Hypertrophic phenotypic cardiomyopathy in an ocelot (Leopardus pardalis)

Background: Hypertrophic cardiomyopathy phenotype (HCM) is the most common cardiac disease in domestic cats but is rarely described in wild species. This phenotype is characterized by concentric hypertrophy of the left ventricle and may be of familial inheritance or secondary to other diseases such as hyperthyroidism, chronic kidney disease, systemic arterial hypertension, and hyperaldosteronism. HCM can cause diastolic and systolic dysfunction and may cause congestive heart failure in affected animals. The present work aims to describe the first report of cardiomyopathy of the hypertrophic phenotype in a specimen of Leopardus pardalis, kept under human care. Case: A 11-year-old female ocelot (Leopardus pardalis) kept under human care, during a preventive care visit, had hypertrophic cardiomyopathy phenotype detected by cardiological evaluation with echocardiogram and a murmur grade III/ VI could be detected on cardiac auscultation. This preventive care occurred under chemical restraint with ketamine [6 mg/kg, i.m] associates with midazolam [0.5 mg/kg, i.m] and other evaluations have been done like complete blood count (CBC), biochemistry (alanine aminotransferase, aspartate aminotransferase, total proteins, albumin, albumin:globulin ratio, creatinine, urea, sodium, potassium, calcium, phosphorus, and globulin) and tyroid hormones [free tyroxine (T4) and thyroid-stimulating hormone (TSH)]. Medical management based on clopidogrel, and atenolol was administered for 3 months until the patient showed manifestations of congestive heart failure (CHF) 80 days later the initial evaluation. In this moment the patient presented with dyspnea, so a cardiological and laboratory evaluation was requested. On pulmonary auscultation crackling was identified, suggesting pulmonary edema and, on echocardiographic examination, some parameters had worsened. The CBC and biochemistry were all within reference ranges. Then, the beta-blocker was discontinued and replaced by pimobendan combined with furosemide as treatment of CHF, and the condition stabilized. After one year, the patient was re-evaluated and showed a slight improvement in the condition but still remained stable. Also, feline proBNP levels was tested (SNAP Feline proBNP® IDEXX) in this moment and it was increased. Discussion: The findings on echocardiography associated with the subjective evaluation associated with progressive worsening and clinical manifestation of CHF, as well as the response to treatment, even though there are no reference values for the species, reinforce the diagnosis. There is no evidence to suggest diseases that may contribute to secondary left ventricular hypertrophy. It is believed that pimobendan plays a key role in maintaining hemodynamic balance, since this has already been observed in other mammalian species. The use of beta blockers is commonly employed in domestic cats with HCM, and they have been prescribed in an attempt to promote greater ventricular relaxation, decrease left ventricular outflow obstruction, thus improving ventricular filling for maintenance of cardiac output. In view of the atrial enlargement and possible risk of thrombus formation, clopidogrel was prescribed, extrapolating what is known from domestic cats. It is reasonable to conclude that in this case, the cardiomyopathy behaved similarly to what is observed in domestic cats, both in its clinical evolution and in the means of diagnosis, and in its response to the therapy instituted.

Felinos portadores de cardiomiopatia fenótipo hipertrófica - eixo elétrico da onda P / Cats with hypertrophic phenotype cardiomyopathy - P-wave electrical axis

Background: Hypertrophic phenotype cardiomyopathy is the most common heart disease in cats. Although the echocardiogram is the gold standard test for diagnosing fHCM, patients with the disease may have electrocardiographic changes. Despite being reported in most 12-lead electrocardiograms, the P wave axis generally receives little attention when compared to other wave parameters. We performed a Doppler echocardiographic and electrocardiographic study in cats, in order to verify the presence of correlation between the electrical axis average P wave and the presence of fCMH, aiming to investigate the possibility of its aid in the early diagnosis of cardiac disorders. Materials, Methods & Results: One hundred cats of different breeds, ages, males and females were evaluated. Those animals with a history of previous disease other than hypertrophic cardiomyopathy were excluded from the study. The groups were formed after obtaining the results of the echocardiographic examination. Eight of the 100 cats did not allow echocardiographic evaluation, and the remaining 92 were divided into 2 groups (control group, n = 64 and heart disease group, n = 28) after the examination. Of these 92 animals, 28 cats had the hypertrophic cardiomyopathy phenotype. The electrocardiographic examination was performed after the allocation of animals into groups lasting 5 min with the recording of tracings for later interpretation. To calculate the axis of the P wave, leads D1 and D3 were used, measuring the amplitude of the P wave in these leads and calculating the resulting amplitude. All cats studied had mean electrical axis of the P wave within the normal range for the species (0º to 90º). Based on mean electrical axis P wave values, there was no significant difference between groups. The control group had a median of 63.7° with a maximum value of 80°, a minimum value of 60° and a mean of 65.1°. The fCMH group had a median of 68.7° with a maximum value of 85.3°, a minimum value of 56.3° and a mean of 68.8°. Of the fCMH group, 3 cats had increased P wave duration (50.33 ± 5.77 ms), suggesting left atrial overload, and 13 cats had increased QRS complex duration (66.30 ± 11.23 ms). Also, 18 cats (Control group: 11; fCMH group: 7) showed T wave amplitude greater than 25% of R, suggesting the presence of myocardial hypoxia and/or electrolyte disturbance. One cat had a prolonged PR interval (from the fCMH group). As for the QT interval, 6 cats had an interval < 120 (2 from the control group and 4 from the affected group) and 3 had an interval > 180 (1 from the control group and 2 from the affected group). The ST segment remained isoelectric in all segments. As for the mean electrical axis of the QRS complex, 5 cats (10.42%) had axis deviation to the right (control: 1; fCMH: 4) suggesting right ventricular overload; 7 cats (14.58%) had left axis deviation (control: 5; fCMH: 2), suggestive of left ventricular overload; and 36 cats (75%) had a normal mean electrical axis. Discussion: Based on the results obtained in the present study, it can be concluded that screening studies in asymptomatic felines should be increasingly implemented in the veterinary clinical routine, since the frequency found was high (30.44%) and that patients may remain asymptomatic for years until the development of signs. It should be concluded that there was no correlation between the mean electric axis of P-wave and the presence of subclinical phenotype hypertrophic cardiomyopathy. Therefore, more studies are needed, with felines at different stages of the disease, to evaluate whether this electrocardiographic measurement allows us to assist in its diagnosis, since it is a feasible measure in cats. Furthermore, it is concluded that the electrocardiogram should be used as an aid method in the diagnosis of the disease and not as a screening test.

