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DOI: 10.1055/a-1483-3342
Reversible linksventrikuläre Muskelhypertrophie und Herzversagen durch vermutete Myokarditis bei einer Katze im Zuge einer FLUTD
Reversible left ventricular hypertrophy and congestive heart failure due to suspected myocarditis in a cat in the course of FLUTD![](https://www.thieme-connect.de/media/10.1055-s-00034911/202103/lookinside/thumbnails/10-1055-a-1483-3342-1.jpg)
Zusammenfassung
Ein 2,5-jähriger, kastrierter Europäisch-Kurzhaar-Kater, der 8 Tage zuvor wegen einer FLUTD behandelt worden war, wurde nachts aufgrund Apathie und Anorexie vorgestellt. Röntgenaufnahmen, EKG, Blutdruckmessung und Echokardiografie ergaben linksventrikuläres kongestives Herzversagen, linksventrikuläre konzentrische Muskelhypertrophie, Vorhofstauung links, fortgeschrittene diastolische Dysfunktion, Hypotension und vagotonusabhängige Sinusbradykardie mit AV-Block 1. Grades und Rechtsschenkelblock. NT-ProBNP- und Troponin-I-Konzentrationen waren stark erhöht (NT-ProBNP > 1500 pmol/l, Troponin I 32,87 ng/ml). Die Verdachtsdiagnose lautete akute Myokarditis. Die PCR auf Bartonella henselae verlief negativ, für Toxoplasma gondii wurden ein negativer IgM- und ein IgG-Antikörpertiter von 1:32 (Referenzbereich < 1:32) bestimmt, eine spätere Kontrolle des IgG-Titers lieferte einen negativen Befund. FeLV- und FIV-Schnelltest waren negativ. Ein Test auf Coronavirus erfolgte nicht, da die Katze geimpft war. Eine metastatische Infektion von dem zuvor aus dem Harn isolierten Keim Proteus mirabilis erschien möglich. In Erwägung gezogen wurde auch eine Überempfindlichkeitsreaktion auf Medikamente oder eine stressinduzierte Myokarditis. Die Katze wurde stationär mit Furosemid (initial und später im Verlauf), Theophyllin initial, Dauertropfinfusion von Ringer-Laktat-Lösung, Pimobendan und Zusatz von Enrofloxacin zur bestehenden Gabe von Amoxicillin/Clavulansäure behandelt. Nach 4 Tagen zeigte der Patient ein gutes Allgemeinbefinden und einen Blutdruck im Referenzbereich. Die linksventrikuläre Muskelhypertrophie war rückläufig, die diastolische Dysfunktion und die Vorhofstauung hielten an. Im Verlauf von 8 Wochen normalisierten sich die echokardiografischen Befunde und die Herzmarker weitestgehend. Alle Medikamente konnten sukzessive abgesetzt werden. Bei der Abschlussuntersuchung nach 7 Monaten ließen sich keine kardialen Veränderungen mehr nachweisen.
Abstract
A 2.5-year-old castrated male domestic shorthair cat with a past pertinent history of FLUTD treatment 8 days earlier was presented during the night due to apathy and anorexia. Radiographs, ECG, blood pressure measurement and echocardiography revealed left-sided congestive heart failure, left ventricular concentric hypertrophy, left atrial dilation, severe diastolic dysfunction, hypotension, and vagotonus-associated sinus bradycardia with a first degree AV-block as well as a right bundle brunch block. NT-ProBNP and troponin I concentrations were elevated (NT-ProBNP > 1500 pmol/l, Troponin I 32.87 ng/ml). Presumptive diagnosis was acute myocarditis. Bartonella henselae PCR and Toxoplasma gondii IgM titer were negative. Initial IgG titer amounted to 1:32 (reference range: < 1:32) and on later testing this was negative. FeLV and FIV tests exhibited negative results. Coronavirus testing was not performed because the cat was vaccinated accordingly. A metastatic infection with Proteus mirabilis, which had been isolated from the urine, appeared possible. Alternatively, a hypersensivity reaction to drugs or a stress-induced myocarditis was taken into consideration. The hospitalized cat was treated with furosemide (initialy and in the course of further treatment), theophyllin (initially), continuous infusion with lactated Ringer’s solution, pimobendan, and the addition of enrofloxacin to the ongoing amoxicillin/clavulanic acid administration. After 4 days, the cat’s general condition improved satisfactorily and blood pressure returned to normal range. Left ventricular hypertrophy resolved, however, diastolic dysfunction as well as left atrial dilation persisted. Within the next 8 weeks, echocardiographic findings and cardiac biomarkers returned to near normal values. All medication was tapered and finally discontinued. During the last recheck examination 7 months following initial presentation, no cardiac changes were apparent.
Zusatzmaterial
- Zusätzliches Material finden Sie unter https://dx.doi.org/10.1055/a-1483-3342
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Publication History
Received: 10 September 2020
Accepted: 09 December 2020
Article published online:
22 June 2021
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