Motion Mode Echocardiography on Healthy Male Indonesian Domestic House Cat
ABSTRACT
LYNN KAAT LAURA KURNIAWAN. Motion Mode Echocardiography of
Healthy Male Indonesian Domestic House Cat. Supervised by DENI NOVIANA.
The purpose of this study was to determine the normal echocardiographic
heart measurements of healthy male Indonesian Domestic House Cat. Nine male
cats weighing between 3.3 – 4.4 kg were anesthetized using zolazepam-tiletamine
(8 mg/kgBW). Echocardiographic examination was performed on the right
parasternal short axis at the papillary muscles and the aorta level using a 7.5 MHz
transducer. Parameters observed were: left ventricular wall thickness (LVW),
interventricular septa thickness (IVS), left ventricular internal diameter (LVID),
aorta (AO), and left atrium (LA), all during systole (s) and diastole (d). Derivative
measurements include left ventricular end-diastolic volume (LVED), end-systolic
volume (LVES), stroke volume (SV), cardiac output (CO), ejection fraction (EF),
and fractional shortening (FS). Brightness mode shows that the IVS and LVW
were hypoechoic, the LA, LVID and aorta lumen were anechoic and the aorta wall
was hyperechoic. The average measurements of the Indonesian Domestic House
Cat were: LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm,
IVSd 0.30 ± 0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ±
0.06 cm, LA 0.73 ± 0.04 cm. The LA:AO ratio was 1.07 ± 0.1. Derivative
measurements: LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml,
CO 865.18 178.66 ml/minute, EF 82.28 4.64 %, FS 48 5 %.
Keywords: Indonesian Domestic House Cat, motion mode echocardiography,
normal values
ABSTRAK
LYNN KAAT LAURA KURNIAWAN. Motion mode Ekhokardiografi Kucing
Jantan Lokal Indonesia. Dibimbing oleh DENI NOVIANA.
Tujuan dari penelitian ini adalah untuk mengetahui nilai ekhokardiografi
normal ukuran jantung dari kucing jantan lokal Indonesia yang sehat. Sembilan
ekor kucing jantan dengan bobot badan antara 3.3 – 4.4 kg dianaestesi
menggunakan kombinasi zolazepam-tiletamine (8 mg/kgBB). Pengambilan data
diambil menggunakan transduser 7.5 MHz pada sumbu pendek jantung (short
axis) dengan hewan berbaring pada posisi lateral kanan. Parameter yang diukur
antara lain: ketebalan dinding ventrikel kiri (LVW), ketebalan interventrikular
septa (IVS), dimensi ventrikel kiri (LVID), dimensi aorta (AO), dan dimensi
atrium kiri (LA) pada saat sistole (s) dan diastole (d). Perhitungan turunan antara
lain volume ventrikel kiri pada akhir diastole (LVED), pada akhir sistole (LVES),
stroke volume (SV), cardiac output (CO), ejection fraction (EF), dan fraksi
pemendekan (FS). Brightness mode menunjukkan bahwa IVS dan LVW bersifat
hipoekhoik, dimensi LA, LVID dan AO bersifat anekhoik, dan dinding aorta
bersifat hiperekhoik. Perhitungan rata-rata pengukuran yang didapat adalah:
LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm, IVSd 0.30 ±
0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ± 0.06 cm, LA
0.73 ± 0.04 cm. Perbandingan LA:AO adalah 1.07 ± 0.1. Perhitungan turunan:
LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml, CO 865.18
178.66 ml/menit, EF 82.28 4.64 %, FS 48 5 %.
Kata Kunci: Kucing lokal Indonesia, motion mode ekhokardiografi, nilai normal
20
Attachment 1 Heart measurement references
Parameter
N
AO
LA
LVWs
LVWd
LVIDs
LVIDd
IVSs
IVSd
HR
BW
LVST
LVWT
FS
LA:AO
Moise and
Dietz*
11
0.95 ± 0.15
1.21 ± 0.18
0.78 ± 0.10
0.46 ± 0.05
0.69 ± 0.22
1.51 ± 0.21
0.76 ± 0.12
0.50 ± 0.07
182 ± 22
4.3 ± 0.5
33.5 ± 8.2
39.5 ± 7.6
55.0 ± 10.2
1.29 ± 0.23
Jacobs and
Knight*
30
0.95 ± 0.11
1.23 ± 0.14
0.68 ± 0.07
0.33 ± 0.06
0.80 ± 0.14
1.59 ± 0.19
0.58 ± 0.06
0.31 ± 0.04
194 ± 23
4.1 ± 1.1
49.3 ± 5.3
1.30 ± 0.17
Fox et al.*
Allen**
10
0.94 ± 0.11
1.03 ± 0.14
0.55 ± 0.88
0.35 ± 0.05
0.81 ± 0.16
1.40 ± 0.13
0.36 ± 0.08
255 ± 36
3.91 ± 1.2
42.7 ± 8.1
1.10 ± 0.18
10
0.90 ± 0.07
1.00 ± 0.07
0.40 ± 0.40
0.86 ± 0.16
1.30 ± 0.12
0.40 ± 0.03
175 ± 20
3.64 ± 0.66
0.35 ± 0.25
-
* source: Kealy et al. (2011), ** source: Brown and Gaillot (2008); N: number of cats, AO: aorta
diameter, LA: left atrium, LVWs: left ventricular wall thickness during systole, LVWd: left
ventricular wall thickness during diastole, LVIDs: left ventricular internal diameter during systole,
LVIDd: left ventricular internal diameter during diastole, IVSs: interventricular septa thickness
during systole, IVSd: interventricular septa thickness during diastole, HR: heart rate, BW: body
weight, LVST: left ventricular septa thickening, LVWT: left ventricular wall thickening, FS:
fractional shortening,
MOTION MODE ECHOCARDIOGRAPHY ON HEALTHY
MALE INDONESIAN DOMESTIC HOUSE CAT
LYNN KAAT LAURA KURNIAWAN
DEPARTMENT OF CLINIC, REPRODUCTION AND PATHOLOGY
FACULTY OF VETERINARY MEDICINE
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2012
STATEMENT ABOUT UNDERGRADUATE THESIS AND
INFORMATION SOURCES AND COPY RIGHT*
I hereby state that this undergraduate thesis entitled “Motion Mode
Echocardiography on Healthy Indonesian Domestic House Cat” is my own work
with the assistance of my supervisor and has not been submitted in any form to
other institutes. Sources of information used in this undergraduate thesis quoted
from other sources both publicized and unpublicized are written at the end of this
thesis.
