Solution: "What's Your Diagnosis?"
(1) Electrocardiogram - Heart rate 165 bpm; irregularly irregular rhythm; atrial fibrillation
(2) Thoracic radiographs and echocardiogram:
- Thoracic radiographs - moderate amount of pleural effusion; marked generalized cardiomegaly; mild generalized interstitial pattern
- Echocardiogram - restrictive cardiomyopathy (RCM); MR/TR; CHF; pleural effusion; left atrial thrombus
(3) Emergency stabilization:
- Thoracocentesis
- O2 cage rest
- Furosemide 2 mg/kg IV TID
- Nitrol paste 1/8-in. QID
- Heparin (unfractionated) therapy 2,000 units IV, then 500 units QID SQ
Hospital management/to go home medication:
- Furosemide 10 mg PO BID
- Enalapril 1.25mg PO SID
- Diltiazem 7.5mg PO BID
- Digoxin 0.125mg PO Q 48 hrs
- Clopidogrel 18.75 mg PO SID
Long-term monitoring:
- Renal panel 1 week after initiation of treatment with furosemide/enalapril
- Serum digoxin level 7-10 days after initiating therapy (8-10 hours post dose)
- Thoracic radiographs every 2-4 months
- Echocardiogram, blood pressure, and ECG every 3-6 months
Pink Floyd was discharged three weeks ago and continues to do well.
Atrial fibrillation is a rare disease in cats most often occurring in older male cats with structural heart disease that is severe enough to lead to atrial enlargement. At diagnosis, most cats are in congestive heart failure; however, in one study, it was found as an incidental physical examination finding in 11/50 cats. Long-term survival is possible with medical management, in one study, 8 of 24 (33%) cats survived for one year after diagnosis.