IMHA and cardiac disease?

Re: IMHA and cardiac disease?

Tony Knapp — Tue, 09 Dec 2014 22:26:46 GMT

Sorry been absolutely useless with internet, as it happens she came back for her recheck, PCV at 44% and no jugular thrill, bright as a button, so I am leaning towards the altered blood viscosity theory!

Re: IMHA and cardiac disease?

james herriot lied — Fri, 28 Nov 2014 20:56:22 GMT

Not a direct answer, Tony, but we have a similar case at the moment. Boxer with potentially multiple issues - GI, anaemia and collapse, which may of course all be related.

Essentially, always been a vaso-vagal type, without progression: transient, non-stressful and very sporadic. Bloods this week for a number of reasons. Regenerative anaemia, which we're homing in on at the moment; however, at the same time we sent off a proBNP and troponin. Former high-ish at 1520, latter wnl.

Now, my reckoning is that anaemia would increase stroke volume - and possibly effective circulating volume - and so increase secretion of proBNP. Unfortunately, getting a straight answer on this is nigh on impossible. But at the moment, it's not the first issue in any case. If the above mechanism is correct, output is high which means that in the short term at least, heart function is OK. So long as we bring the red cells up, cardiac stress should reduce and proBNP levels drop. If they don't, we have a second issue on which to focus.

My patient's not as anaemic as yours, but I still think that that'll finish him off before his heart becomes the major problem - although a trip to see the cardiologist is upcoming.

Anybody seen any work on proBNP in anaemic states, specifically in dogs? There are a few abstracts through Google, but no veterinary references.

Re: IMHA and cardiac disease?

Andrew Kent — Wed, 26 Nov 2014 08:17:31 GMT

Hi Tony,

Interesting case. As you say jugular distension is most classically associated with cardiac disease however I wonder if it is also possible with altered blood viscosity or because of thromboembolic disease. I think both would be possible.

But, I would probably at least check for a pericardial effusion for interest. Is the dog on any anti-thrombotics? What is the heart rate etc? And have you done any other imaging? In a 9 year old dog I would worry about an underlying disease which then might account for your jugular changes as well so would be screening for that.

Andy