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Re: echo recheck results

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  • nala_zq
    Susan, That is wonderful news regarding Pye -especially given that the disease has been stablized to the point that the cardiologist doesn t even want to see
    Message 1 of 3 , Dec 4, 2007
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      Susan,

      That is wonderful news regarding Pye -especially
      given that the disease has been stablized to the point
      that the cardiologist doesn't even want to see her
      again for a YEAR!

      I am not an expert in understanding everything
      the cardiologist wrote, but I will give you my take on
      it.

      > "Compared with the findings of the prior study, there has been no
      > significant change in the degree of LV hypertrophy or any other
      > cardiac size measurements. There is no LV outflow turbulence or
      > obstruction now on the Atenolol. There is still mitral valve
      > thickening and a mild mitral insufficiency."

      HCM is characterized by the thickening of the left ventricle
      of the heart. Often this occurs along the septum that
      separates the left ventricle from the right ventricle. It
      can also occur at the apex of the ventricle. So what this
      report says is that for the region of Pye's heart that is
      abnormally thickened, it is no thicker now that it was
      before.

      Sometimes, the thickening on the heart wall will cause
      a disturbance in blood flow - it partially obstructs the
      normal flow of blood resulting in Hypertrophic obstructive
      cardiomyopathy. My understanding is that systolic anterior
      motion of the mitral valve (SAM) will also interfere with the
      normal flow of blood through the heart, but it is not
      clear to me that this was an issue for Pye. The standard
      treatment for HOCM is atenolol. Atenolol, for some cats,
      can improve the dynamics of blood flow in the heart. So it
      sounds like for Pye, interference with blood flow, due to
      the obstruction is negligible or non-existent.
      >
      > What concerns me is that in the first report, she wrote "mild
      > thickening of the anterior mitral valve leaflet" and this time she
      > wrote "moderate thickening." That seems obviously worse to me but if I
      > am understanding correctly the first sentence, she is saying no
      > measurements in the heart have changed?

      It is my understanding that heart measurements are those of
      the walls of the heart and the size of the atria. The information
      regarding the mitral valve is not strictly a heart parameter, and
      yes, I would wonder about the continued thickening of the
      mitral valve as well.

      >
      > She also wrote in the prognosis section "stable disease since 05/07
      > with control of outflow obstruction." So here again this sounds as
      > though the mitral valve did not get any thicker?

      I think she is just saying that even though the valve is thicker,
      it is not interfering with blood flow in the heart.
      >
      > I plan to call my regular vet when he comes in to see if he can
      > explain, but I thought I'd post here first to see if anyone is better
      > at figuring out a cardiologist's lingo than I am. I don't know which
      > of the values on the echo report pertain to the mitral valve either,
      > so I can't tell anything from that.

      They don't usually include the measurements of the mitral valve
      in the report, just as they don't usually include the measurements
      of the papillary muscles.
      >
      > I *think* it was all good news and I am very pleased--just wonder why
      > she wrote "moderate" this time instead of "mild" if nothing changed.

      My understanding is that if the leaflets of the valve are seated
      properly and there is no leakage (regurgitation) or over-tightness
      (stenosis), then the thickness of the mitral valve doesn't really matter
      from a clinical perspective. However, that doesn't mean that
      other problems cannot develop over time.

      I hope this helps.
    • dshale1
      Nala, thanks so much for your message. This helps me understand the report better. I am still waiting for a call back from my vet to hear his explanation. I
      Message 2 of 3 , Dec 5, 2007
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        Nala, thanks so much for your message. This helps me understand the
        report better. I am still waiting for a call back from my vet to hear
        his explanation. I have made some comments/clarifications below.


        --- In feline-heart@yahoogroups.com, "nala_zq" <nala_zq@...> wrote:
        >
        > Susan,
        >
        > That is wonderful news regarding Pye -especially
        > given that the disease has been stablized to the point
        > that the cardiologist doesn't even want to see her
        > again for a YEAR!

        I had been told that if the atenolol halted progression of the
        disease, the echoes would only need to be done once a year. I'm not
        sure I'm comfortable with that, but I assume this means she thinks
        there's no progression.
        >
        > I am not an expert in understanding everything
        > the cardiologist wrote, but I will give you my take on
        > it.
        >
        > > "Compared with the findings of the prior study, there has been no
        > > significant change in the degree of LV hypertrophy or any other
        > > cardiac size measurements. There is no LV outflow turbulence or
        > > obstruction now on the Atenolol. There is still mitral valve
        > > thickening and a mild mitral insufficiency."
        >
        > HCM is characterized by the thickening of the left ventricle
        > of the heart. Often this occurs along the septum that
        > separates the left ventricle from the right ventricle. It
        > can also occur at the apex of the ventricle. So what this
        > report says is that for the region of Pye's heart that is
        > abnormally thickened, it is no thicker now that it was
        > before.