I hereby present the copy right of my undergraduate thesis to the Bogor
Agricultural University.
Bogor, November 2011
Lynn Kaat Laura Kurniawan
NIM B04080055
ABSTRACT
LYNN KAAT LAURA KURNIAWAN. Motion Mode Echocardiography of
Healthy Male Indonesian Domestic House Cat. Supervised by DENI NOVIANA.
The purpose of this study was to determine the normal echocardiographic
heart measurements of healthy male Indonesian Domestic House Cat. Nine male
cats weighing between 3.3 – 4.4 kg were anesthetized using zolazepam-tiletamine
(8 mg/kgBW). Echocardiographic examination was performed on the right
parasternal short axis at the papillary muscles and the aorta level using a 7.5 MHz
transducer. Parameters observed were: left ventricular wall thickness (LVW),
interventricular septa thickness (IVS), left ventricular internal diameter (LVID),
aorta (AO), and left atrium (LA), all during systole (s) and diastole (d). Derivative
measurements include left ventricular end-diastolic volume (LVED), end-systolic
volume (LVES), stroke volume (SV), cardiac output (CO), ejection fraction (EF),
and fractional shortening (FS). Brightness mode shows that the IVS and LVW
were hypoechoic, the LA, LVID and aorta lumen were anechoic and the aorta wall
was hyperechoic. The average measurements of the Indonesian Domestic House
Cat were: LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm,
IVSd 0.30 ± 0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ±
0.06 cm, LA 0.73 ± 0.04 cm. The LA:AO ratio was 1.07 ± 0.1. Derivative
measurements: LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml,
CO 865.18 178.66 ml/minute, EF 82.28 4.64 %, FS 48 5 %.
Keywords: Indonesian Domestic House Cat, motion mode echocardiography,
normal values
ABSTRAK
LYNN KAAT LAURA KURNIAWAN. Motion mode Ekhokardiografi Kucing
Jantan Lokal Indonesia. Dibimbing oleh DENI NOVIANA.
Tujuan dari penelitian ini adalah untuk mengetahui nilai ekhokardiografi
normal ukuran jantung dari kucing jantan lokal Indonesia yang sehat. Sembilan
ekor kucing jantan dengan bobot badan antara 3.3 – 4.4 kg dianaestesi
menggunakan kombinasi zolazepam-tiletamine (8 mg/kgBB). Pengambilan data
diambil menggunakan transduser 7.5 MHz pada sumbu pendek jantung (short
axis) dengan hewan berbaring pada posisi lateral kanan. Parameter yang diukur
antara lain: ketebalan dinding ventrikel kiri (LVW), ketebalan interventrikular
septa (IVS), dimensi ventrikel kiri (LVID), dimensi aorta (AO), dan dimensi
atrium kiri (LA) pada saat sistole (s) dan diastole (d). Perhitungan turunan antara
lain volume ventrikel kiri pada akhir diastole (LVED), pada akhir sistole (LVES),
stroke volume (SV), cardiac output (CO), ejection fraction (EF), dan fraksi
pemendekan (FS). Brightness mode menunjukkan bahwa IVS dan LVW bersifat
hipoekhoik, dimensi LA, LVID dan AO bersifat anekhoik, dan dinding aorta
bersifat hiperekhoik. Perhitungan rata-rata pengukuran yang didapat adalah:
LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm, IVSd 0.30 ±
0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ± 0.06 cm, LA
0.73 ± 0.04 cm. Perbandingan LA:AO adalah 1.07 ± 0.1. Perhitungan turunan:
LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml, CO 865.18
178.66 ml/menit, EF 82.28 4.64 %, FS 48 5 %.
Kata Kunci: Kucing lokal Indonesia, motion mode ekhokardiografi, nilai normal
MOTION MODE ECHOCARDIOGRAPHY ON HEALTHY
MALE INDONESIAN DOMESTIC HOUSE CAT
LYNN KAAT LAURA KURNIAWAN
Undergraduate Thesis
as a requirement for a degree of
Bachelor of Veterinary Medicine
Faculty of Veterinary Medicine
DEPARTMENT OF CLINIC, REPRODUCTION AND PATHOLOGY
FACULTY OF VETERINARY MEDICINE
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2012
Title
Name
NIM
: Motion Mode Echocardiography on Healthy Male Indonesian
Domestic House Cat
: Lynn Kaat Laura Kurniawan
: B04080055
Approved by
Drh. Deni Noviana, Ph.D
Supervisor
Known by
Drh. Agus Setiono, MS, Ph.D, APVet (K)
Vice Dean
Graduation Date:
FOREWORD
Praise and grace to the Lord for His guidance and blessings during the
writing of this undergraduate thesis. This thesis entitled “Motion Mode
Echocardiography on Indonesian Domestic House Cat” was done from November
2011 until April 2012 in the Clinic, Reproduction and Pathology Department.
The writer would like to thank everyone who made this undergraduate thesis
possible:
1. Drh. Deni Noviana, Ph.D as the supervisor for the assistance and guidence in
making this thesis
2. Dr. Drh. Trioso Purnawarman, M.Si as the academic advisor for the
assistance and support these past three years
3. Dr. Drh. Hj. Gunanti, MS as the head of the Division of Surgery and
Radiology for the opportunity to do the research in the Radiology Laboratory
4. Colleagues in the Radiology Laboratory: drh. Mokhamad Fakhrul Ulum,
M.Si, drh. Devi Paramitha, Mr. Katim, Ajeng, Rio, Nengsih, Andi, Pras, Ruri,
Cholis, Nisa, Hastin, Ayip, Erly, Medy, Yiyi, Ridwan
5. Father, mother, brother, grandmother, and my whole family in Indonesia,
Belgium, China, and the Netherlands for the love, spirit and support
6. My best friends: Puvean, Hana, Arca, Rio, Moniq, Irin, Titus, Cory, Novra
for the friendship, laughter, crazyness and everything in between
7. KeMaKI, UKF, HKSA for the second home
The writer hopes that this thesis can be beneficial for the readers, especially
veterinary small animal practitioners.