Doxorubicin nephrotoxicity in cats (Felis catus) with malignant mammary neoplasms / Nefrotoxicidade da doxorrubicina em gatas (Felis catus) com neoplasias mamárias malignas

The aim of the study was to investigate the nephrotoxicity of doxorubicin in cats with malignant neoplasms of the mammary gland. All selected cats did not present comorbidities such as nephropathies and/or cardiomyopathies, confirmed by physical and laboratory tests, underwent radical mastectomy associated with regional lymph node excision and were treated with a protocol based on doxorubicin. Renal markers of urea, creatinine, symmetrical dimethylarginine were evaluated during all the treatment, and two months after the end. Abdominal ultrasound, urinalysis and biochemical analysis of protein, urinary creatinine and urinary GGT were performed in the beginning and two months after the end of the treatment, to evaluate possible renal alterations. Six cats did not present renal alterations in any exams performed during the study. Two cats presented azotemia during this study, and one of them stopped the treatment early, because of the intense azotemia. Clinical imaging and laboratory monitoring of patients throughout the treatment is essential, including the measurement of analytes that detect kidney changes early. Thus, it is emphasized that doxorubicin is a safe drug for use in non-nephropathic cats.

O objetivo do estudo foi investigar a nefrotoxicidade da doxorrubicina em gatas com neoplasias malignas da glândula mamária. Todas as gatas selecionadas não apresentaram comorbidades como nefropatias e/ou cardiomiopatias, comprovadas por exames físicos e laboratoriais, foram submetidas à mastectomia radical associada à exérese de linfonodos regionais e tratadas com protocolo baseado em doxorrubicina. Os marcadores renais ureia, creatinina, dimetilarginina simétrica foram avaliados durante todo o tratamento e dois meses após o término. Ultrassonografia abdominal, urinálise e análise bioquímica de proteínas, creatinina urinária e GGT urinária foram realizadas no início e dois meses após o término do tratamento, para avaliar possíveis alterações renais. Seis gatas não apresentaram alterações renais em nenhum dos exames realizados durante o estudo. Duas gatas apresentaram azotemia durante este estudo, e uma delas interrompeu o tratamento precocemente, devido à intensa azotemia. A individualidade de cada paciente deve ser sempre considerada, pois são muitas as variáveis. O monitoramento clínico, com exames complementares, tais como bioquímicos séricos e de imagem dos pacientes durante todo o tratamento, é essencial, especialmente a mensuração de analitos que detectam alterações renais precocemente. Diante disso, ressalta-se que a doxorrubicina é um medicamento seguro para utilização em gatas não nefropatas.

Ionóforos e intoxicação em equinos / Ionophores and poisoning in horses

Ionóforos são substâncias que foram inicialmente utilizadas como coccidiostáticos na produção de frangos de corte e, posteriormente, passaram a ser adicionados como aditivos na dieta de ruminantes. A intoxicação por ionóforos pode ocorrer em diversas espécies animais, no entanto, a espécie equina é especialmente sensível. O quadro clínico e anatomopatológico relacionado à intoxicação em equinos é caracterizado por sinais clínicos decorrentes de cardiomiopatia e miopatia da musculatura esquelética devido a necrose causada nestes tecidos. Não existe tratamento específico para os quadros de intoxicação por ionóforos, sendo assim, a prevenção deve ser preconizada de modo a evitar exposição dos equinos a alimentos que contenham ionóforos, especialmente nas criações em que bovinos e equinos compartilham do mesmo ambiente de criação. O objetivo deste artigo é abordar os principais aspectos relacionados aos ionóforos, bem como a intoxicação por estas substâncias em equinos.(AU)

Ionophores are substances that were initially used as coccidiostats in the production of broilers and later were added as additives in the diet of ruminants. Ionophores poisoning can occur in several animal species, however, horses are especially sensitive. The clinical and anatomopathological features related to poisoning in horses are characterized by clinical signs resulting from cardiomyopathy and myopathy of the skeletal musculature due to necrosis caused in these tissues. There is no specific treatment for ionophores poisoning conditions, therefore, prevention must be advocated in order to avoid exposure of horses to feed containing ionophores, especially in breeding where cattle and horses share the same rearing environment. The aim of this article is to address the main aspects related to ionophores, as well as poisoning by these substances in horses.(AU)

Risk of arrhythmias in dogs with structural heart disease / Potencial arrítmico de cardiopatias em cães

Presently, pet life expectancy is becoming longer and several diseases inherent to age have been diagnosed, with heart disease being a frequent finding. Although various heart diseases have different pathophysiologies, many morphological and hemodynamic changes can predispose patients to arrhythmias. The presence of arrhythmias can worsen the underlying heart disease and predispose patients to develop new alterations, making arrhythmia detection important for establishing adequate therapeutic protocols and a better prognosis. The present study aimed to determine the arrhythmias most frequently found in dogs treated at the Cardiology and Respiratory Diseases Service (SCDR) of the Small Animals Sector of the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (UFRRJ), during the period from January to 2014 to December 2017, relating them to sex, age group, size, and the presence or absence of heart disease. A total of 586 medical records of dogs treated with SCDR-UFRRJ were retrospectively evaluated. Of these, 15.4% had arrhythmias, 95.6% had diagnoses of heart disease, 61.1% (55/90) were diagnosed with mitral valve disease, and 27.8% (25/90) had dilated cardiomyopathies. The most frequent rhythm disturbances were premature ventricular complexes associated with chronic degenerative mitral valve disease or dilated cardiomyopathy. Statistical analysis confirmed the risk of a cardiac patient developing rhythm or conduction alterations (OR, 4.46; p = 0.0003). In conclusion, the pathophysiology of heart failure can lead to the development of rhythm and conduction disorders.