        I should explain that also in the report, the cardiologist wrote "Left
        ventricle: LV size, wall thickness and systolic function are normal,
        with a normal FS%, except for a mild focal hypertrophy (.61-.62 cm) of
        the basal IVS with a small bulge into the LVOT. No SAM or LVOT
        obstruction."

        I was told originally that the HCM is very mild so what she is saying,
        then, is that this little part that is thickened has not gotten any
        worse, correct?
        >
        > Sometimes, the thickening on the heart wall will cause
        > a disturbance in blood flow - it partially obstructs the
        > normal flow of blood resulting in Hypertrophic obstructive
        > cardiomyopathy. My understanding is that systolic anterior
        > motion of the mitral valve (SAM) will also interfere with the
        > normal flow of blood through the heart, but it is not
        > clear to me that this was an issue for Pye.

        Yes, she had mild SAM with mild LV outflow tract obstruction (<50 mm
        Hg). This is gone now with atenolol.


        The standard
        > treatment for HOCM is atenolol. Atenolol, for some cats,
        > can improve the dynamics of blood flow in the heart. So it
        > sounds like for Pye, interference with blood flow, due to
        > the obstruction is negligible or non-existent.

        Yes, her heart murmur is gone and the SAM and obstruction is gone. I
        am happy about all this--just not sure I should worry about the mitral
        valve.
        > >
        > > What concerns me is that in the first report, she wrote "mild
        > > thickening of the anterior mitral valve leaflet" and this time she
        > > wrote "moderate thickening." That seems obviously worse to me but if I
        > > am understanding correctly the first sentence, she is saying no
        > > measurements in the heart have changed?
        >
        > It is my understanding that heart measurements are those of
        > the walls of the heart and the size of the atria. The information
        > regarding the mitral valve is not strictly a heart parameter, and
        > yes, I would wonder about the continued thickening of the
        > mitral valve as well.


        That's what I'm waiting to ask my vet if he can explain. I don't know
        whether by "there is still mitral valve thickening" she means it is
        still there, or that it has gotten worse. They did tell me that it's
        possible the mitral valve problem could get worse, but of course, it
        might not either.
        >
        > >
        > > She also wrote in the prognosis section "stable disease since 05/07
        > > with control of outflow obstruction." So here again this sounds as
        > > though the mitral valve did not get any thicker?
        >
        > I think she is just saying that even though the valve is thicker,
        > it is not interfering with blood flow in the heart.
        > >
        > > I plan to call my regular vet when he comes in to see if he can
        > > explain, but I thought I'd post here first to see if anyone is better
        > > at figuring out a cardiologist's lingo than I am. I don't know which
        > > of the values on the echo report pertain to the mitral valve either,
        > > so I can't tell anything from that.
        >
        > They don't usually include the measurements of the mitral valve
        > in the report, just as they don't usually include the measurements
        > of the papillary muscles.

        Oh, I didn't know this. So is the mitral valve insufficiency a
        separate condition from the HCM?
        > >
        > > I *think* it was all good news and I am very pleased--just wonder why
        > > she wrote "moderate" this time instead of "mild" if nothing changed.
        >
        > My understanding is that if the leaflets of the valve are seated
        > properly and there is no leakage (regurgitation) or over-tightness
        > (stenosis), then the thickness of the mitral valve doesn't really matter
        > from a clinical perspective. However, that doesn't mean that
        > other problems cannot develop over time.
        >
        > I hope this helps.

        There is leakage--in the first report she wrote "mild mitral
        regurgitation is present, predominately a posteriorly directed jet."
        She also said the atenolol would decrease "LVOT obstruction and
        secondary mitral regurgitation."

        In this report, she also wrote "mild mitral regurgitation is present,
        predominately a centrally directed jet."

        So the degree of mitral regurgitation didn't get any worse, it seems
        although I don't know what it means that the direction changed.

        She wrote to continue on the atenolol which will decrease the LVOT
        obstruction and secondary mitral regurgitation. Apparently the
        atenolol is not controlling the mitral regurgitation?

        If the mitral valve thickening is not due to HCM, can anything be done
        about it? We already give Pye taurine and CoQ10 supplements and I am
        going to add carnithine. I know that in human beings, mild mitral
        regurgitation is often benign but I don't know what it means in cats.

        I'm getting worried again. While I was writing this my vet called and
        he said he will call the cardiologist to discuss the mitral valve
        issue because it is separate from the HCM. He said in dogs, mitral
        valve thickening is caused by infection but he doesn't know what is
        causing the mitral valve thickening in this case.

        Thanks again for your explanation. I'm not glad to have something else
        to worry about but I am glad that I noticed this on the report and
        questioned it. I hope the cardiologist will have something positive to
        report but I'm guessing if there were treatment for the valve problem,
        she would have said so.
        -Susan
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