pericardial effusion in cat

RE: pericardial effusion in cat

Evelyn Barbour-Hill — Thu, 03 Oct 2019 01:25:11 GMT

[quote user="Dave Dickson"]

Hmmm. Doesn't seem to like MP4 or .mov

Let me know if you can see them.

[/quote]

They all open straight away in QuickTime.

RE: pericardial effusion in cat

Joyce Whitehead — Wed, 02 Oct 2019 21:11:15 GMT

I can see them on iPad, that is a pretty impressive effusion!

RE: pericardial effusion in cat

Dave Dickson — Wed, 02 Oct 2019 20:09:17 GMT

And this...

www.vetsurgeon.org/.../Cat-CM-CHF-PE-LAAo.mp4

RE: pericardial effusion in cat

Dave Dickson — Wed, 02 Oct 2019 20:08:49 GMT

Try these...www.vetsurgeon.org/.../Cat-CM-CHF-PE-RPLA.mp4

RE: pericardial effusion in cat

Kate Richardson — Wed, 02 Oct 2019 17:57:47 GMT

Can view the last one you posted (but only 1-2 secs) but not the 3 above. I plan to tap my kitten's PE tomorrow, FeLV pro virus PCR was negative. Kitten still v bright. Repeating FeLV Ag now as well. Rethinking FIP!!!

RE: pericardial effusion in cat

Ian Johnson — Wed, 02 Oct 2019 17:17:10 GMT

These work well when downloaded on iPhone. That’s a pretty big pericardial effusion!

RE: pericardial effusion in cat

Dave Dickson — Wed, 02 Oct 2019 15:50:35 GMT

Hmmm. Doesn't seem to like MP4 or .mov

Let me know if you can see them.

RE: pericardial effusion in cat

Dave Dickson — Wed, 02 Oct 2019 15:49:52 GMT

Not sure the videos will work (anyone know the best format to try?) so will try another way...

www.vetsurgeon.org/.../Cat-CM-CHF-PE-LV.mp4

RE: pericardial effusion in cat

Dave Dickson — Wed, 02 Oct 2019 15:14:31 GMT

Hi again Kate.

Because everyone loves an anecdote (best form of evidence, right?) I've seen three cats in CHF in two days. Two had a small/tiny PE, then one today (history of ascites and SQ oedema, responding well to frusemide) looked like this...

Thought you'd enjoy this one :)

Dave

www.vetsurgeon.org/.../Cat-CM-PE-CHF-RPLA-2.mov www.vetsurgeon.org/.../Cat-CM-PE-CHF-LAAo.mov www.vetsurgeon.org/.../Cat-CM-PE-CHF-RPSA-LV.mov

RE: pericardial effusion in cat

Dave Dickson — Sat, 28 Sep 2019 14:23:30 GMT

I think I see a small PE in probably 1/4 - 1/3 of the cats I see in CHF. Often it's only a sniff, but sometimes more. However I think large PE causing tamponade is rare - I've only seen 3 cases in about 10 years. One had some weird cystic disease involving the liver and pericardium. Another had a left atrial rupture and acute haemorrhagic PE and the final one had a foreign body causing a septic effusion.

However I'm talking about seeing a thin rim of pericardial fluid, usually around the base of the heart - not a 1-2cm wide effusion. I've recently switched to using a very high resolution probe (11MHz) which makes a big difference for imaging the near field in cats.

You'll probably have a run of them now and I won't see any for 6 months!

Dave

RE: pericardial effusion in cat

Kate Richardson — Sat, 28 Sep 2019 13:18:03 GMT

Interesting that you see pericardial effusion quite often, as I really don't. I'm no expert in echos but do regularly assess LA size in a multitude of cats, incl symptomatic HCF cats, and other than the kitten I posted about on the other thread (which may or may not be cardiac as jury still out on that one!) I can't remember the last time I saw a PE!

RE: pericardial effusion in cat

Dave Dickson — Sat, 28 Sep 2019 00:38:14 GMT

Hi Beats

nice answer! It’s a long way of saying “we don’t know”! Some people (Prof Kittleson, for one) think it’s due to differences in venous drainage, though I don’t think that has been proven. It’s likely a mixture of everything - drainage, compliance, tachycardia-induced and occasionally PHT.

