What would you do with this cat?

RE: What would you do with this cat?

Julie Innes — Fri, 26 Jan 2018 09:15:20 GMT

Hi Anthony, I saw the cat (in an evening surgery, unfortunately, as that was all they could manage) a couple of days ago. The cat has been well, still asymptomatic. I did stick the scanner on it, but as I suspected I couldn't really get anything meaningful- just a very fast heart rate! Couldn't get the cat to sit still, which, combined with too big scan head meant getting a wall thickness measurement of any kind was impossible. I couldn't hear a murmur today, though.

Had a long discussion with the owners- they feel the cat is well and they are reluctant to pursue further investigation. I am going to have the cat back in a couple of weeks to reassess it's heart rate, if it's still that high we might trial atenolol, they are aware we don't have a diagnosis and would only be doing it to try to reduce the risks of clots etc. We shall see..

RE: What would you do with this cat?

Anthony Todd — Thu, 25 Jan 2018 16:23:12 GMT

Any update?

RE: What would you do with this cat?

Michael Woodhouse — Sun, 21 Jan 2018 03:05:31 GMT

[quote user="Kate Richardson"]Failing all of that, remember the cat is asymptomatic, it doesn't know it might have a heart problem therefore it won't worry about sudden death/clots/heart failure, but do warn the owners [/quote]

That's all I'd do if it was my cat!

RE: What would you do with this cat?

Kate Richardson — Sat, 20 Jan 2018 16:54:51 GMT

Absolutely. Put it down as cpd!

RE: What would you do with this cat?

Julie Innes — Sat, 20 Jan 2018 16:08:03 GMT

Cat doesn't seem to be polyphagic, but they have another cat, so but vague.

After my success with other case I think I will attempt to get some kind of look with my scanner! Can't hurt..

RE: What would you do with this cat?

Roland Bulkyn-Rackowe — Sat, 20 Jan 2018 13:26:09 GMT

A couple of thoughts:

- Regarding the weight loss, is the cat polyphagic? Have they seen any faeces?

- For home monitoring of the possible cardiac disease, I ask the owner to check the sleeping respiratory rate and get a cheap ebay stethoscope (£2!) and check the heart rate at home.

-I would also do an echo, even with a totally inappropriate probe you can get some sort of long axis view of the heart. The main question being is there a large left atrium, the second being is there ventricular hypertrophy? Could you ask your visiting sonographer how to get these images with your scanner?

RE: What would you do with this cat?

Rob Loxley — Thu, 18 Jan 2018 15:04:50 GMT

[quote user="Julie Innes"]just after musing this morning that I should really have bought that cardiac probe I promised myself when I originally bought the ultrasound, I've now had another case today where we needed to have a look at the heart! Cardiologist is coming to scan that one later. Is the universe telling me to buy a cardiac scan head??!![/quote]

For 2D scans can you not do a decent job with a micro-convex probe? Ultrasound suppliers seem very keen to suggest something more fancy, which is overkill for basic 2D work?

RE: What would you do with this cat?

Julie Innes — Thu, 18 Jan 2018 14:35:36 GMT

Will do!

Ironically, just after musing this morning that I should really have bought that cardiac probe I promised myself when I originally bought the ultrasound, I've now had another case today where we needed to have a look at the heart! Cardiologist is coming to scan that one later. Is the universe telling me to buy a cardiac scan head??!!

RE: What would you do with this cat?

Anthony Todd — Thu, 18 Jan 2018 11:42:42 GMT

[quote user="Julie Innes"]Thanks again for all your input![/quote]

Let us know though, or I won't give you any more vital help.....

RE: What would you do with this cat?

Julie Innes — Thu, 18 Jan 2018 11:25:20 GMT

Thanks all!

Yes, I have warned the owners re risk of sudden death. Not sure they believed me though!

Our ultrasound probes are unfortunately too big for getting a decent picture between the ribs, really just use it for abdominal scans, so I don't think I would manage to get anything meaningful I'm afraid!

I know hyperthyroidism seems really unlikely in a cat this age, but I remember seeing an obese 4 year old cat at vet school that turned out to be hyperthyroid, so I'd feel stupid if I missed it, think I'd at least want to rule it out, and it's a cheap in house test. Given the weight loss (and before I'd consider sedating this cat, or starting down the route of further investigation of its heart issue) I'd like to at least check his kidneys etc, again, cheap and in-house. Also lets me keep the cat in for the morning so I can re-auscultate/ watch it at rest/ see if it is actually eating (O's have another younger cat, so not sure) Might also be able to get a urine sample while it's in.

Thanks again for all your input! <makes mental note to get round to buying that cardiac probe I promised myself when I bought the machine originally>

RE: What would you do with this cat?