Bogor, November 2011
Lynn Kaat Laura Kurniawan
CONTENT
LIST OF PICTURES
xiii
LIST OF TABLES
LIST OF ATTACHMENT
xiii
xiii
INTRODUCTION
Background
Objective
Benefit
LITERATURE STUDY
Indonesian Domestic House Cat
1
1
1
1
1
1
Heart
Ultrasonography
2
3
Heart Ultrasonography (Echocardiography)
Right Parasternal Short Axis View
4
5
Zolazepam-Tiletamine (Zoletil)
MATERIALS AND METHOD
6
7
Time and Place
Animals and Materials
7
7
Method
Animals
7
7
Preparation
Echocardiography Technique
8
8
Data Analysis
RESULT AND DISCUSSION
8
9
Physical Examination
Echocardiography
9
10
Muscular Walls: Left Ventricular Wall and Interventricular Septa
Internal Dimensions: Aorta, Left Atrium, Left Ventricle
10
12
Derivative Measurements
Fractional Shortening
14
15
Left Ventricular Volumes and Ejection Fraction
Left Ventricular Stroke Volume and Cardiac Output
15
16
CONCLUSION
REFERENCES
16
16
ATTACHMENT
BIOGRAPHY
20
21
LIST OF PICTURES
1
2
3
4
5
The cat heart
Probe positions and motion mode imaging
Right parasternal short axis views of the heart
View of the heart at the papillary muscle level
View of the heart at the aorta level
3
4
6
11
13
LIST OF TABLES
1
2
3
4
5
6
7
Normal physiological measurements of a cat
Comparative heart size of a normal cat
Equations for the measurement derivates
Physical examination result of Indonesian Domestic House Cat
Heart wall thickness of Indonesian Domestic House Cat
Internal dimension measurement of Indonesian Domestic House Cat
Derivative cardiac measurements of the Indonesian Domestic House
Cat
2
5
9
9
12
14
15
LIST OF ATTACHMENT
1 Heart measurement references
20
INTRODUCTION
Background
The Indonesian Domestic House Cat (DHC) is a typical Indonesian short
hair cat breed from the genus Felis. Cats are prone to various diseases, especially
cardiovascular diseases (Scansen 2011b; Mottet et al. 2012). The most common
complaint in cats is the evaluation of heart murmur during auscultation. The use
of ultrasonographic imaging has had a tremendous impact on the diagnosis of
cardiac disease, giving a surrogate measure of the heart size (Chandler et al. 2004;
Abbott and MacLean 2006; Coatney 2001). Cardiologists are commonly asked to
perform echocardiographic examinations on cats to screen for both acquired and
congenital heart diseases (Adin and McCloy 2005; Chetboul et al. 2006).
Echocardiographic values show significant breed variations. Data
concerning normal heart-size values have been reported in a number of pedigree
cats, however little the normal echocardiogram of the Indonesian DHC has been
reported. This is why the purpose of this study was to determine the normal
echocardiographic reference values in anesthetized Indonesian DHC. Knowledge
of the normal measurements for a specific body weight can help to indicate the
degree and direction of the change from normal (Muzzi et al. 2006).
Objective
The objective of this study was to provide the normal values of Motionmode (M-mode) echocardiographic cardiac measurements in healthy anesthetized
male Indonesian Domestic House Cat.
Benefits
It is hoped that the normal cardiac measurements of the male Indonesian
Domestic House Cat can add the physiological database of cat heart
measurements to then be used, especially by veterinary practitioners, as a
reference when dealing with heart ultrasonography of the Indonesian Domestic
House Cat.
LITERATURE STUDY
Indonesian Domestic House Cat (DHC)
Domestic House Cats belong to the class Mammalia, the order Carnivora,
the family Felidae, and the genus Felis. Depending on their hair length, there are
3 groups of house cats: short hair, medium hair and long hair. Depending on their
pedigree, cats are divided into non-pedigree and pedigree cats (Edwards 1999).
Despite having the same ancestors as pedigree cats, non-pedigree cats were not
2
subject to selective breeding and conform no special standards. They have coats of
any length in a range of colors that are usually plain, blotched, striped, or parched
(Foss et al. 2008). They usually have green or yellow eyes and a fairly long nose
(Edwards 1999).
Domestic House Cats belong to the short hair and non-pedigree group. Male
cats are generally larger than females. Table 1 shows the normal physiological
data of a cat. A healthy cat has the following physical features: clean and shiny
coat, clean eyes and nose, no indications of swollen gums and bad breath, and no
physical trauma (Edwards 1999).
Table 1 Normal physiological data of a cat
Body Temperature (°C)
Heart Rate (bpm)
Respiratory Rate
(respiration/minute)
Adult cat
Average adult cat
37.7–39.4
140–240
20–24
38.6
195
22
Newborn
kitten
35–37.2
200–300
15–35
Source: Eldredge et al (2008); bpm: beats per minute.
Heart
The heart rests in the cavity of the mediastinum near the midline of the
thoracic cavity on the diaphragm. About two-thirds of the mass of the heart lies on
the left of the body’s midline (Amitrano and Tortora 2007). Anatomically, the
heart is a hollow organ with muscular walls and four chambers separated by
valves (Norsworthy 2012). The walls of the heart has three layers: the epicardium
organized by a single layer of squamous epithelium, the myocardium organized
by muscle cells and the endocardium organized by a single layer of epithelium
cells (Sebastiani and Fishbeck 2005). Interventricular septum (IVS) is the
muscular separation between the left and right ventricle. Papillary muscles are
broad, finger-like projections in the cavity of the ventricle. Each papillary muscle
has multiple smaller heads giving rise to the chordae tendineae (Factor et al.
