一例猫感染性心内膜炎的诊治

Diagnosis and management of a case of infective endocarditis in a cat

1只雄性英国短毛猫,因呼吸窘迫和后肢轻瘫而就诊,采用基本信息及病史调查、体格检查、实验室检查及影像学检查,并参考改良的杜克诊断标准,对患猫进行诊断。结果表明:体格检查发现患猫双后肢无股动脉脉搏,且触诊有痛感;血清肌酸激酶浓度轻度升高至1019 U/L(参考范围0~386 U/L);胸部X射线检查显示胸膜腔积液;超声心动检查显示主动脉瓣叶上存在一个高回声赘生物,主动脉瓣反流;腹部B型超声波检查显示腹主动脉腔未完全栓塞。根据以上检查结果该猫诊断为感染性心内膜炎(infective endocarditis,IE),使用吸氧、利尿、镇痛、抗血栓、抗感染等治疗措施后,患猫病情明显好转,存活时间达到5个月,相对较长。说明超声心动检查对于感染性心内膜炎的确诊非常重要,而相对于更为常见的猫心肌病和先天性心脏病,猫感染性心内膜炎的治疗方案不同,且预后更差。

A male British Shorthair cat,which was presented with respiratory distress and mild paralysis of the hind limbs,was diagnosed using basic information and history investigation,physical examination,laboratory tests and imaging examination,and with reference to the modified Duke diagnostic criteria.The results showed that physical examination revealed no femoral artery pulsation in both hind limbs and pain on palpation;serum creatine kinase concentration was mildly elevated to 1019 U/L(reference range 0-386 U/L);chest X-ray showed pleural cavity effusion;echocardiography showed the presence of a hyperechoic redundancy on the aortic valve leaflets and aortic regurgitation;abdominal B-mode ultrasonography showed incomplete embolization of the abdominal aortic cavity.Based on these findings,the cat was diagnosed with infective endocarditis(IE);after treatment with oxygen,diuretics,analgesia,antithrombotic and anti-infective measures,the cat’s condition improved significantly.Survival time reached five months,which was relatively long.The results suggested that echocardiography was important in confirming the diagnosis of infective endocarditis,while for the more common feline cardiomyopathies and congenital heart disease,feline infective endocarditis had different treatment options and a worse prognosis.