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 µg/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.