2002). The aorta also consists of three layers: the innermost layer, the media and
the adventitia (Schmidt 2006).
The heart and blood vessels form the circulatory system. Blood enters the
right atrium through the anterior and posterior vena cava. It then flows into the
right ventricle through the tricuspid valve. Most of this ventricular filling happens
passively because the tricuspid valve is open. However, the atrial contraction
results in the final ventricular volume. High pressure in the ventricle causes blood
to backflow and the valves to shut. The contraction of the papillary muscles
pulling the chorda tendinae prevents the valves to prolapse into the atrium. From
the right ventricle, blood is pumped through the pulmonary semilunar valve into
the pulmonary trunk and lungs. From the lungs, blood returns to the left atrium
through the pulmonary veins and passively flows into the left ventricle through
the bicuspid valve. Contraction of the left ventricle forces blood past the aortic
semilunar valve into aorta to the whole body (Sebastiani and Fishbeck 2005).
Figure 1 illustrates the normal heart figure of a cat.
3
Figure 1 The cat heart; A: aorta, VC: vena cava, RA: right atrium, TCV:
tricuspidalis valve, RV: right ventricle, PulV: pulmonary valve, PA:
pulmonary artery, PV: pulmonary vein, LA: left atrium, MitV: mitral
valve, LV: left ventricle, AorV: aortic valve, LVFW: left ventricular
free wall, IVS: interventricular septa; the numbers (1, 2, 3, 4, 5, 6, 7, 8a,
8b) show the sequence of blood flow process; Source: Norsworthy
(2012).
Ultrasonography
Ultrasonography is a non-invasive diagnostic tool commonly used by
veterinary practitioners (Chandler et al. 2004; Copley et al. 2008; Corwin 2008;
Kealy et al. 2011). It uses frequencies greater than 20.000 cycles/second (Hz).
The transmission velocity of ultrasound waves in blood and most soft tissues cells
is uniform at 1540 m/sec (Coatney 2001). Common ultrasound frequencies used
in cats are between 2 and 15 MHz (Chandler et al. 2004; Schober and Todd 2010;
Kealy et al. 2011; Noviana et al. 2012). Lower frequencies result in higher
penetration but lower resolution (Silkowski 2010). Ultrasound can not be
transmitted through vacum and it’s velocity in gas is very low (Noviana et al.
2012).
An ultrasound device consists of a probe and a monitor (Noviana et al.
2012). Ultrasound waves are formed inside the probe by a piezoelectric effect on a
medium such as a crystal made of lead zirconate. The probe can act as an emitter
(wave producer) and receiver (echo accepter). An electrical impulse causes the
crystal to lose its shape, vibrate and release ultrasound waves. The waves
transmitted by the transducer are called pulse, while the waves reflected back to
the transducer is called echo. The probe is connected to a computer or signal
processor which processes the signals and presents it as grey dots. The stronger
the echo, the brighter the dots (Kealy et al. 2011; Noviana et al. 2012).
Hypoechoic is a projection in the monitor with a lower amount of echoes,
appearing as shades of darker gray. Anechoic happens when there are no
4
echoes/sonolucent present, appearing black on the screen. Hyperechoic is a
projection with rich and highly reflective echoes, appearing as varying shades of
lighter gray (Silkowski 2010).
There are two kinds of ultrasound imaging: Brightness mode (B-mode) and
Motion mode (M-mode). B-mode releases multiple ultrasound pulses at all times
and is shown as a two dimensional imaging of the organ (Noviana et al. 2012). Mmode provides a one-dimensional view (depth) into the heart, where the beam
transverses as their relative position and moves through time (Ware 2007). Mmode imaging usually provides a clearer resolution of the cardiac borders and a
more accurate timing of events within the cycle. Therefore, measurements of the
cardiac dimensions and motion are often more accurately assessed from the Mmode tracings (Ware 2007; Boon 2011). The difference between M-mode
imagings on different probe view angles is illustrated in Figure 2.
Figure 2 Probe positions at the right parasternal long axis view (A) and Motion
mode imaging (B); T: transducer, TW: thorax wall, RVW: right
ventricular wall, RV: right ventricle, S: septa, LV: left ventricle, AV:
aortic valve, AO: aorta, AMV: anterior mitral valve, PMV: posterior
mitral valve, LA: left atrium, LVW: left ventricular wall; Source: Ware
(2007). RVM: right ventricle muscular, TV: tricuspidal valve, RS: right
septa; the numbers (1, 2, 3, 4) indicate the motion mode ultrasound of
each level at the right parasternal long axis view.
Heart Ultrasonography
Heart size is important when evaluating cats for cardiac diseases (Chandler
et al. 2004; Ghadiri et al. 2008). Diseases such as cardiac neoplasia and
lymphoma, idiopathic pericarditis, congestive heart failure, hypertrophic
cardiomyopathy, and left ventricular hypertrophy can be diagnosed using
ultrasound (Scansen 2001a; Adin and McCloy 2005; Shinohara et al. 2005; Abbot
and MacLean 2006; Schober and Todd 2010).
Measurements of the heart include intraventricular septa wall thickness
(IVS) which measures the septum between the ventricles, left ventricular internal
diameter (LVID) which measures the ventricular space and left ventricular wall
thickness (LVW) which measures the wall thickness of the ventricle. Other
measurements include the diameter of the aorta (AO) and left atrium (LA)
(Fleming 2009). The heart can be measured during diastole and systole. Diastole
5
is the time when the heart is fully relaxed while systole is the time when the heart
is in full contraction (Muzzi et al. 2006). Table 2 shows the comparison sizes of
the cat heart.
Table 2 Comparative heart size of a normal cat
Organ
Interventricular septal wall (IVS) thickness
Left ventricular wall (LVW) thickness
Left atrium (LA) internal diameter
Right ventricular wall (RVW) thickness
Right ventricular (RV) internal diameter
Fractional shortening (FS)
Size
< 6 mm*
< 6 mm* or < 1.5 cm**
LYNN KAAT LAURA KURNIAWAN. Motion Mode Echocardiography of
Healthy Male Indonesian Domestic House Cat. Supervised by DENI NOVIANA.