Com a maior expectativa de vida dos animais de estimação, diversas enfermidades inerentes a idade têm sido diagnosticadas, sendo as cardiopatias um achado frequente. Apesar das diferentes cardiopatias terem fisiopatologias distintas, diversas alterações morfológicas e hemodinâmicas podem ocorrer predispondo ao aparecimento de arritmias. A presença de arritmias pode agravar a doença cardíaca de base e predispor ao desenvolvimento de novas alterações, tornando-se importante a sua detecção para instituição de protocolos terapêuticos adequados e melhor prognóstico da doença. O presente estudo teve como objetivo determinar as arritmias mais frequentemente encontradas em cães atendidos no Serviço de Cardiologia e Doenças Respiratórias (SCDR) do Setor de Pequenos Animais do Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro (UFRRJ), no período de janeiro de 2014 a dezembro de 2017, relacionando-as com sexo, faixa etária, porte e presença ou não de cardiopatias. De maneira retrospectiva, foram avaliados 586 prontuários de cães atendidos no SCDR-UFRRJ. Destes, 15.4% apresentavam alguma arritmia e 95,6% apresentavam diagnostico de alguma cardiopatia, sendo 61.1% (55/90) diagnosticados com endocardiose de mitral e 27.8% (25/90) com cardiomiopatia dilatada. O distúrbio de ritmo mais frequente foram os complexos ventriculares prematuros associados a doença valvar degenerativa crônica de mitral ou a cardiomiopatia dilatada. Na análise estatística, o risco de um paciente cardiopata desenvolver alterações de ritmo ou de condução foi confirmado (OR: 4,46; p=0,0003). Conclui-se que a fisiopatologia da insuficiência cardíaca pode levar ao desenvolvimento de distúrbios de ritmo e também distúrbios de condução.

Feline aortic thromboembolism diagnosed by thermography

Background: In cats, arterial thromboembolism is one of the most devastating diseases, with an acute presentation, andis often caused by undiagnosed cardiomyopathy. Defined as the obstruction of one or more arterial lumens by emboli,the arterial thromboembolism is responsible for hypoperfusion signs. As the temperature of the skin surface is directlyrelated to tissue perfusion, thermography can be promising for the early diagnosis of thromboembolism. Therefore, thisstudy reports the importance of thermography as a complementary examination for the diagnosis of thromboembolism inthe abdominal aorta of a domestic cat.Case: A 4-year-old mixed-breed cat weighing 2.95 kg was presented with a history of sudden onset paraplegia, apathy,and pain when handled, with greater intensity in the sacro-coccidian region. During physical exam, it was noted that thefemoral artery pulse was undetectable bilaterally during manual pulse measurement. Superficial and deep sensitivity inthe pelvic limbs and proprioception were also absent and the plantar cushions and nail beds of the posterior limbs werepale to cyanotic. Thermographic images revealed that the temperature of both hind limbs was lower than that of forelimbs,with difference of 3.2ºC and 2.9ºC between the left and right limbs, respectively. Doppler ultrasonography revealed theabsence of pulse and flow in the femoral arteries bilaterally. Electrocardiography revealed sinus tachycardia, with a heartrate of 250 bpm. Echocardiography revealed dilation of the left atrium and concentric cardiac hypertrophy. After 24 h, dueto the worsening of the clinical condition and unfavorable prognosis, the animal was euthanized and sent for necropsy.Necropsy revealed that the arterial lumen of the caudal abdominal aorta and bifurcation of the iliac arteries were obliterated...

Feline aortic thromboembolism diagnosed by thermography

Background: In cats, arterial thromboembolism is one of the most devastating diseases, with an acute presentation, andis often caused by undiagnosed cardiomyopathy. Defined as the obstruction of one or more arterial lumens by emboli,the arterial thromboembolism is responsible for hypoperfusion signs. As the temperature of the skin surface is directlyrelated to tissue perfusion, thermography can be promising for the early diagnosis of thromboembolism. Therefore, thisstudy reports the importance of thermography as a complementary examination for the diagnosis of thromboembolism inthe abdominal aorta of a domestic cat.Case: A 4-year-old mixed-breed cat weighing 2.95 kg was presented with a history of sudden onset paraplegia, apathy,and pain when handled, with greater intensity in the sacro-coccidian region. During physical exam, it was noted that thefemoral artery pulse was undetectable bilaterally during manual pulse measurement. Superficial and deep sensitivity inthe pelvic limbs and proprioception were also absent and the plantar cushions and nail beds of the posterior limbs werepale to cyanotic. Thermographic images revealed that the temperature of both hind limbs was lower than that of forelimbs,with difference of 3.2ºC and 2.9ºC between the left and right limbs, respectively. Doppler ultrasonography revealed theabsence of pulse and flow in the femoral arteries bilaterally. Electrocardiography revealed sinus tachycardia, with a heartrate of 250 bpm. Echocardiography revealed dilation of the left atrium and concentric cardiac hypertrophy. After 24 h, dueto the worsening of the clinical condition and unfavorable prognosis, the animal was euthanized and sent for necropsy.Necropsy revealed that the arterial lumen of the caudal abdominal aorta and bifurcation of the iliac arteries were obliterated...(AU)