Rach — Thu, 18 Jan 2018 11:17:54 GMT

Haha, what Kate says, we must have been simultaneously typing!

RE: What would you do with this cat?

Kate Richardson — Thu, 18 Jan 2018 11:09:03 GMT

Personally, I would skip the bloods (or at least hang fire for a couple of months and see if continues to lose weight and then think about checking T4). Depending on your scanning skills, I'd see if you or a colleague can have a look at the LA size and subjectively see if ventricles look hypertrophic.

I would also ask the owners to see if they can measure heart rate at home, generally fairly easy just by placing hand around chest.

If HR is consistently high/LV thickening, then I would start a low dose of atenolol (after discussing usual risks/benefits without a specific diagnosis obviously!), and if LA enlarged, low dose aspirin 2-3 times weekly as very cheap, just get them to monitor faecal colour for melaena.

Failing all of that, remember the cat is asymptomatic, it doesn't know it might have a heart problem therefore it won't worry about sudden death/clots/heart failure, but do warn the owners

RE: What would you do with this cat?

Rach — Thu, 18 Jan 2018 11:08:40 GMT

Assuming the rhythm was regular I’m not sure an ECG would add much (in my hands at least) I think you need to look for the underlying pathology behind thevtachycardia rather than reaching for atenolol at this stage. I would suspect HCM in this cat, and if I had to choose one diagnostic ‘test’ I would put the scanner on it’s heart - even if they can’t afford/cat won’t tolerate a ‘full echo’ a few minutes would probably be enough to eyeball the myocardial thickness, just make sure the owners are aware of the limitations of this type of scan and you have nothing to loose, just charge accordingly. Honestly if you can do a half-decent abdominal scan you can assess the myocardial thickness, there is some debate as to the cut off thickness but iirc it’s 6-8mm but there is an argument that you should just eyeball it. Think Mike Martin has uploaded a load of images of normal and abnormal echos on here that are worth looking at.

If they wouldn’t go for that then pro-BNP, but then if its raised you need an echo and if it’s not, your not much further forward. Would ideally run a T4 too, but that’s behind HCM on the differentials for me.

Oh, and should have started with the freebie - get them to measure resting respiratory rate at home.

and yes warn re sudden death/clots etc.

RE: What would you do with this cat?

Anthony Todd — Thu, 18 Jan 2018 10:43:01 GMT

If it wasn't for it's age a T4 would be odds on to give a diagnosis if you were only going to do one thing, so I'd do that.

The mean age of discovery is approximately 13 years, with a range of 4-22 years. ...

Just a cherry-pick from the web but records are made to be broken.......

RE: What would you do with this cat?

Edward Jones — Thu, 18 Jan 2018 10:34:50 GMT

I agree with Martin. I'd suggest to ensure the owners are aware the cat might drop dead suddenly, and to look out for dyspnoea.

RE: What would you do with this cat?

Julie Innes — Thu, 18 Jan 2018 10:30:03 GMT

They're not great clients, as in really only saw them for neutering/ kitten vac's, but they are nice enough, and he is a nice wee cat! I'll probably do bloods, see if I can get an ECG and go from there. I won't charge for the ECG, as I'm not sure I'll get a good one on this wee guy (not being great at it ), but would do it for my own interest. I'm slightly hesitant to sedate him for an xray without having a bit more info! I'll let you know how it goes!

RE: What would you do with this cat?

Martin Atkinson — Thu, 18 Jan 2018 09:43:11 GMT

[quote user="Julie Innes"]I have a horrible feeling the money will run out at that point and we will never see it again...[/quote]I guess it depends how much you want to treat the cat and how empathetic you are with the owners. An ECG and X-ray effectively costs you next to nothing, depending how much you can do in-house and how much has to go away bloods and a TT4 would only cost £50 or so. There are bonded clients I would bend over backwards to help but if they're just chancers/poor value clients I'd not be inclined to help because they're just taking advantage of your goodwill. But in the end if they're that strapped then is there any point in investigating if they're not likely to treat this long term if necessary?

RE: What would you do with this cat?

Julie Innes — Thu, 18 Jan 2018 09:21:27 GMT

Thanks Martin! It's coming back for a recheck on Monday, and my thought was to have it in for bloods, could always see if we can get an ECG at the same time.

I have a horrible feeling the money will run out at that point and we will never see it again...

As the cat is asymptomatic, they aren't too concerned, iyswim

RE: What would you do with this cat?

Martin Atkinson — Thu, 18 Jan 2018 09:17:19 GMT

If its not going for echo, I'd perform an ECG first, hyperthyroidism is rare in such a young cat but not unknown so do a T4, a general biochemistry screen + Na & K and hematology (does it look anaemic?), radiography, NT proNBNP, in that order until the money runs out. Don't give any meds until you have an ECG.