The purpose of this study was to determine the normal echocardiographic
heart measurements of healthy male Indonesian Domestic House Cat. Nine male
cats weighing between 3.3 – 4.4 kg were anesthetized using zolazepam-tiletamine
(8 mg/kgBW). Echocardiographic examination was performed on the right
parasternal short axis at the papillary muscles and the aorta level using a 7.5 MHz
transducer. Parameters observed were: left ventricular wall thickness (LVW),
interventricular septa thickness (IVS), left ventricular internal diameter (LVID),
aorta (AO), and left atrium (LA), all during systole (s) and diastole (d). Derivative
measurements include left ventricular end-diastolic volume (LVED), end-systolic
volume (LVES), stroke volume (SV), cardiac output (CO), ejection fraction (EF),
and fractional shortening (FS). Brightness mode shows that the IVS and LVW
were hypoechoic, the LA, LVID and aorta lumen were anechoic and the aorta wall
was hyperechoic. The average measurements of the Indonesian Domestic House
Cat were: LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm,
IVSd 0.30 ± 0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ±
0.06 cm, LA 0.73 ± 0.04 cm. The LA:AO ratio was 1.07 ± 0.1. Derivative
measurements: LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml,
CO 865.18 178.66 ml/minute, EF 82.28 4.64 %, FS 48 5 %.
Keywords: Indonesian Domestic House Cat, motion mode echocardiography,
normal values
ABSTRAK
LYNN KAAT LAURA KURNIAWAN. Motion mode Ekhokardiografi Kucing
Jantan Lokal Indonesia. Dibimbing oleh DENI NOVIANA.
Tujuan dari penelitian ini adalah untuk mengetahui nilai ekhokardiografi
normal ukuran jantung dari kucing jantan lokal Indonesia yang sehat. Sembilan
ekor kucing jantan dengan bobot badan antara 3.3 – 4.4 kg dianaestesi
menggunakan kombinasi zolazepam-tiletamine (8 mg/kgBB). Pengambilan data
diambil menggunakan transduser 7.5 MHz pada sumbu pendek jantung (short
axis) dengan hewan berbaring pada posisi lateral kanan. Parameter yang diukur
antara lain: ketebalan dinding ventrikel kiri (LVW), ketebalan interventrikular
septa (IVS), dimensi ventrikel kiri (LVID), dimensi aorta (AO), dan dimensi
atrium kiri (LA) pada saat sistole (s) dan diastole (d). Perhitungan turunan antara
lain volume ventrikel kiri pada akhir diastole (LVED), pada akhir sistole (LVES),
stroke volume (SV), cardiac output (CO), ejection fraction (EF), dan fraksi
pemendekan (FS). Brightness mode menunjukkan bahwa IVS dan LVW bersifat
hipoekhoik, dimensi LA, LVID dan AO bersifat anekhoik, dan dinding aorta
bersifat hiperekhoik. Perhitungan rata-rata pengukuran yang didapat adalah:
LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm, IVSd 0.30 ±
0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ± 0.06 cm, LA
0.73 ± 0.04 cm. Perbandingan LA:AO adalah 1.07 ± 0.1. Perhitungan turunan:
LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml, CO 865.18
178.66 ml/menit, EF 82.28 4.64 %, FS 48 5 %.
Kata Kunci: Kucing lokal Indonesia, motion mode ekhokardiografi, nilai normal
20
Attachment 1 Heart measurement references
Parameter
N
AO
LA
LVWs
LVWd
LVIDs
LVIDd
IVSs
IVSd
HR
BW
LVST
LVWT
FS
LA:AO
Moise and
Dietz*
11
0.95 ± 0.15
1.21 ± 0.18
0.78 ± 0.10
0.46 ± 0.05
0.69 ± 0.22
1.51 ± 0.21
0.76 ± 0.12
0.50 ± 0.07
182 ± 22
4.3 ± 0.5
33.5 ± 8.2
39.5 ± 7.6
55.0 ± 10.2
1.29 ± 0.23
Jacobs and
Knight*
30
0.95 ± 0.11
1.23 ± 0.14
0.68 ± 0.07
0.33 ± 0.06
0.80 ± 0.14
1.59 ± 0.19
0.58 ± 0.06
0.31 ± 0.04
194 ± 23
4.1 ± 1.1
49.3 ± 5.3
1.30 ± 0.17
Fox et al.*
Allen**
10
0.94 ± 0.11
1.03 ± 0.14
0.55 ± 0.88
0.35 ± 0.05
0.81 ± 0.16
1.40 ± 0.13
0.36 ± 0.08
255 ± 36
3.91 ± 1.2
42.7 ± 8.1
1.10 ± 0.18
10
0.90 ± 0.07
1.00 ± 0.07
0.40 ± 0.40
0.86 ± 0.16
1.30 ± 0.12
0.40 ± 0.03
175 ± 20
3.64 ± 0.66
0.35 ± 0.25
-
* source: Kealy et al. (2011), ** source: Brown and Gaillot (2008); N: number of cats, AO: aorta
diameter, LA: left atrium, LVWs: left ventricular wall thickness during systole, LVWd: left
ventricular wall thickness during diastole, LVIDs: left ventricular internal diameter during systole,
LVIDd: left ventricular internal diameter during diastole, IVSs: interventricular septa thickness
during systole, IVSd: interventricular septa thickness during diastole, HR: heart rate, BW: body
weight, LVST: left ventricular septa thickening, LVWT: left ventricular wall thickening, FS:
fractional shortening,
MOTION MODE ECHOCARDIOGRAPHY ON HEALTHY
MALE INDONESIAN DOMESTIC HOUSE CAT
LYNN KAAT LAURA KURNIAWAN
DEPARTMENT OF CLINIC, REPRODUCTION AND PATHOLOGY
FACULTY OF VETERINARY MEDICINE
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2012
STATEMENT ABOUT UNDERGRADUATE THESIS AND
INFORMATION SOURCES AND COPY RIGHT*
I hereby state that this undergraduate thesis entitled “Motion Mode
Echocardiography on Healthy Indonesian Domestic House Cat” is my own work
with the assistance of my supervisor and has not been submitted in any form to
other institutes. Sources of information used in this undergraduate thesis quoted
from other sources both publicized and unpublicized are written at the end of this
thesis.
