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(A) ve (B) Two examples of auscultation and recording with a digital stethoscope; cats were held in a standing or sitting position on an examination table. Cats were held in a standing or sitting position on an examination table.
(C) Phonocardiographic trace and ECG obtained by DS in a cat with normal auscultation and no heart disease on echocardiography.
(D) Phonocardiographic trace and ECG obtained by DS in a cat with a systolic murmur.
(E) Phonocardiographic trace and ECG obtained by DS in a cat with a gallop sound.
How should auscultation be performed in cats?
To correctly assess heart murmurs in cats parasternal auscultation, use of correct equipment ve deneyim In cases where a murmur is detected, it is essential to examine the patient's general health status and heart functions in more detail.
Heart murmurs in cats are more difficult to assess accurately than in dogs. This is because cats have different chest anatomy and murmurs are often softer and less audible. Heart murmurs in cats are usually on the side of the sternum (parasternal) is heard more clearly.
Tips for Evaluating Heart Murmurs in Cats
1. Listening Position:
Murmurs are heard around the sternum in cats, i.e. parasternal This makes it easier to assess the valve region where the murmur originates.
2. Pediatric Stethoscope Use:
When performing auscultation in cats a pediatric stethoscope with a small head area is necessary to hear heart sounds and murmurs more clearly. A standard stethoscope can make it difficult to listen in the right places in the small rib cage area.
3. Experience Requirement:
It takes a great deal of experience and sensitivity to determine with certainty which valve the murmur is originating from. In cats, attributing a murmur to a valve is possible with knowledge of the anatomical locations and proper placement of the stethoscope.
What are the most common types of murmurs detected during auscultation in cats?
Congenital heart diseases in cats (e.g. VOD or PDA), especially two acquired systolic heart murmurs These two conditions account for approximately 98% of heart murmurs in cats:
1. SAM (Systolic Anterior Motion)
2. DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
SAM (Systolic Anterior Motion)
• Term: It is a condition where the anterior leaflet of the mitral valve takes an incorrect position during the outflow of blood from the left ventricle, partially obstructing the left ventricular outflow tract (LVOT).
• Mechanism: Associated with hypertrophic cardiomyopathy (HCM) and usually caused by thickening of the left ventricular wall. SAM can cause mitral regurgitation (backflow of blood through the mitral valve) and produces a systolic murmur with turbulent blood flow.
DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
• Term: It is a dynamic narrowing of the right ventricular outflow tract (RVOT).
• Mechanism: It is usually associated with stress, increased heart rate, or hypertrophy of the right ventricle. This creates turbulence in the passage of blood from the right ventricle to the pulmonary artery, producing a systolic murmur.
Localization Problem and Diagnostic Need
Unfortunately, SAM and DR VOTO murmurs cannot be clearly distinguished in terms of localizationBoth conditions are usually heard in similar areas and a definitive diagnosis cannot be made by auscultation alone.
Because, Cardiac ultrasonography (echocardiography) in all cats with a heart murmur Echocardiography is critical to determining the source of the murmur, diagnosing underlying diseases such as HCM, and creating a treatment plan.
Conclusion
• SAM ve DR VOTO, accounts for the majority (98%) of systolic heart murmurs in cats.
• These murmurs cannot be accurately distinguished by auscultation alone.
• In cats with any heart murmur detected, echocardiography is necessary for diagnosis and treatment.
• Since these conditions are usually a symptom of serious cardiac pathologies, early diagnosis and follow-up are important.
What is Systolic Anterior Motion (SAM) in Cats?
SAM (Systolic Anterior Motion) occurs when the septal mitral valve leaflet moves towards the left ventricular outflow tract (LVOT) during systole. This is particularly hypertrophic cardiomyopathy (HCM) It is seen in the context of and results from abnormal thickening of the left ventricular musculature.
Mechanism
1. Positional Change in Papillary Muscles and Mitral Valve
• Thickening of the left ventricular muscle, a change in the position of the papillary muscles leads to
• Mitral valve leaflets, Chordae Tendinae It is connected to the papillary muscles via the papillary muscles. As the papillary muscles change position, the mitral valve leaflets also change position.
2. Movement of Mitral Valve Leaflets into the Left Ventricular Outflow Tract
• Mitral valve leaflets during systole to the left ventricular outflow tract (LVOT) In particular, the septal (anterior) mitral leaflet partially obstructs the left ventricular outflow tract.
3. Dynamic Subaortic Stenosis and Mitral Insufficiency
• This position change occurs during systole. a dynamic subaortic stenosis creates.
• At the same time, blood leakage occurs from the mitral valve to the left atrium, which mitral regurgitation (defined as mitral insufficiency).
Clinical Findings and Dynamic Murmur
• SAM is generally at high heart rates (tachycardia) becomes evident.
• When the heart rate is slowed (for example, by sedatives), the dynamic murmur may disappear or decrease in intensity.
• Murmur usually in the left parasternal region is heard at its best.
Clinical Significance
• SAM, hypertrophic cardiomyopathy (HCM) It is closely associated with and is a common finding in cats with HCM.
• This situation is both left ventricular outflow tract obstruction as well as mitral insufficiency If left untreated, it can lead to progressive cardiovascular complications.
• The intensity of the heart murmur may vary depending on the heart rate. Therefore, echocardiography is necessary to evaluate dynamic changes in cats with suspected SAM.
SAM, is a significant cardiac condition that is associated with HCM and affects the left ventricular outflow tract. In cases of SAM detected in cats, it is essential to establish an accurate diagnosis and treatment plan. cardiac ultrasonography (echocardiography) should be performed. The murmur may become apparent at high heart rates and disappear at low rates, so it is important to observe dynamic changes. Treatment is aimed at management of the underlying HCM and relief of symptoms.
DR VOTO, what is dynamic right ventricular outflow tract obstruction?
DR VOTOis a cardiac condition resulting from dynamic narrowing of the right ventricular outflow tract. This condition usually benign It is considered a murmur and is usually only at high heart rates (tachycardia) audible.
Mechanism
1. Excessive Movement of the Right Ventricular Free Wall
• DR VOTO occurs as a result of abnormally excessive movement of the right ventricular free wall.
• This excessive movement causes compression of the right ventricular outflow tract and a temporary narrowing (dynamic stenosis).
2. Turbulent Blood Flow
• Blood flowing from the right ventricle to the pulmonary artery creates turbulence in the narrowed outflow tract, which a systolic murmur is heard as.
Clinical Significance
• A Benign Murmur:DR VOTO, in most cases unrelated to cardiac disease It is a benign murmur.
• Relationship with HCM: In rare cases hypertrophic cardiomyopathy (HCM) It may be associated with cardiac diseases such as. However, this association is generally rare.
• Relationship with Systemic Diseases:DR VOTO, in some cases anemia or may be seen with other systemic diseases. Therefore, it is important to evaluate an underlying systemic condition.
Dynamic Murmur and Diagnosis
• High Heart Rate Significance:DR VOTO murmurs usually become evident at high heart rates and may disappear when the heart rate returns to normal.
• Echocardiography: To confirm right ventricular outflow tract narrowing and excessive free wall motion echocardiography It should be used.
DR VOTO, is usually a benign condition and does not cause any clinically significant problems in most cats. However, hypertrophic cardiomyopathy, anemia It is important to evaluate the underlying causes in cats with a murmur, as it may rarely be associated with other systemic diseases. As a dynamic murmur, the intensity of DR VOTO may vary depending on the heart rate and may require detailed evaluation with echocardiography.
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“What is not in the senses cannot be in the mind.”
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