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Skylar - Echo Results - Now Severe UCM/RCM

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  • moonpye
    Hi Everyone, Skylar had a echo recheck with a new cardiologist. He now has UCM/RCM. He went from mild HCM with Hyperthyroidism to - severe RCM, heart
    Message 1 of 3 , Dec 3, 2008
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      Hi Everyone,

      Skylar had a echo recheck with a new cardiologist. He now has UCM/RCM. He
      went from mild HCM with Hyperthyroidism to - severe RCM, heart chambers
      severely enlarged, left atrium severely enlarged, severe everything and high
      risk for clots... Grade 3 murmur now.

      He had an EKG too - showed sinus rhythm and occasional supraventricular
      premature beats.

      His last echo had showed some improvement, so I was not expecting any of
      this at all.:(
      He says he feels fine and is happy, he was sitting on the windowsill getting
      a little sun that shined thru the clouds, me I keep crying and thinking of
      the song Angels on the moon...


      UCM/RCM, severe LAE/LAuE, LA "smoke", MR/MS, moderate RAE

      Echo showed severe unclassified (restrictive-like) cardiomyopathy, mitral
      insufficiency and stenosis (accounting for the new murmur) and "smoke" in
      the left atrium.

      Advanced structural heart disease is present and secondary to severe
      end-stage heart muscle disease. Severe heart chamber enlargement has
      occurred. High risk for spontaneous onset of congestive heart failure or
      clot formation. Monitor for labored breathing, sudden lameness, or fainting
      (syncope) and seek immediate veterinary attention if seen.

      Spontaneous echogenic contrast positive, but no formed intracardiac thrombi
      visualized today.

      I'm too sad to write anymore of the severe results so if there is something
      anyone needs to know just ask me.

      No evidence of SAM

      No pericardial or pleural effusion. The cardio wants to see Skylar back in
      3 months for
      chest xrays, I'm not sure if another echo too. He sent us home with a
      bottle of liquid Lasix(furosemide oral solution) 10mg/ml to have right away
      for emergencies. He said if his BPM's get to be 40 - 50 to give him 0.3cc's
      and call him. The liquid Lasix says 11.6% alcohol - is anyone using this?


      In addition to 6.25mg (1/4 tab) Atenolol and the Methimazole (for
      hyperthyroidism) he will start:

      Plavix 1/4 tab 1x a day and after 1 week call cardio to check how he is
      doing.

      If eating and drinking well on Plavix will add Enalapril 2.5mg (1/2 tab) 1x
      a day.

      I'm going to look into l carnitine again and increase his Coq10 and keep
      taurine the same.
      The cardio wants to add one thing at a time as Skylar has a very sensitive
      system and
      IBD issues.

      Any thoughts are much appreciated and thanks for reading this and being
      here!

      Hugs,
      Candace with Cinnamon and Skylar ^..^


      [Non-text portions of this message have been removed]
    • jintzr
      I m sorry to hear of Skylar s bad Echo... my thoughts are with you and him. That s nice that the vet gave you liquid lasix for emergencies. They never gave
      Message 2 of 3 , Dec 4, 2008
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        I'm sorry to hear of Skylar's bad Echo... my thoughts are with you
        and him. That's nice that the vet gave you liquid lasix for
        emergencies. They never gave me that with Ren and I wish they would
        have.

        It's also good he added the Enalapril and Plavix.

        My Mom's cat was just recently diagnosed with hyperthyroidism.
        Although the Methimazole doesn't cure it, it does help to control
        it. I think the only way it is "cured" is by having the radioactive
        iodine treatment, but that would probably not be something you would
        want to do with a heart patient.

        I hope you are doing OK today, and Skylar is soaking up some more
        sunshine through the window.