I hereby present the copy right of my undergraduate thesis to the Bogor
Agricultural University.
Bogor, November 2011
Lynn Kaat Laura Kurniawan
NIM B04080055
ABSTRACT
LYNN KAAT LAURA KURNIAWAN. Motion Mode Echocardiography of
Healthy Male Indonesian Domestic House Cat. Supervised by DENI NOVIANA.
The purpose of this study was to determine the normal echocardiographic
heart measurements of healthy male Indonesian Domestic House Cat. Nine male
cats weighing between 3.3 – 4.4 kg were anesthetized using zolazepam-tiletamine
(8 mg/kgBW). Echocardiographic examination was performed on the right
parasternal short axis at the papillary muscles and the aorta level using a 7.5 MHz
transducer. Parameters observed were: left ventricular wall thickness (LVW),
interventricular septa thickness (IVS), left ventricular internal diameter (LVID),
aorta (AO), and left atrium (LA), all during systole (s) and diastole (d). Derivative
measurements include left ventricular end-diastolic volume (LVED), end-systolic
volume (LVES), stroke volume (SV), cardiac output (CO), ejection fraction (EF),
and fractional shortening (FS). Brightness mode shows that the IVS and LVW
were hypoechoic, the LA, LVID and aorta lumen were anechoic and the aorta wall
was hyperechoic. The average measurements of the Indonesian Domestic House
Cat were: LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm,
IVSd 0.30 ± 0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ±
0.06 cm, LA 0.73 ± 0.04 cm. The LA:AO ratio was 1.07 ± 0.1. Derivative
measurements: LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml,
CO 865.18 178.66 ml/minute, EF 82.28 4.64 %, FS 48 5 %.
Keywords: Indonesian Domestic House Cat, motion mode echocardiography,
normal values
ABSTRAK
LYNN KAAT LAURA KURNIAWAN. Motion mode Ekhokardiografi Kucing
Jantan Lokal Indonesia. Dibimbing oleh DENI NOVIANA.
Tujuan dari penelitian ini adalah untuk mengetahui nilai ekhokardiografi
normal ukuran jantung dari kucing jantan lokal Indonesia yang sehat. Sembilan
ekor kucing jantan dengan bobot badan antara 3.3 – 4.4 kg dianaestesi
menggunakan kombinasi zolazepam-tiletamine (8 mg/kgBB). Pengambilan data
diambil menggunakan transduser 7.5 MHz pada sumbu pendek jantung (short
axis) dengan hewan berbaring pada posisi lateral kanan. Parameter yang diukur
antara lain: ketebalan dinding ventrikel kiri (LVW), ketebalan interventrikular
septa (IVS), dimensi ventrikel kiri (LVID), dimensi aorta (AO), dan dimensi
atrium kiri (LA) pada saat sistole (s) dan diastole (d). Perhitungan turunan antara
lain volume ventrikel kiri pada akhir diastole (LVED), pada akhir sistole (LVES),
stroke volume (SV), cardiac output (CO), ejection fraction (EF), dan fraksi
pemendekan (FS). Brightness mode menunjukkan bahwa IVS dan LVW bersifat
hipoekhoik, dimensi LA, LVID dan AO bersifat anekhoik, dan dinding aorta
bersifat hiperekhoik. Perhitungan rata-rata pengukuran yang didapat adalah:
LVWs 0.57 ± 0.03 cm, LVWd 0.35 ± 0.06 cm, IVSs 0.56 ± 0.03 cm, IVSd 0.30 ±
0.05 cm, LVIDs 0.78 ± 0.11 cm, LVIDd 1.48 ± 0.12 cm, AOs 0.69 ± 0.06 cm, LA
0.73 ± 0.04 cm. Perbandingan LA:AO adalah 1.07 ± 0.1. Perhitungan turunan:
LVED 5.96 1.17 ml, LVES 1.08 0.42 ml, SV 1.08 0.42 ml, CO 865.18
178.66 ml/menit, EF 82.28 4.64 %, FS 48 5 %.
Kata Kunci: Kucing lokal Indonesia, motion mode ekhokardiografi, nilai normal
MOTION MODE ECHOCARDIOGRAPHY ON HEALTHY
MALE INDONESIAN DOMESTIC HOUSE CAT
LYNN KAAT LAURA KURNIAWAN
Undergraduate Thesis
as a requirement for a degree of
Bachelor of Veterinary Medicine
Faculty of Veterinary Medicine
DEPARTMENT OF CLINIC, REPRODUCTION AND PATHOLOGY
FACULTY OF VETERINARY MEDICINE
BOGOR AGRICULTURAL UNIVERSITY
BOGOR
2012
Title
Name
NIM
: Motion Mode Echocardiography on Healthy Male Indonesian
Domestic House Cat
: Lynn Kaat Laura Kurniawan
: B04080055
Approved by
Drh. Deni Noviana, Ph.D
Supervisor
Known by
Drh. Agus Setiono, MS, Ph.D, APVet (K)
Vice Dean
Graduation Date:
FOREWORD
Praise and grace to the Lord for His guidance and blessings during the
writing of this undergraduate thesis. This thesis entitled “Motion Mode
Echocardiography on Indonesian Domestic House Cat” was done from November
2011 until April 2012 in the Clinic, Reproduction and Pathology Department.
The writer would like to thank everyone who made this undergraduate thesis
possible:
1. Drh. Deni Noviana, Ph.D as the supervisor for the assistance and guidence in
making this thesis
2. Dr. Drh. Trioso Purnawarman, M.Si as the academic advisor for the
assistance and support these past three years
3. Dr. Drh. Hj. Gunanti, MS as the head of the Division of Surgery and
Radiology for the opportunity to do the research in the Radiology Laboratory
4. Colleagues in the Radiology Laboratory: drh. Mokhamad Fakhrul Ulum,
M.Si, drh. Devi Paramitha, Mr. Katim, Ajeng, Rio, Nengsih, Andi, Pras, Ruri,
Cholis, Nisa, Hastin, Ayip, Erly, Medy, Yiyi, Ridwan
5. Father, mother, brother, grandmother, and my whole family in Indonesia,
Belgium, China, and the Netherlands for the love, spirit and support
6. My best friends: Puvean, Hana, Arca, Rio, Moniq, Irin, Titus, Cory, Novra
for the friendship, laughter, crazyness and everything in between
7. KeMaKI, UKF, HKSA for the second home
The writer hopes that this thesis can be beneficial for the readers, especially
veterinary small animal practitioners.
