?thrombosis in cats

RE: ?thrombosis in cats

Richard Carter — Sun, 25 Mar 2018 22:59:40 GMT

from the ISFM forum on a discussion about monitoring blood pressures and i/v fluids during GA:

ISFM-Members@groupspaces.com

on behalf of

Kieran Borgeat

Regarding the routine LA:Ao checks... I am never sure how to feel about this. I don't believe in unnecessary testing, but you could consider point of care, basic ultrasound "a visual stethoscope". We listen to every cat - but murmurs have, at best, a positive predictive value for heart disease of around 50% (so hear a murmur and toss a coin...? In reality, older cats, males, those with a grade III+ murmur and fatter cats are more likely to have HCM, just based on statistics from the Catscan project by Payne et al 2015 in JVC Feline special issue) - so why not use a visual stethoscope?

The proviso is that you are reasonably good at checking left atrial size in a reliable way. You need CPD training and a fair amount of practice to do this. But it will help you to make decisions.

Re. routine GA/fluids and CHF... I see this a lot. I hear of many more occurring than I see. There are a couple of things to consider - first, HCM is common. Affects 30% cats over 9 years old, and more in older age brackets. It is a disease of diastole, so they can't cope with higher intravascular volume. Also, GA/surgery leads to a volume retention state for 7 days or so - they won't shift the fluid easily, so the heart failure risk is not intra-op it's for up to 5-7 days post-op. Finally, look up transient myocardial thickening associated with GA - our case series is here: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jvim.14897 and open access.

Happy reading!

Kieran

Kieran Borgeat BSc BVSc MVetMed CertVC MRCVS DipACVIM DipECVIM-CA (Cardiology)

Clinical Lead in Cardiology, Langford Vets

American Specialist in Veterinary Cardiology

EBVS® European Veterinary Specialist in Small Animal Cardiology

RCVS Recognised Specialist in Veterinary Cardiology

T: +44 (0) 117 394 0513 / 0514

E: k.borgeat@bristol.ac.uk / vet-cardiology@bristol.ac.uk
W: langfordvets.co.uk

RE: ?thrombosis in cats

Kate Richardson — Sat, 17 Mar 2018 21:03:51 GMT

David Mills do you have a hypothesis as to why those cats have an enlarged LA not due to cardiac disease?

RE: ?thrombosis in cats

Julie Innes — Sat, 17 Mar 2018 20:24:50 GMT

I did a CPD recently where they said if the LA was 1.5 times the size of the aorta or more then the cat had an increased risk of thrombosis and should be put on clopidogrel.

RE: ?thrombosis in cats

David Mills — Sat, 17 Mar 2018 11:58:36 GMT

[quote user="Kate Richardson"]Do you have a link?[/quote]

In the Smith study around 30% had no cardiomyopathy on echo (65/90 did), although 90%+ had dilated LA.

The relevance of enlarged LA to thrombus formation is controversial, and it may be more related to molecular changes such as increases in TNF-a and hypercoagulable states that many cats (at least the latter point) have been shown to display.

RE: ?thrombosis in cats

Richard Carter — Sat, 17 Mar 2018 09:12:23 GMT

cat still fine, running around like nothing happened so not got cardiac disease.

The BSAVA emergency book mentions the human fibrinogen / thrombosis kits but also warns that not researched for relevance in animals

RE: ?thrombosis in cats

Kate Richardson — Sat, 17 Mar 2018 08:04:24 GMT

[quote user="David Mills"]

In a cat you only need LA and wall thickness

When I teach people basic echo all I teach them is the right sided short axis 4/5 chamber view. For cats it gives diagnosis and prognosis in one view.

[/quote]

Am so glad you said that! [quote user="David Mills"]According to the evidence upto 30% of cats with thrombosis have no cardiac disease. [/quote]

Do you have a link?

RE: ?thrombosis in cats

David Mills — Sat, 17 Mar 2018 00:23:04 GMT

[quote user="Anthony Dennison"]Speaking from experience - I'm just about now starting to get some proper echo images, for the last 12-18 months all I've been looking for is an enlarged left atrium and changes to the ventricular wall thickness. [/quote]

In a cat you only need LA and wall thickness

When I teach people basic echo all I teach them is the right sided short axis 4/5 chamber view. For cats it gives diagnosis and prognosis in one view.

Agree if concernd re thrombosis then D dimers etc way to go but bit of a fishing trip and not that well referenced in animals.

According to the evidence upto 30% of cats with thrombosis have no cardiac disease.

RE: ?thrombosis in cats

Anthony Dennison — Fri, 16 Mar 2018 22:47:14 GMT

[quote user="Kate Richardson"]

Echo? If no cardiac changes, less likely thrombus, although you can get them for other reasons which would be less likely in a fit well cat

check blood pressure as well

[/quote]

+1 for this. You could take bloods for NT proBNP and possibly fibrinogen/D-Dimers but the Echo would be the easiest thing to do. Don't have to be good at scanning either - scanning the right hand side is easier than the left I find, and you'll easily be able to see an enlarged atrium*.

Speaking from experience - I'm just about now starting to get some proper echo images, for the last 12-18 months all I've been looking for is an enlarged left atrium and changes to the ventricular wall thickness.

RE: ?thrombosis in cats

Kate Richardson — Thu, 15 Mar 2018 18:25:14 GMT

Echo? If no cardiac changes, less likely thrombus, although you can get them for other reasons which would be less likely in a fit well cat

check blood pressure as well