        Donna & Ivy and angel Ren

        --- In feline-heart@yahoogroups.com, moonpye <moonpye@...> wrote:
        >
        > Hi Everyone,
        >
        > Skylar had a echo recheck with a new cardiologist. He now has
        UCM/RCM. He
        > went from mild HCM with Hyperthyroidism to - severe RCM, heart
        chambers
        > severely enlarged, left atrium severely enlarged, severe everything
        and high
        > risk for clots... Grade 3 murmur now.
        >
        > He had an EKG too - showed sinus rhythm and occasional
        supraventricular
        > premature beats.
        >
        > His last echo had showed some improvement, so I was not expecting
        any of
        > this at all.:(
        > He says he feels fine and is happy, he was sitting on the
        windowsill getting
        > a little sun that shined thru the clouds, me I keep crying and
        thinking of
        > the song Angels on the moon...
        >
        >
        > UCM/RCM, severe LAE/LAuE, LA "smoke", MR/MS, moderate RAE
        >
        > Echo showed severe unclassified (restrictive-like) cardiomyopathy,
        mitral
        > insufficiency and stenosis (accounting for the new murmur)
        and "smoke" in
        > the left atrium.
        >
        > Advanced structural heart disease is present and secondary to severe
        > end-stage heart muscle disease. Severe heart chamber enlargement
        has
        > occurred. High risk for spontaneous onset of congestive heart
        failure or
        > clot formation. Monitor for labored breathing, sudden lameness, or
        fainting
        > (syncope) and seek immediate veterinary attention if seen.
        >
        > Spontaneous echogenic contrast positive, but no formed
        intracardiac thrombi
        > visualized today.
        >
        > I'm too sad to write anymore of the severe results so if there is
        something
        > anyone needs to know just ask me.
        >
        > No evidence of SAM
        >
        > No pericardial or pleural effusion. The cardio wants to see
        Skylar back in
        > 3 months for
        > chest xrays, I'm not sure if another echo too. He sent us home
        with a
        > bottle of liquid Lasix(furosemide oral solution) 10mg/ml to have
        right away
        > for emergencies. He said if his BPM's get to be 40 - 50 to give him
        0.3cc's
        > and call him. The liquid Lasix says 11.6% alcohol - is anyone
        using this?
        >
        >
        > In addition to 6.25mg (1/4 tab) Atenolol and the Methimazole (for
        > hyperthyroidism) he will start:
        >
        > Plavix 1/4 tab 1x a day and after 1 week call cardio to check how
        he is
        > doing.
        >
        > If eating and drinking well on Plavix will add Enalapril 2.5mg (1/2
        tab) 1x
        > a day.
        >
        > I'm going to look into l carnitine again and increase his Coq10 and
        keep
        > taurine the same.
        > The cardio wants to add one thing at a time as Skylar has a very
        sensitive
        > system and
        > IBD issues.
        >
        > Any thoughts are much appreciated and thanks for reading this and
        being
        > here!
        >
        > Hugs,
        > Candace with Cinnamon and Skylar ^..^
        >
        >
        > [Non-text portions of this message have been removed]
        >
      • nala nala
        Candace, ... UCM/RCM - Unclassified or restrictive cardiomyopathy. In some cases of HCM, the heart eventually becomes dilated but RCM is different. In
        Message 3 of 3 , Dec 5, 2008
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          Candace,

          > I am sorry that the report on Skylar is what it is. I know
          > how> frightening it is. I have been there with Cozette.
          > Although Skylar's> situation is different, I was
          > always hopeful that our visits to thecardiologist would
          > have an outcome of improvement or no change.

          > > Skylar had a echo recheck with a new cardiologist. He
          > now has UCM/RCM. > >

          UCM/RCM - Unclassified or restrictive cardiomyopathy. In some cases of HCM, the heart eventually becomes dilated but RCM is different. In
          restrictive cardiomyopathy, the heart chambers become stiff
          and are restricted in their movement. From an echo,
          sometimes RCM is the diagnosis when there are
          hyperechoic regions on the surface of the heart - these
          hyperechoic regions are sometimes interpreted as
          fibrosis (the muscle fibers of the heart are not
          arranged properly).

          Camille had a few small hyperechoic
          patches on her heart when I had hew examined by
          Cozette's cardiologist. She told me that
          Camille's heart was as normal as any kitty heart and if
          anything there was perhaps a tiny indication of RCM
          based on those patches. She also said that it could have
          had other causes (e.g. virus as a kitten) and not to worry
          about it.

          > He went from mild HCM with
          >Hyperthyroidism to - severe RCM, heart chambers>
          > severely enlarged, left atrium severely enlarged, severe
          > everything and high risk for clots... Grade 3
          > murmur now. He had an EKG too - showed
          > sinus rhythm and occasional supraventricular
          > premature beats.> >

          Cozette also had premature beats,
          but I don't know the source. After the echo and
          x-rays she was too stressed for an EKG. The x-rays always
          stressed her terribly (until we went to a different
          vet). I actually caught this myself with my stethoscope.
          It actually sounded like skipped beats to me. The
          cardiologist suggested that I need not worry about it unless
          there were strings of the premature beats - and this
          would likely lead to fainting and I had to get her to a
          vet ASAP.

          > > > His last echo had showed
          > some improvement, so I was not expecting any of> >
          > this at all.:(> >

          I am sorry for the shock and
          disappointment. . .

          >>He says he feels fine and
          > is happy, he was sitting on the windowsill getting> >
          > a little sun that shined thru the clouds, me I keep crying
          > and thinking of> > the song Angels on the moon...>
          > >

          I cried almost every time Cozettie saw the
          cardiologist. I cried in front of the cardiologist and
          off and on for the rest of the week. But then I thought -
          hey, Cozette seems the same to me, so I will try to be
          the same for her. I wanted to pet her more, but of
          course she wasn't going to have that . . . Eventually
          she slowed down, but I let her be her. I let Cozette be
          Cozette. If she wanted to play, I let her play, if she
          wanted to sleep, I let her sleep. . .