Bogor, November 2011
Lynn Kaat Laura Kurniawan
CONTENT
LIST OF PICTURES
xiii
LIST OF TABLES
LIST OF ATTACHMENT
xiii
xiii
INTRODUCTION
Background
Objective
Benefit
LITERATURE STUDY
Indonesian Domestic House Cat
1
1
1
1
1
1
Heart
Ultrasonography
2
3
Heart Ultrasonography (Echocardiography)
Right Parasternal Short Axis View
4
5
Zolazepam-Tiletamine (Zoletil)
MATERIALS AND METHOD
6
7
Time and Place
Animals and Materials
7
7
Method
Animals
7
7
Preparation
Echocardiography Technique
8
8
Data Analysis
RESULT AND DISCUSSION
8
9
Physical Examination
Echocardiography
9
10
Muscular Walls: Left Ventricular Wall and Interventricular Septa
Internal Dimensions: Aorta, Left Atrium, Left Ventricle
10
12
Derivative Measurements
Fractional Shortening
14
15
Left Ventricular Volumes and Ejection Fraction
Left Ventricular Stroke Volume and Cardiac Output
15
16
CONCLUSION
REFERENCES
16
16
ATTACHMENT
BIOGRAPHY
20
21
LIST OF PICTURES
1
2
3
4
5
The cat heart
Probe positions and motion mode imaging
Right parasternal short axis views of the heart
View of the heart at the papillary muscle level
View of the heart at the aorta level
3
4
6
11
13
LIST OF TABLES
1
2
3
4
5
6
7
Normal physiological measurements of a cat
Comparative heart size of a normal cat
Equations for the measurement derivates
Physical examination result of Indonesian Domestic House Cat
Heart wall thickness of Indonesian Domestic House Cat
Internal dimension measurement of Indonesian Domestic House Cat
Derivative cardiac measurements of the Indonesian Domestic House
Cat
2
5
9
9
12
14
15
LIST OF ATTACHMENT
1 Heart measurement references
20
INTRODUCTION
Background
The Indonesian Domestic House Cat (DHC) is a typical Indonesian short
hair cat breed from the genus Felis. Cats are prone to various diseases, especially
cardiovascular diseases (Scansen 2011b; Mottet et al. 2012). The most common
complaint in cats is the evaluation of heart murmur during auscultation. The use
of ultrasonographic imaging has had a tremendous impact on the diagnosis of
cardiac disease, giving a surrogate measure of the heart size (Chandler et al. 2004;
Abbott and MacLean 2006; Coatney 2001). Cardiologists are commonly asked to
perform echocardiographic examinations on cats to screen for both acquired and
congenital heart diseases (Adin and McCloy 2005; Chetboul et al. 2006).
Echocardiographic values show significant breed variations. Data
concerning normal heart-size values have been reported in a number of pedigree
cats, however little the normal echocardiogram of the Indonesian DHC has been
reported. This is why the purpose of this study was to determine the normal
echocardiographic reference values in anesthetized Indonesian DHC. Knowledge
of the normal measurements for a specific body weight can help to indicate the
degree and direction of the change from normal (Muzzi et al. 2006).
Objective
The objective of this study was to provide the normal values of Motionmode (M-mode) echocardiographic cardiac measurements in healthy anesthetized
male Indonesian Domestic House Cat.
Benefits
It is hoped that the normal cardiac measurements of the male Indonesian
Domestic House Cat can add the physiological database of cat heart
measurements to then be used, especially by veterinary practitioners, as a
reference when dealing with heart ultrasonography of the Indonesian Domestic
House Cat.
LITERATURE STUDY
Indonesian Domestic House Cat (DHC)
Domestic House Cats belong to the class Mammalia, the order Carnivora,
the family Felidae, and the genus Felis. Depending on their hair length, there are
3 groups of house cats: short hair, medium hair and long hair. Depending on their
pedigree, cats are divided into non-pedigree and pedigree cats (Edwards 1999).
Despite having the same ancestors as pedigree cats, non-pedigree cats were not
2
subject to selective breeding and conform no special standards. They have coats of
any length in a range of colors that are usually plain, blotched, striped, or parched
(Foss et al. 2008). They usually have green or yellow eyes and a fairly long nose
(Edwards 1999).
Domestic House Cats belong to the short hair and non-pedigree group. Male
cats are generally larger than females. Table 1 shows the normal physiological
data of a cat. A healthy cat has the following physical features: clean and shiny
coat, clean eyes and nose, no indications of swollen gums and bad breath, and no
physical trauma (Edwards 1999).
Table 1 Normal physiological data of a cat
Body Temperature (°C)
Heart Rate (bpm)
Respiratory Rate
(respiration/minute)
Adult cat
Average adult cat
37.7–39.4
140–240
20–24
38.6
195
22
Newborn
kitten
35–37.2
200–300
15–35
Source: Eldredge et al (2008); bpm: beats per minute.
Heart
The heart rests in the cavity of the mediastinum near the midline of the
thoracic cavity on the diaphragm. About two-thirds of the mass of the heart lies on
the left of the body’s midline (Amitrano and Tortora 2007). Anatomically, the
heart is a hollow organ with muscular walls and four chambers separated by
valves (Norsworthy 2012). The walls of the heart has three layers: the epicardium
organized by a single layer of squamous epithelium, the myocardium organized
by muscle cells and the endocardium organized by a single layer of epithelium
cells (Sebastiani and Fishbeck 2005). Interventricular septum (IVS) is the
muscular separation between the left and right ventricle. Papillary muscles are
broad, finger-like projections in the cavity of the ventricle. Each papillary muscle
has multiple smaller heads giving rise to the chordae tendineae (Factor et al.