Anasarca associated with restrictive cardiomyopathy in cats

Background: Cardiomyopathies are a primary heart disorder and are one of the most causes of heart failure and sudden death in cats. Restrictive cardiomyopathy is a diastolic dysfunction resulting from endomyocardial fibrosis, with filling restriction and ventricular distention. In these cases, a poor outcome is expected. Anasarca in animals is often associated with dystocia secondary to congenital changes. In adults, this is a rare condition, since subcutaneous edema in animals with congestive heart failure is an uncommon finding. Therefore, this report describes clinical and pathological findings in an unusual presentation of anasarca in two adult cats with restrictive cardiomyopathy. Cases: A 12-year-old female mixed breed cat (case 1) and a 6-year-old male mixed-breed cat (case 2) were present on an emergent basis at the veterinary hospital with a history of respiratory distress. Case 1 showed on physical examination intense restrictive mixed dyspnea and lethargy, with muffled heart sounds and respiratory noises in cardiorespiratory auscultation. The cat exhibited abdominal distension resulting from ascites. Generalized subcutaneous edema was evident mainly in the abdominal and submandibular areas and the thoracic and pelvic limbs. In these regions, a positive Godet signal was observed. Thoracic radiography revealed pleural effusion, and the cat underwent fluid drainage on both sides of the thoracic cavity. Drainage material was sent to the laboratory for clinical analysis, which indicated that it was a modified transudate. The clinical signs worsened, and the cat was euthanized. In case 2, physical examination showed severe restrictive mixed dyspnea, lethargy, and low body temperature (< 32°C). Abdominal distension resulting from ascites and generalized edema in the subcutaneous tissue with a positive Godet sign was observed. On cardiorespiratory auscultation, cardiac sounds and breathing noises were muffled. Thoracic radiography revealed pleural effusion. The cat was immediately placed in an incubator for clinical stabilization with oxygen therapy and warm-up. After 2 h of hospitalization, thoracentesis and drainage of cavity fluids were performed, which were classified as modified transudate. The patient remained in critical condition during hospitalization, evolving to death. The two cats were referred for a complete post mortem examination. Grossly, both cats showed distension of the abdomen and marked edema of subcutaneous tissue, mainly in the abdominal, ventral cervical, and thoracic and pelvic members. In the abdominal and thoracic cavities, a moderate amount of serous-free liquid, slightly reddish was observed. The heart of both cats was enlarged, with a globose appearance and a slightly whitish epicardium. The left ventricular endocardium was mild and diffusely thick and whitish, in addition to moderate dilation of the left atrium. Histological analyses of the heart showed in both cats moderate and diffuse proliferation of fibrous connective tissue in the endocardial region. Discussion: Restrictive cardiomyopathy has major importance in feline medicine due to its severity and poor outcome. Pleural effusion, pulmonary edema, and ascites are common findings in cats with congestive heart failure; however, generalized subcutaneous edema is uncommon. To the author's knowledge, there are no published cases in the literature of anasarca in adult cats with restrictive cardiomyopathy. In human cardiology, this presentation is commonly related to congestive heart failure, and it is reported under several conditions, such as restrictive cardiomyopathy and constrictive pericarditis. The present study suggests that anasarca should be included in the list of associated clinical signs suggestive of severe congestive heart failure, mainly related to restrictive cardiomyopathy.

Bilateral auricular aneurysm with intact pericardial sac in a dog

A nine-year-old, male, Pekingese dog was presented with a history of dyspnea, lethargy, syncope, polyuria, polydipsia, and selective appetite over two years. When the clinical signs first began, a radiographic exam revealed a radiopaque mass in the cranial mediastinum. An adequate treatment was not performed and the dog was presented to the hospital with severe tachycardia, dyspnea, and tachypnea, and died during physical examination. On necropsy, the heart presented bilateral auricular aneurysms. The pericardial sac was intact, and no other defects were found within the heart. Microscopically, the cardiomyocytes were marked degenerated and proliferation of connective tissue. This is the first case report of a bilateral auricular aneurysm with intact pericardial sac in a dog.~ien

Bilateral auricular aneurysm with intact pericardial sac in a dog

A nine-year-old, male, Pekingese dog was presented with a history of dyspnea, lethargy, syncope, polyuria, polydipsia, and selective appetite over two years. When the clinical signs first began, a radiographic exam revealed a radiopaque mass in the cranial mediastinum. An adequate treatment was not performed and the dog was presented to the hospital with severe tachycardia, dyspnea, and tachypnea, and died during physical examination. On necropsy, the heart presented bilateral auricular aneurysms. The pericardial sac was intact, and no other defects were found within the heart. Microscopically, the cardiomyocytes were marked degenerated and proliferation of connective tissue. This is the first case report of a bilateral auricular aneurysm with intact pericardial sac in a dog.(AU)~ien

Clinical approach for treating dilated cardiomyopathy in a hog-nosed skunk (Conepatus chinga)

Background: Dilated cardiomyopathy (DCM) is a multifactorial disease characterized by systolic dysfunction of myocardium, affecting domestic animals like dogs, cats, and ferrets. It was sporadically described in non-domestic species, generally as a necropsy observation. The hog-nosed skunk (Conepatus chinga) is a small mammal, carnivore, belonging to the Mephitidae family, found in southern South America, and considered as concerned in a conservation status of the species. The goal of this issue is report the first clinical approach of dilated cardiomyopathy in a young hog-nosed skunk, elucidating the challenging aspects of the diagnostic, therapy, and clinical outcome. Case: A newborn hog-nosed skunk (Conepatus chinga) was found in a farm of southern Brazil in poor nutritional and behavioral conditions. Thirty days of nutritional supplementation based on cow's milk, fruits and insects were necessary to recover its body weight score and activity level. However, 2 months after adoption, the skunk showed acute dyspnea and abnormal breath sound, decreased appetite, and loss of weight. Firstly, these signs were associated with a possible pulmonary infection or other respiratory disease. However, the general cardiomegaly and pulmonary edema pattern observed on the thoracic radiography, changed the clinical approach, conducting the presumptive diagnosis to congestive heart failure (pulmonary edema) caused by an unknown cardiac disease as a dilated cardiomyopathy (CDM). An adequate physical, echocardiographic, electrocardiographic, and hematological evaluation was possible only after chemical restraint by sevofluorane. Systolic heart murmur and pulmonary cracking sounds were detected on thoracic auscultation. These findings associated to the echocardiography features of four chamber dilatation, systolic (fractional shortening-FS = 9% and ejection fraction-EF= 22%) and diastolic (mitral E/A ratio = 4.93) dysfunctions, and bilateral ventriculoatrial regurgitation (mitral and tricuspid) were highly correlated with DCM. Considering the etiologies of CDM described in domestic species and the poor nutritional condition previously observed in the case, nutritional and idiopathic etiologies of DCM were considered for this case. Therapy was based on furosemide at hospital (4 mg/kg subcutaneous, single doses) and home (2 mg/kg orally, BID), enalapril maleate (0.5 mg/kg orally, every 48 h), taurine supplementation (100 mg orally, SID), and pimobendan (0.5 mg/kg orally, BID). Clinical improvement was already observed on the second day of treatment, and monitored for 5 months, when the skunk was completely revaluated. The second echocardiographic exam showed improvement in systolic (FS = 20% and EF = 43%) and diastolic functions (mitral E/A ratio = 2.05), tricuspid regurgitation was not observed, and decrease the left atrial and ventricular dimensions were seen. Due to good clinical outcome, furosemide was gradually reduced until complete withdrawal without any clinical complications or worsening. After 30 months of therapy of pimobendan, taurine, and enalapril maleate, the skunk has good quality captive life without congestive heart failure recurrence. Discussion: The lack of information about DCM in hog-nosed skunk turns the clinical diagnosis and therapy challenging. However, the radiographic and echocardiographic features seamed to lead the same domestic animal patterns. The therapy based on decrease the cardiac overload, increase the myocardial inotropic function (pimobendan and taurine) resulted on excellent clinical and echocardiographic outcome. Although the etiologies of DCM in this species are not stablished, the diagnostic and therapeutic approaches applied resulted on excellent clinical results, and therefore may provide useful information about this cardiac condition in skunk species.