          > > > >
          > UCM/RCM, severe LAE/LAuE, MR/MS, moderate RAE, LA
          > "smoke"> >

          Unclassifiedcardiomyopathy/Restrictive cardiomyopathy.
          severe left atrial enlargement/ I don't know about the "u"
          perhaps upper??
          Mitral valve regurgitation/mitral valve
          stenosis
          moderate right atrial enlargement
          Left atrial smoke - indicates aggregates of red blood cells.
          This is information with regard to HUMANS.> J Am
          > Coll Cardiol, 2000; 35:1932-1938> Clinical and
          > echocardiographic characteristics > of left atrial
          > spontaneous echo contrast in sinus rhythm> > Saihari
          > Sadanandan, MDa and Mark V. Sherrid, MD, FACCa>
          > "Spontaneous echocardiographic contrast (SEC) or
          > "smoke" in the left atrium (LA) is a > pattern
          > of increased blood echogenicity caused by ultrasonic
          > backscatter from red blood > cell aggregates. These
          > aggregates form due to noncovalent binding between red cells
          > and > plasma proteins under low flow and low shear
          > conditions (1–3). Since this interaction is > largely
          > independent of platelet and coagulation cascade, it is
          > unaltered by the > administration of antiplatelet and
          > anticoagulant drugs (2,3). [Nala's note, I was not aware
          > > of this information: "unaltered by the
          > administration of antiplatelet and anticoagulant >
          > drugs" and want to look into it further] . Even though
          > stasis of blood in the LA is the most > significant
          > factor contributing to SEC, clinical studies have
          > demonstrated correlation with > hemorheological
          > abnormalities such as increased hematocrit and increased
          > fibrinogen > levels (3,4). Several studies have shown
          > that SEC is a frequent finding in patients with > atrial
          > fibrillation (AF), mitral stenosis and in patients with
          > prior thromboembolism, > occurring in about 30% to 60% of
          > such patients, depending on clinical circumstances (5–>
          > 15). The clinical importance of SEC in such patients is its
          > association with LA thrombus and > increased
          > thromboembolic complications."


          > > > > Echo
          > showed severe unclassified (restrictive-like)
          > cardiomyopathy, mitral> > insufficiency and stenosis
          > (accounting for the new murmur) and "smoke" in>
          > > the left atrium.> >

          Mitral insufficiency - the mitral valve is not doing its job of preventing blood flow from the left ventricle back up into the left atrium,

          Mitral stenosis - the opening where the mitral valve is smaller than normal.

          > Advanced structural heart disease is present and secondary
          > to severe> > end-stage heart muscle disease. Severe
          > heart chamber enlargement has> > occurred. > >
          >
          These are related. Advanced structural heart disease can be
          indicated by all four chambers of the heart being
          dilated/enlarged.

          > > > High risk for spontaneous
          > onset of congestive heart failure

          Based on the condition of the heart

          > > >or clot formation. >
          Based on the "smoke" and the enlarged left
          > atrium.

          > > Monitor for labored breathing,
          (as you already know - heart failure)

          > sudden lameness (clot as you know),

          or fainting (syncope) - (can be sign of
          > arrhythmia > and lack of oxygen to brain).

          Seek immediate
          > veterinary attention if seen.

          (same warnings > that the
          > cardiologist gave me for Cozetter).

          > Spontaneous echogenic contrast positive, but no formed
          > intracardiac thrombi> > visualized today.> >

          Cardiologist notes that he could not visualize an actual
          clot in the heart, but the smoke is a sign of red blood
          cell aggregation.

          > > > > I'm too sad to
          > write anymore of the severe results so if there is
          > something> > anyone needs to know just ask me.>
          > >

          I'm sorry. I know it is hard. I really, really do.

          > > > > No evidence of SAM
          - systolic anterior motion of the mitral valve.

          > > > No pericardial or pleural effusion.
          Good - no sign of heart failure now.

          > > The cardio wants to see Skylar back in>
          > > 3 months for> > chest xrays, I'm not sure if
          > another echo too. > >

          Chest x-rays seem reasonable to me. Of course if Skylar starts breathing like mentioned below, I am sure the cardiologist will want an
          x-ray.

          > > > He sent us home with a> > bottle
          > of liquid Lasix(furosemide oral solution) 10mg/ml to have
          > right away> > for emergencies. He said if his
          > BPM's get to be 40 - 50 to give him 0.3cc's> >
          > and call him. The liquid Lasix says 11.6% alcohol - is
          > anyone using this?> >

          I have no experience with the oral solution. It seems that some people from the> UK had these oral suspensions?? I always pilled Cozette. Based
          on my experience with Cozette, the dose seems small to me
          (3.33 mg) . When her respirations got that high we needed more lasix to bring them back down. However, it will probably help and will give you time to call the cardiologist and take Skylar to the vet.

          > > >
          > > > > In addition to 6.25mg (1/4 tab) Atenolol and
          > the Methimazole (for> > hyperthyroidism) he will
          > start:> > > > Plavix 1/4 tab 1x a day and after
          > 1 week call cardio to check how he is> > doing.>
          > > > > If eating and drinking well on Plavix will
          > add Enalapril 2.5mg (1/2 tab) 1x> > a day.> >


          Seems reasonable.
          Hugs and love to all. . .
          Nala
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