2002). The aorta also consists of three layers: the innermost layer, the media and
the adventitia (Schmidt 2006).
The heart and blood vessels form the circulatory system. Blood enters the
right atrium through the anterior and posterior vena cava. It then flows into the
right ventricle through the tricuspid valve. Most of this ventricular filling happens
passively because the tricuspid valve is open. However, the atrial contraction
results in the final ventricular volume. High pressure in the ventricle causes blood
to backflow and the valves to shut. The contraction of the papillary muscles
pulling the chorda tendinae prevents the valves to prolapse into the atrium. From
the right ventricle, blood is pumped through the pulmonary semilunar valve into
the pulmonary trunk and lungs. From the lungs, blood returns to the left atrium
through the pulmonary veins and passively flows into the left ventricle through
the bicuspid valve. Contraction of the left ventricle forces blood past the aortic
semilunar valve into aorta to the whole body (Sebastiani and Fishbeck 2005).
Figure 1 illustrates the normal heart figure of a cat.
3
Figure 1 The cat heart; A: aorta, VC: vena cava, RA: right atrium, TCV:
tricuspidalis valve, RV: right ventricle, PulV: pulmonary valve, PA:
pulmonary artery, PV: pulmonary vein, LA: left atrium, MitV: mitral
valve, LV: left ventricle, AorV: aortic valve, LVFW: left ventricular
free wall, IVS: interventricular septa; the numbers (1, 2, 3, 4, 5, 6, 7, 8a,
8b) show the sequence of blood flow process; Source: Norsworthy
(2012).
Ultrasonography
Ultrasonography is a non-invasive diagnostic tool commonly used by
veterinary practitioners (Chandler et al. 2004; Copley et al. 2008; Corwin 2008;
Kealy et al. 2011). It uses frequencies greater than 20.000 cycles/second (Hz).
The transmission velocity of ultrasound waves in blood and most soft tissues cells
is uniform at 1540 m/sec (Coatney 2001). Common ultrasound frequencies used
in cats are between 2 and 15 MHz (Chandler et al. 2004; Schober and Todd 2010;
Kealy et al. 2011; Noviana et al. 2012). Lower frequencies result in higher
penetration but lower resolution (Silkowski 2010). Ultrasound can not be
transmitted through vacum and it’s velocity in gas is very low (Noviana et al.
2012).
An ultrasound device consists of a probe and a monitor (Noviana et al.
2012). Ultrasound waves are formed inside the probe by a piezoelectric effect on a
medium such as a crystal made of lead zirconate. The probe can act as an emitter
(wave producer) and receiver (echo accepter). An electrical impulse causes the
crystal to lose its shape, vibrate and release ultrasound waves. The waves
transmitted by the transducer are called pulse, while the waves reflected back to
the transducer is called echo. The probe is connected to a computer or signal
processor which processes the signals and presents it as grey dots. The stronger
the echo, the brighter the dots (Kealy et al. 2011; Noviana et al. 2012).
Hypoechoic is a projection in the monitor with a lower amount of echoes,
appearing as shades of darker gray. Anechoic happens when there are no
4
echoes/sonolucent present, appearing black on the screen. Hyperechoic is a
projection with rich and highly reflective echoes, appearing as varying shades of
lighter gray (Silkowski 2010).
There are two kinds of ultrasound imaging: Brightness mode (B-mode) and
Motion mode (M-mode). B-mode releases multiple ultrasound pulses at all times
and is shown as a two dimensional imaging of the organ (Noviana et al. 2012). Mmode provides a one-dimensional view (depth) into the heart, where the beam
transverses as their relative position and moves through time (Ware 2007). Mmode imaging usually provides a clearer resolution of the cardiac borders and a
more accurate timing of events within the cycle. Therefore, measurements of the
cardiac dimensions and motion are often more accurately assessed from the Mmode tracings (Ware 2007; Boon 2011). The difference between M-mode
imagings on different probe view angles is illustrated in Figure 2.
Figure 2 Probe positions at the right parasternal long axis view (A) and Motion
mode imaging (B); T: transducer, TW: thorax wall, RVW: right
ventricular wall, RV: right ventricle, S: septa, LV: left ventricle, AV:
aortic valve, AO: aorta, AMV: anterior mitral valve, PMV: posterior
mitral valve, LA: left atrium, LVW: left ventricular wall; Source: Ware
(2007). RVM: right ventricle muscular, TV: tricuspidal valve, RS: right
septa; the numbers (1, 2, 3, 4) indicate the motion mode ultrasound of
each level at the right parasternal long axis view.
Heart Ultrasonography
Heart size is important when evaluating cats for cardiac diseases (Chandler
et al. 2004; Ghadiri et al. 2008). Diseases such as cardiac neoplasia and
lymphoma, idiopathic pericarditis, congestive heart failure, hypertrophic
cardiomyopathy, and left ventricular hypertrophy can be diagnosed using
ultrasound (Scansen 2001a; Adin and McCloy 2005; Shinohara et al. 2005; Abbot
and MacLean 2006; Schober and Todd 2010).
Measurements of the heart include intraventricular septa wall thickness
(IVS) which measures the septum between the ventricles, left ventricular internal
diameter (LVID) which measures the ventricular space and left ventricular wall
thickness (LVW) which measures the wall thickness of the ventricle. Other
measurements include the diameter of the aorta (AO) and left atrium (LA)
(Fleming 2009). The heart can be measured during diastole and systole. Diastole
5
is the time when the heart is fully relaxed while systole is the time when the heart
is in full contraction (Muzzi et al. 2006). Table 2 shows the comparison sizes of
the cat heart.
Table 2 Comparative heart size of a normal cat
Organ
Interventricular septal wall (IVS) thickness
Left ventricular wall (LVW) thickness
Left atrium (LA) internal diameter
Right ventricular wall (RVW) thickness
Right ventricular (RV) internal diameter
Fractional shortening (FS)
Size
< 6 mm*
< 6 mm* or < 1.5 cm**