Pimobendan em gatos / Pimobendan in cats

As miocardiopatias são as cardiopatias mais comumente diagnosticadas em felinos domésticos. A cardiomiopatia hipertrófica (CMH) soma a maioria dos casos de cardiomiopatias em pacientes atendidos na rotina da medicina interna de felinos. Gatos com doenças cardíacas podem não apresentar manifestações clínicas evidentes podendo apresentar sinais sutis de insuficiência cardíaca (IC) ao longo do tempo de modo que em um dado momento descompensam e evidenciam sinais clínicos. O pimobendan é um fármaco denominado inodilatador devido a sua capacidade de promover inotropismo positivo e vasodilatação. Apesar de escassos, os estudos existentes com a utilização de pimobendan demonstram boa tolerância em gatos saudáveis e com cardiopatias diversas. Atualmente, o uso do pimobendan em gatos é extra bula e a dose baseia-se em estudos realizados com cães. No entanto, sabe-se que as concentrações plasmáticas diferem entre as espécies o que pode requerer possíveis ajustes. A terapia da IC em gatos é bastante discutida e evidências recentes demonstram que o pimobendan pode ser um aliado no tratamento de diversas doenças cardíacas que levem à disfunção sistólica sendo capaz de prover melhora dos sinais clínicos e até aumento da expectativa de vida desses pacientes. Contudo, pesquisas são necessárias para melhor entendimento dos efeitos hemodinâmicos do medicamento em gatos com disfunção diastólica.

Myocardiopathies are the most diagnosed heart disease in domestic cats. Hypertrophic cardiomyopathy (HCM) adds up to most cases of cardiomyopathies in patients seen in the routine of feline internal medicine. Cats with heart disease may not have evident clinical manifestations and may show subtle signs of heart failure (HF) over time so that at a given moment they decompensate and show clinical symptoms. Pimobendan is an inodilator drug due to its ability to promote positive inotropism and vasodilation. Although scarce, the existing studies with the use of pimobendan demonstrate good tolerance in healthy cats with various heart diseases. Currently, the use of pimobendan in cats is off-label and the dose is based on studies conducted in dogs. However, it is known that plasma concentrations differ between species, which may require possible adjustments. The therapy of HF in cats is widely discussed and recent evidence shows that pimobendan can be an ally in the treatment of various heart diseases that lead to systolic dysfunction, being able to provide improvement in clinical signs and even increase the life expectancy of these patients. However, research is necessary to better understand the hemodynamic effects of the drug in cats with diastolic dysfunction.

Epidemiological and pathological aspects of cardiomyopathies in cats in Southern Brazil / Aspectos epidemiológicos e patológicos das cardiomiopatias em gatos no Sul do Brasil

Cardiomyopathies are considered one of the most important causes of heart failure in cats and are subdivided into three main morphological types: hypertrophic (HCM), dilated (DCM), and restrictive (RCM). This study aimed to determine the frequency and types of cardiomyopathies in cats diagnosed in southern Brazil, with an emphasis on their epidemiological and pathological aspects. Necropsy reports filed in a veterinary pathology laboratory were reviewed, and cats diagnosed with cardiomyopathy were selected for the study. Animal identification data, history and clinical signs, and gross lesions, were reviewed and compiled. During the study period, 1.594 cat necropsies were performed, of which 72 (4.5%) comprised a diagnosis of cardiomyopathy. HCM was the most frequent followed by CMR and CMD, representing 77.8%, 12.5% and 9.7%, respectively. Age ranged from three months to 18 years, with a median age of seven years. In relation to sex, 62.5% were males and 37.5% females. In 76.4% of the cases, it affected cats without a breed defined. Restrictive mixed dyspnea and hydrothorax were the main signs or findings of the clinical examination. Sudden death and acute paresis of the pelvic limbs due to aortic thromboembolism have also been described. In HCM, myocardial thickening was observed, with a reduction in the ventricular chamber. Hypertrophy, disarray, and fibrosis of the myofibers were the main histological findings. In RCM, whitish and thickened endocardium was seen in most cases. DCM was characterized by dilated cardiac chambers, and microscopic examination revealed no significant findings. The main extra cardiac lesions revealed pulmonary edema and congestion, hydrothorax and chronic passive congestion of the liver. Cardiomyopathies are important causes of death in cats and should be included in the differential diagnosis of patients with cardio respiratory clinical signs and in cases related to sudden death and acute paresis of the pelvic limbs.(AU)

