Help with severely dyspnoeic cat

RE: Help with severely dyspnoeic cat

Elliot Kneba — Fri, 14 Apr 2017 03:47:26 GMT

[quote user="David Mills"]Here's a quiz question - does anyone know why cats get pleural effusion with left sided failure but dogs don't?[/quote]

Pulmonary lymphatic positioning - they are near the visceral pleura. CHF causes lymphatic congestion, so excess fluid gets dumped into pleural space.

If you have ultrasound capabilities, you can pick up pulmonary edema and pleural effusion in <60 seconds. Check out the publications on TFAST. Very helpful, fast, and much safer than restraining for radiographs.

RE: Help with severely dyspnoeic cat

Beats — Fri, 10 Mar 2017 22:51:01 GMT

[quote user="David Mills"]I can't see how a blood test is any easier on a dyspnoeic cat than a quick probe on the rhs and an LA measurement. [/quote]

If you're draining pleural fluid anyway, and test that, I think it's complementary rather than better - a low NT-proBNP result would make me go back and look again if I'd thought was heart failure or would reassure me I probably wasn't missing something if I'd thought wasn't heart failure.

Given that, in my limited experience, neoplastic and cardiac causes of pleural effusion both have a fairly short-term outlook and risk of sudden fatal dyspnoeic suffering within a couple of months, I often euthanase these patients anyway irrespective of precise diagnosis. Equally, I'm probably going to treat with furosemide irrespective if not euthanasing, especially in older patient.

[quote user="David Mills"]Here's a quiz question - does anyone know why cats get pleural effusion with left sided failure but dogs don't?[/quote]

Differences in pulmonary and pleural anatomy?

Greater incidence of right-sided heart failure either as part of primary cardiac pathology or secondary to pulmonary arterial hypertension?

RE: Help with severely dyspnoeic cat

David Mills — Fri, 10 Mar 2017 22:06:39 GMT

I can't see how a blood test is any easier on a dyspnoeic cat than a quick probe on the rhs and an LA measurement.

Here's a quiz question - does anyone know why cats get pleural effusion with left sided failure but dogs don't?

RE: Help with severely dyspnoeic cat

Kate Richardson — Fri, 10 Mar 2017 20:59:31 GMT

You have to be careful in interpreting on pleural fluid tho, a negative effectively rules out cardiac cause, a positive means it is possible but not specific to cardiac disease

RE: Help with severely dyspnoeic cat

Matt Hilary — Fri, 10 Mar 2017 17:48:40 GMT

You can - lower specificity is suggested compared to pleural fluid but good sensitivity.

[quote]The POC test had good sensitivity (95.2%) and specificity (87.5%) when using plasma samples. In pleural fluid samples, the POC test had good sensitivity (100%) but low specificity (64.7%).[/quote]

RE: Help with severely dyspnoeic cat

Lucy Fleming — Fri, 10 Mar 2017 15:53:53 GMT

[quote user="shanley barber"]We have recently got some cardiac proBNP snap tests in for this type of case- when you need to decide if a dyspneic cat is cardiac or respiratory. Obviously a snap test is just one of several diagnostic tools, before someone else adds this......[/quote]

I feel like I heard at some CPD recently that you can also use pleural fluid for a snap - to give an idea whether it is likely to be cardiac or more likely to be something else (eg neoplastic) after you have tapped the chest. We don't keep the snaps in, but if we did I'd be keen to do this as it would require less restraint!

RE: Help with severely dyspnoeic cat

shanley barber — Thu, 09 Mar 2017 20:09:48 GMT

We have recently got some cardiac proBNP snap tests in for this type of case- when you need to decide if a dyspneic cat is cardiac or respiratory. Obviously a snap test is just one of several diagnostic tools, before someone else adds this......

RE: Help with severely dyspnoeic cat

vs0u — Wed, 08 Mar 2017 12:05:32 GMT

[quote user="janine redman"]the heart which was paradoxically slow at 128 bpm[/quote]

I was told once at a cpd that a low heart rate with dyspnoea meant heart failure (as it should be very fast if the animal can't breathe/is stressed, so if it isn't, it's because it can't go any faster)

RE: Help with severely dyspnoeic cat

Anthony Todd — Sun, 05 Mar 2017 20:45:51 GMT

Confirmed with echocardiography, severe hypertrophic cardiomyopathy, with poor contractility

How old was the cat? How long for signs to develop?

[quote user="David Mills"]Lovely lobar sign on the lateral thst and the oedema = chf most likely[/quote]

Wow, defo one to you, I'd have thought?

