting of the organs through the
dental, then surgery is not necessary. diaphragmatic surface.