As cardiomiopatias são consideradas umas das mais importantes causas de insuficiência cardíaca em gatos e são subdivididas morfologicamente em três principais tipos: cardiomiopatia hipertrófica (CMH), dilatada (CMD) e restritiva (CMR). Este trabalho teve como objetivo determinar a frequência e os tipos de cardiomiopatias em gatos diagnosticados no Sul do Brasil, abordando seus aspectos epidemiológicos e patológicos. Foram revisados os laudos de necropsias de gatos e selecionados para o estudo de diagnóstico de cardiomiopatia. Os dados referentes à identificação do animal, o histórico/sinais clínicos e lesões macroscópicas foram revisados e compilados. No período estudado, foram realizadas 1.594 necropsias de gatos, destas, 72 (4,5%) compreenderam diagnóstico de cardiomiopatia. A CMH foi a mais frequente seguida pela CMR e CMD, representando 77,8%, 12,5% e 9,7%, respectivamente. A idade variou de três meses a 18 anos, com a idade mediana de sete anos. Em relação ao sexo, 62,5% eram machos e 37,5% fêmeas. Em 76,4% dos casos, afetou gatos sem raça definida. Dispneia mista restritiva e hidrotórax foram os principais sinais ou achados do exame clínico. Morte súbita e paresia aguda de membros pélvicos em razão do tromboembolismo aórtico também foram descritos. Na CMH, observou-se espessamento do miocárdio, com redução da câmara ventricular. Hipertrofia, desarranjo e fibrose das miofibras foram os principais achados histológicos. Na CMR, visualizou-se endocárdio esbranquiçado e espessado na maioria dos casos. A CMD caracterizou-se pela dilatação das câmaras cardíacas, e sem lesão histológica significante. As principais lesões extracardíacas encontradas foram edema e congestão pulmonares, hidrotórax e congestão passiva crônica do fígado. As cardiomiopatias são causas importantes de morte em gatos, devem ser incluídas no diagnóstico diferencial de pacientes com sinais clínicos cardiorrespiratórios e também em casos relacionados a morte súbita e paresia aguda dos membros pélvicos.(AU)

Epidemiological and pathological aspects of cardiomyopathies in cats in Southern Brazil / Aspectos epidemiológicos e patológicos das cardiomiopatias em gatos no Sul do Brasil

Cardiomyopathies are considered one of the most important causes of heart failure in cats and are subdivided into three main morphological types: hypertrophic (HCM), dilated (DCM), and restrictive (RCM). This study aimed to determine the frequency and types of cardiomyopathies in cats diagnosed in southern Brazil, with an emphasis on their epidemiological and pathological aspects. Necropsy reports filed in a veterinary pathology laboratory were reviewed, and cats diagnosed with cardiomyopathy were selected for the study. Animal identification data, history and clinical signs, and gross lesions, were reviewed and compiled. During the study period, 1.594 cat necropsies were performed, of which 72 (4.5%) comprised a diagnosis of cardiomyopathy. HCM was the most frequent followed by CMR and CMD, representing 77.8%, 12.5% and 9.7%, respectively. Age ranged from three months to 18 years, with a median age of seven years. In relation to sex, 62.5% were males and 37.5% females. In 76.4% of the cases, it affected cats without a breed defined. Restrictive mixed dyspnea and hydrothorax were the main signs or findings of the clinical examination. Sudden death and acute paresis of the pelvic limbs due to aortic thromboembolism have also been described. In HCM, myocardial thickening was observed, with a reduction in the ventricular chamber. Hypertrophy, disarray, and fibrosis of the myofibers were the main histological findings. In RCM, whitish and thickened endocardium was seen in most cases. DCM was characterized by dilated cardiac chambers, and microscopic examination revealed no significant findings. The main extra cardiac lesions revealed pulmonary edema and congestion, hydrothorax and chronic passive congestion of the liver. Cardiomyopathies are important causes of death in cats and should be included in the differential diagnosis of patients with cardio respiratory clinical signs and in cases related to sudden death and acute paresis of the pelvic limbs.(AU)

As cardiomiopatias são consideradas umas das mais importantes causas de insuficiência cardíaca em gatos e são subdivididas morfologicamente em três principais tipos: cardiomiopatia hipertrófica (CMH), dilatada (CMD) e restritiva (CMR). Este trabalho teve como objetivo determinar a frequência e os tipos de cardiomiopatias em gatos diagnosticados no Sul do Brasil, abordando seus aspectos epidemiológicos e patológicos. Foram revisados os laudos de necropsias de gatos e selecionados para o estudo de diagnóstico de cardiomiopatia. Os dados referentes à identificação do animal, o histórico/sinais clínicos e lesões macroscópicas foram revisados e compilados. No período estudado, foram realizadas 1.594 necropsias de gatos, destas, 72 (4,5%) compreenderam diagnóstico de cardiomiopatia. A CMH foi a mais frequente seguida pela CMR e CMD, representando 77,8%, 12,5% e 9,7%, respectivamente. A idade variou de três meses a 18 anos, com a idade mediana de sete anos. Em relação ao sexo, 62,5% eram machos e 37,5% fêmeas. Em 76,4% dos casos, afetou gatos sem raça definida. Dispneia mista restritiva e hidrotórax foram os principais sinais ou achados do exame clínico. Morte súbita e paresia aguda de membros pélvicos em razão do tromboembolismo aórtico também foram descritos. Na CMH, observou-se espessamento do miocárdio, com redução da câmara ventricular. Hipertrofia, desarranjo e fibrose das miofibras foram os principais achados histológicos. Na CMR, visualizou-se endocárdio esbranquiçado e espessado na maioria dos casos. A CMD caracterizou-se pela dilatação das câmaras cardíacas, e sem lesão histológica significante. As principais lesões extracardíacas encontradas foram edema e congestão pulmonares, hidrotórax e congestão passiva crônica do fígado. As cardiomiopatias são causas importantes de morte em gatos, devem ser incluídas no diagnóstico diferencial de pacientes com sinais clínicos cardiorrespiratórios e também em casos relacionados a morte súbita e paresia aguda dos membros pélvicos.(AU)

Sobrevida e características ecocardiográficas de gatos com e sem cardiomiopatias / Survival and echocardiographic characteristics of cats with and without cardiomyopathies

