Disopyramide reduces the left ventricular outflow tract (LVOT) pressure gradient and improves symptoms in humans with
hypertrophic obstructive cardiomyopathy (HOCM). However, the efficacy of
disopyramide in cats has not been reported. We treated a cat with HOCM with
carvedilol and
disopyramide cotherapy and monitored the changes in LVOT flow velocity and N-terminal pro
B-type natriuretic peptide (
NT-proBNP) concentration. A 10-month-old neutered male Norwegian Forest cat was referred with a moderate systolic
cardiac murmur. Echocardiography revealed thickening of the left ventricular wall, systolic anterior motion of the mitral valve leaflets, and turbulent aortic flow in the LVOT at systole. The LVOT flow velocity was 5.6 m/s. The plasma
NT-proBNP concentration exceeded 1,500 pmol/L. The cat was diagnosed with HOCM and the β-blocker
carvedilol was started and gradually increased to 0.30 mg/kg, bid. After 57 days, the LVOT flow velocity (4.8 m/s) and plasma
NT-proBNP concentration (870 pmol/L) had decreased but remained elevated. Therefore,
disopyramide was added at 5.4 mg/kg po bid and increased to 10.9 mg/kg po bid after 22 days. After 141 days of
carvedilol and
disopyramide treatment, the systolic anterior motion of the mitral valve leaflets had disappeared and the LVOT flow velocity and plasma
NT-proBNP concentration had decreased to 0.7 m/s and 499 pmol/L, respectively. No adverse effect has been observed during the follow-up.
Disopyramide might relieve feline
LVOT obstruction after only partial response to a beta-blocker. Further large-scale studies are required to investigate the efficacy and safety of
disopyramide use in cats with moderate to severe HOCM.