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Case #13: Situs Inversus
Signalment:
Species: Feline
Breed: DSH
Age:
Sex: Male, Neutered
History:
On January 11th 2004, the patient presented to a local emergency clinic with the primary complaint of being lethargic all day with episodes of 'staring-into-space'. Patient was mydriatic and unresponsive to touch or other stimuli. These episodes lasted from between 30 seconds to 60 seconds. CBC, Biochemical profile and Urinalysis were performed. Patient was found to have a mature neutrophilia, hyperglycemia, high normal BUN, and a urine specific gravity of 1.045. He was also noted to have a grade III/VI heart murmur. Patients blood pressure was 90 mmHg systolic.

The Patient presented to the Veterinary Medical Center for a one day history of non-responsiveness, extreme lethargy, and difficulty standing and walking. He also had episodes of being spread out on the floor with a rigid tail and paws clentched. He has also had a slight head tremor for the past 6 months. Patient is FeLV / FIV negative and is up to date on all vaccinations, including FelV. There is one other cat and a dog in the household.

Physical Examination:
Weight 6.4 kg; Depressed; Respiratory - 44 bpm, MM - pale, tacky CRT 2 sec; Precordial Impulse - hypokinetic; Femoral Pulse - 150 bpm, quality - normal; abdominal palpation - normal; hydration - 8% dehydrated; Heart Auscultation - HR 152 bpm; abnormal heart sounds, normal rhythm; Murmur - Left [Grade IV / VI], Right [Grade IV/VI, pansystolic]. BV sounds - early expiratory wheezes left cranial, harsh sounds, muffled ventrally. early to mid expiratory wheezes right cranial, harsh sounds, muffled ventrally; expiratory stertor.
Laboratory Profiles:
CBC:
lymphocytosis [16,500], mature neutrophilia [14,030], monocytosis [999], 1+ echinocytes, rare howell-jolly bodies, 1+ large platelets.
Blood Chemistry:
high BUN [41], hypocalcemia [8.1], hypermagnesemia [3.6], hyponatremia [143], hypochloridemia [114], high AST [63], hyperglycemia [191]
Urinalysis:
specific gravity 1.050, 3+ occult blood, trace protein, >50 RBCs / hpf, 6-20 fat / hpf [cystocentesis].
T4: 0.8 g/dL; Feline Heartworm Ab/Ag:  negative
Thoracic Radiographs: see below
Cardio Examination:
ECG: Rate [160], Rhythm [regular], P-wave [not visible], PR Interval [P wave not visible], QRS Complex [R amplitude 1.5 mV, 0.05 sec], ST segment [], QT interval [0.22 sec], T wave [0.3 mV, 0.1 sec], MEA [85 degrees]; 
Interpretation:  a high R amplitude suggests left ventricular enlargement, long QRS, long QT interval. With situs inversus, I am not sure an ECG will be accurate for judging chamber enlargement.

Thoracic Radiographs:

[Read Radiograph Report]

Echocardiograms: 

The Patients Echo

"normal' HCM echo

Diagnosis:   Situs Inversus

 
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