Cardiopatias felinas apresentam importante relevância na rotina veterinária, todavia os seus aspectos epidemiológicos em gatos não são conhecidos regionalmente. O objetivo do estudo foi descrever a frequência das cardiopatias na região Norte e Vale do Itajaí no estado de Santa Catarina e determinar a sobrevida de pacientes cardiopatas e não cardiopatas. O estudo contou com a análise retrospectiva de 74 laudos ecocardiográficos e prontuários médicos de gatos oriundos de estabelecimentos veterinários da região, de janeiro de 2017 a dezembro de 2019. Tutores ou veterinários responsáveis foram contatados para averiguar a sobrevida dos animais. Os animais do estudo em sua maioria eram machos (n=40/74) e sem raça definida (n=47/74). Cardiomiopatia foi o diagnóstico mais comum (n=21/74), com destaque para o fenótipo hipertrófica (n=13/21). As cardiomiopatias foram diagnosticadas mais comumente em gatos acima de oito anos de idade. Os principais sinais clínicos nos gatos sintomáticos (n=41/74) foram sopro (n=15/41) e dispneia (n=6/41). Os principais achados ecocardiográficos foram hipertrofia concêntrica da parede livre do ventrículo esquerdo (n=18/41) e dilatação do átrio esquerdo (n=12/41). A mediana de sobrevida dos 74 gatos foi de 303±209.8 dias, estando altamente relacionado com a classe do estadiamento clínico (P=0,006). Gatos com fenótipo dilatada tiveram menor média de sobrevid

Feline cardiopathies are relevant on veterinary practice although lack of regional epidemiogical description. The purpose of this study is to determine cardiopathy prevalence and survival of cardiac and non-cardiac patients on Santa Catarinas northern and Itajai valley regions. The retrospective study included 74 echocardiographic exams and medical records from January 2017 to December 2019. Veterinarians and owners were contacted to check survival on cardiac and non-cardiac patients. The animals were most male (n=40/74) and mongrel (n=47/74). Cardiomyopathies were the most common diagnosis (n=21/74), specially the hypertrophic phenotype (n=13/21). The cardiomyopathy diagnosis was evidenced in cats above eight years old. The most usual clinical findings on symptomatic patients (n=41/74) were cardiac murmur (n=15/41) and dyspnea (n=6/41). Left ventricular free wall concentric hypertrophy (n=18/41) and left atrium dilation (n=12/41) were the main echocardiographic findings. Median survival from 74 cats was 303±209,8 days and related to clinical staging (p=0,006). Cats with dilated cardiomyopathy phenotype presented lower mean survival (180,5 days). Concomitant diseases included chronic renal disease (n=7/15), systemic arterial hypertension (n=5/15) and/or hyperthyroidism (n=3/15). In conclusion, cats with cardiomyopathies, symptomatic and with more advanced stages of cardiac remodeling, have shown to live less than those in early stage of heart disease. As well as patients with associated concomitant diseases, they had a lower life expectancy.(AU)

Sobrevida e características ecocardiográficas de gatos com e sem cardiomiopatias / Survival and echocardiographic characteristics of cats with and without cardiomyopathies

Cardiopatias felinas apresentam importante relevância na rotina veterinária, todavia os seus aspectos epidemiológicos em gatos não são conhecidos regionalmente. O objetivo do estudo foi descrever a frequência das cardiopatias na região Norte e Vale do Itajaí no estado de Santa Catarina e determinar a sobrevida de pacientes cardiopatas e não cardiopatas. O estudo contou com a análise retrospectiva de 74 laudos ecocardiográficos e prontuários médicos de gatos oriundos de estabelecimentos veterinários da região, de janeiro de 2017 a dezembro de 2019. Tutores ou veterinários responsáveis foram contatados para averiguar a sobrevida dos animais. Os animais do estudo em sua maioria eram machos (n=40/74) e sem raça definida (n=47/74). Cardiomiopatia foi o diagnóstico mais comum (n=21/74), com destaque para o fenótipo hipertrófica (n=13/21). As cardiomiopatias foram diagnosticadas mais comumente em gatos acima de oito anos de idade. Os principais sinais clínicos nos gatos sintomáticos (n=41/74) foram sopro (n=15/41) e dispneia (n=6/41). Os principais achados ecocardiográficos foram hipertrofia concêntrica da parede livre do ventrículo esquerdo (n=18/41) e dilatação do átrio esquerdo (n=12/41). A mediana de sobrevida dos 74 gatos foi de 303±209.8 dias, estando altamente relacionado com a classe do estadiamento clínico (P=0,006). Gatos com fenótipo dilatada tiveram menor média de sobrevid

Feline cardiopathies are relevant on veterinary practice although lack of regional epidemiogical description. The purpose of this study is to determine cardiopathy prevalence and survival of cardiac and non-cardiac patients on Santa Catarina’s northern and Itajai valley regions. The retrospective study included 74 echocardiographic exams and medical records from January 2017 to December 2019. Veterinarians and owners were contacted to check survival on cardiac and non-cardiac patients. The animals were most male (n=40/74) and mongrel (n=47/74). Cardiomyopathies were the most common diagnosis (n=21/74), specially the hypertrophic phenotype (n=13/21). The cardiomyopathy diagnosis was evidenced in cats above eight years old. The most usual clinical findings on symptomatic patients (n=41/74) were cardiac murmur (n=15/41) and dyspnea (n=6/41). Left ventricular free wall concentric hypertrophy (n=18/41) and left atrium dilation (n=12/41) were the main echocardiographic findings. Median survival from 74 cats was 303±209,8 days and related to clinical staging (p=0,006). Cats with dilated cardiomyopathy phenotype presented lower mean survival (180,5 days). Concomitant diseases included chronic renal disease (n=7/15), systemic arterial hypertension (n=5/15) and/or hyperthyroidism (n=3/15). In conclusion, cats with cardiomyopathies, symptomatic and with more advanced stages of cardiac remodeling, have shown to live less than those in early stage of heart disease. As well as patients with associated concomitant diseases, they had a lower life expectancy.