RE: Help with severely dyspnoeic cat

janine redman — Sun, 05 Mar 2017 20:37:16 GMT

Confirmed with echocardiography, severe hypertrophic cardiomyopathy, with poor contractility

RE: Help with severely dyspnoeic cat

Anthony Todd — Sun, 05 Mar 2017 15:42:02 GMT

[quote user="janine redman"]confirmed heart problem today[/quote]

How was it confirmed, what sort of "heart problem", and why was that diagnosis made?

Not a criticism, censure, condemnation, or rebuke, just asking......

RE: Help with severely dyspnoeic cat

Rob Loxley — Sun, 05 Mar 2017 12:53:52 GMT

[quote user="grumpyoldman"]My only other thought was paraquat, not seen any recently[/quote]

Good thing it was banned in Europe

RE: Help with severely dyspnoeic cat

janine redman — Sun, 05 Mar 2017 08:03:21 GMT

Did consider that, never seen it but thought the time course over three days was too long. After four hours on lasix and very minimal improvement I thought about it again .

RE: Help with severely dyspnoeic cat

grumpyoldman — Sat, 04 Mar 2017 23:56:26 GMT

My only other thought was paraquat, not seen any recently but the oedema was very similar, but they were unresponsive to anything.

RE: Help with severely dyspnoeic cat

Anthony Todd — Sat, 04 Mar 2017 22:46:25 GMT

[quote user="Jill Butterworth"]

Some emergency CPD I went on recommended a sub cut single combined injection of 'lazydexyterbutaline' i.e. furusomide/dexomethasone/terbutaline for those 'so sick you daren't get them out of the box' dyspneic cats.

[/quote]

Yes, heard of similar cats dying during positioning for an un-therapeutic xray.......

And I also ask for the contraindications of "lazydexyterbutaline" apart from the noble, but definitely secondary, consideration of a definitive diagnosis in a really critical cat where, apart from a diaphagmatic hernia or hydrothorax [would have been a possibility, surely??] the treatment was going to be pharmaceutical.

RE: Help with severely dyspnoeic cat

Jill Butterworth — Sat, 04 Mar 2017 22:08:59 GMT

RE: Help with severely dyspnoeic cat

Beats — Sat, 04 Mar 2017 21:47:17 GMT

[quote user="janine redman"]Thanks everyone - confirmed heart problem today[/quote]

for my own learning - how did you confirm heart problem? Repeat radiographs after furosemide showing resolution of white lungs?

RE: Help with severely dyspnoeic cat

janine redman — Sat, 04 Mar 2017 20:43:30 GMT

It was one of my main differentials and one of the reasons I asked on this forum. Whether or not to give some steroids. My main differences were that the lungs seemed too radiodense and most of my asthma cases occur in summer and autumn. Also I really struggled to hear the heart which was paradoxically slow at 128 bpm with a weak pulse. But with such a dyspnoeic cat in the middle of the night one doubts oneself

RE: Help with severely dyspnoeic cat

Noweia — Sat, 04 Mar 2017 20:15:15 GMT

[quote user="Tomás Basto"]Why is feline asthma discarded?[/quote]

With asthma I would expect more of a bronchial pattern?

RE: Help with severely dyspnoeic cat

Tomas B — Sat, 04 Mar 2017 17:00:52 GMT

Why is feline asthma discarded?

RE: Help with severely dyspnoeic cat

janine redman — Fri, 03 Mar 2017 20:05:38 GMT

Thanks everyone - confirmed heart problem today

RE: Help with severely dyspnoeic cat

janine redman — Fri, 03 Mar 2017 05:58:25 GMT

Have given 4mg/kg every 2 hours and although it was very slow to respond initially he has gone from lateral to sternal recumbency now. Hopefully my colleague will scan him later.

RE: Help with severely dyspnoeic cat

janine redman — Thu, 02 Mar 2017 23:01:42 GMT

Thanks, heart difficult to auscultate under pulmonary noise but about 128 bpm. Have tried echo but not a strong point of mine. Is only seven , had a cat fight 6 weeks ago and no detected issues when sedated at other practice.

RE: Help with severely dyspnoeic cat

David Mills — Thu, 02 Mar 2017 22:53:38 GMT

Lovely lobar sign on the lateral thst and the oedema = chf most likely

. Needs iv frusenide q1-2 h at 4-6mg/kg until rr under 40. Pimobebdan 1.25mg sid wouldn't do any harm either.

RE: Help with severely dyspnoeic cat

Robin Grimmer — Thu, 02 Mar 2017 22:42:48 GMT

Alveolar pattern most likely pulmonary oedema. Have you got any other evidence of heart failure? Eg murmur, arrythmia, tachycardia etc. I would do an echo and check T4 levels.