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.(AU)

Disfunção miocárdica secundária a sepse em cão: relato de caso / Myocardial dysfunction secondary to sepsis in dog: case report

A redução do empenho do miocárdio é um achado frequente em casos de sepse ou choque séptico, sendo a piometra uma das principais causas de sepse em cães. No presente trabalho relata-se um caso de sepse secundária à piometra levando à disfunção miocárdica em um canino, fêmea, da raça White West Highland Terrier, de dez anos de idade com histórico de prostração e hiporexia. Ao exame físico foi observada presença de secreção vulvar purulenta, abdômen abaulado e tenso à palpação. Foram realizados exames complementares, incluindo hemograma com resultado compatível com quadro infeccioso, bioquímica revelando hipocalemia e hipocalcemia, e exames de imagem. Observou-se por meio do exame ultrassonográfico presença de grande quantidade de líquido com celularidade em cornos e corpo uterino, compatível com piometra. Alterações compatíveis com sepse foram observadas durante o atendimento e estabilização do animal. No exame ecocardiográfico foi observado aumento dos diâmetros sistólico e diastólico do ventrículo esquerdo com diminuição da fração de encurtamento e ejeção, compatível com disfunção sistólica do ventrículo esquerdo. A referida paciente recebeu alta médica após correção cirúrgica e estabilização dos parâmetros clínicos, incluindo a disfunção sistólica, sendo relatado óbito sete dias após. Sugere-se que a causa mortis tenha sido a disfunção sistólica causada pela sepse. Conclui-se

The reduction of myocardial commitment is a frequent finding in cases of sepsis or septic shock, and piometra is one of the main causes of sepsis in dogs. In the present study, the case of sepsis secondary to piometra is reported leading to myocardial dysfunction in a canine, female, of the 10-year-old White West Highland Terrier with a history of prostration and hyporexia. On physical examination, the presence of purulent vulvar secretion, bulging abdomen and taut palpation was observed. Complementary tests were performed, including blood count, biochemistry and imaging tests. It was observed through ultrasound examination the presence of a large amount of fluid with cellularity in horns and uterine body, compatible with piometra. Alterations compatible with sepsis were observed during the care and stabilization of the animal. On echocardiographic examination, an increase in systolic and diastolic diameters of the left ventricle was observed with decreased shortening and ejection fraction, compatible with systolic dysfunction of the left ventricle. The patient received medical discharge after surgical correction and stabilization of clinical parameters, and died seven days later. It is suggested that the cause of death was systolic dysfunction caused by sepsis. It is concluded that myocardial dysfunction is a prognostic determinant factor in cases of sepsis, emphasizing the importance of its diagnosis and early treatment.

Função miocárdica ventricular esquerda em uma gata com cardiomiopatia fenótipo não específico / Left ventricular myocardial function in a cat with nonspecific cardiomyopathy phenotype

Background: Non-specific phenotype feline cardiomyopathy (CFNE) is one that does not fit properly in the other categories, and it is necessary to describe in detail the morphology and cardiac function. The causes of CFNE is not very clear, and it may be due to congenital or acquired disease, or also to primary or secondary myocardial dysfunction associated with other conditions. In symptomatic cases, the clinical signs observed are compatible with left congestive heart failure (ICCE). This study reports a CFNE case in an asymptomatic cat, in order to demonstrate the importance of echocardiographic examination in the early diagnosis of the disease. Case: A 6.5-year-old non-neutered crossbred cat weighing 3.1 kg was seen at the institution’s veterinary hospital for routine cardiac evaluation. No clinical signs were reported in the history. On physical examination, the animal presented calm behavior, body score 5/9, heart rate 200 bpm, systolic blood pressure of 102 mmHg, respiratory rate 64 mrp, and other normal parameters. CBC and urinalysis laboratory tests were requested, which were unchanged. The electrocardiogram showed normal patterns. In the conventional echocardiographic examination, a significant increase in the left atrium (LA) was observed, and the LA/Ao ratio was 2.05 and the diastolic function was abnormal. There was no presence of concentric hypertrophy of the left ventricle (LV), the thickness of the ventricular wall measured at different points, in the two-dimensional mode and the M mode, was less than 5 millimeters. Other parameters of conventional echocardiography were within the normal range. Through these echocardiographic findings, the suggestive diagnosis was non-specific phenotype cardiomyopathy, with a significant increase in LA. For the...

Função miocárdica ventricular esquerda em uma gata com cardiomiopatia fenótipo não específico / Left ventricular myocardial function in a cat with nonspecific cardiomyopathy phenotype

Background: Non-specific phenotype feline cardiomyopathy (CFNE) is one that does not fit properly in the other categories, and it is necessary to describe in detail the morphology and cardiac function. The causes of CFNE is not very clear, and it may be due to congenital or acquired disease, or also to primary or secondary myocardial dysfunction associated with other conditions. In symptomatic cases, the clinical signs observed are compatible with left congestive heart failure (ICCE). This study reports a CFNE case in an asymptomatic cat, in order to demonstrate the importance of echocardiographic examination in the early diagnosis of the disease. Case: A 6.5-year-old non-neutered crossbred cat weighing 3.1 kg was seen at the institutions veterinary hospital for routine cardiac evaluation. No clinical signs were reported in the history. On physical examination, the animal presented calm behavior, body score 5/9, heart rate 200 bpm, systolic blood pressure of 102 mmHg, respiratory rate 64 mrp, and other normal parameters. CBC and urinalysis laboratory tests were requested, which were unchanged. The electrocardiogram showed normal patterns. In the conventional echocardiographic examination, a significant increase in the left atrium (LA) was observed, and the LA/Ao ratio was 2.05 and the diastolic function was abnormal. There was no presence of concentric hypertrophy of the left ventricle (LV), the thickness of the ventricular wall measured at different points, in the two-dimensional mode and the M mode, was less than 5 millimeters. Other parameters of conventional echocardiography were within the normal range. Through these echocardiographic findings, the suggestive diagnosis was non-specific phenotype cardiomyopathy, with a significant increase in LA. For the...(AU)