Whats interesting is that PE is rarely reported in the literature but I see if quite often. I think you did the right thing in draining - sometimes even removing just a small volume is enough to tip the balance back in favour of improved filling.

Let us know what you find.

Dave

RE: pericardial effusion in cat

Dave Dickson — Sat, 28 Sep 2019 00:33:35 GMT

Hi David

[quote user="David Mills"]The previous study published showed no increase in mortality. [/quote]

when you say improved survival I assume you’re discussing the Reina-Doreste paper? Not many HOCM cats in that paper. And a retrospective case series with poor controls means it’s hard to know what to base therapy decisions on. But advising that it’s safe in HOCM cases is an interesting position.

I’ve given pimo to cats with HOCM and seen a fall in systolic BP to under 70mmHg. I used to use it a lot but experience (my own, and others) has tempered my enthusiasm. And also my belief that it is a cure-all. Sure, it’s lusiotropic. But do positive inotropes work in HCM? The evidence, such as we have, is pretty weak and hasn’t been replicated.

if this cat has a left atrial diameter of 20mm then the chance of developing a clot is pretty high. Clopidogrel is a tricky drug but the new BOVA liquid formulation may help and the Summit tablets are well tolerated in most cats. Being as clopidogrel is the only drug I know of to improve outcome in cats with an ATE in a prospective controlled study then I think it’s hard not to recommend.

Based on the available data.

Interesting discussion. I think until we have a diagnosis for this poor cat, any treatment recommendations need to be tempered with a note of caution.

Dave

RE: pericardial effusion in cat

Beats — Sat, 28 Sep 2019 00:28:13 GMT

Thanks David for info, very helpful.

Is the SID pimobendan due to longer half-life in cats or not wishing to ruin fun by trying to get them to take pills in a day twice?

[quote user="David Mills"]Bonus points if you can name the anatomical difference in cats vs dogs that mean they get pce and pleural effusion in chf where dogs don't... [/quote]

I thought this was somewhat open to debate, with potentially differences in pulmonary and pleural anatomy not necessarily well recognised or a greater incidence of right-sided heart failure either as part of primary cardiac pathology or secondary to pulmonary arterial hypertension being potential explanations (e.g. https://www.onlinelibrary.wiley.com/doi/full/10.1111/jvim.14688 and https://www.sciencedirect.com/science/article/pii/S1760273416300637)?

So while, "There has been speculation that variation in feline pulmonary venous anatomy and porosity of subpleural capillary beds may underlie the development of pleural effusion in cats with left‐sided heart disease.",

"It is plausible that multiple factors could contribute to the development of pleural effusion in cats with elevated left heart/atrial pressures, including differences in pulmonary or pleural anatomical features." (all from https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2012.00967.x)

Given the complexity of the physiology of pleural fluids and pathophysiology of pleural effusions, I wonder that altered lymphatic drainage may be a significant factor too?

EDIT - I started that post then didn't finish until a bit later! That should be thank you Davids :-)

RE: pericardial effusion in cat

David Mills — Sat, 28 Sep 2019 00:12:13 GMT

[quote user="Dave Dickson"] For those listening in there actually is evidence that pimo is harmful in HOCM (presented at a conference, currently in review) so[/quote]

I'll await it's publication. The previous study published showed no increase in mortality. Given we know HCM is also systolic failure, and is a lusitrope, I'm not going to be basing any therapy decisions on a conference presentation. How many cats, out of interest? Baring in mind pinobendan is the only drug to show improved survival in cats with chf?

[quote user="Dave Dickson"]give clopidogrel [/quote]

I do have an issue with clopidogrel in cats. The only evidence is that it delays reformation of ATE compared to aspirin. It also tastes foul to cats. Would I use it in this case? No.

RE: pericardial effusion in cat

Dave Dickson — Fri, 27 Sep 2019 23:49:09 GMT

Hi Beats

the heart is huge so I think CHF is the cause of the signs. It isn’t unusual to see pericardial effusion in cats with heart failure. They often get biventricular failure but also sometimes an enlarged left heart will impinge upon the right heart causing right heart failure from reduced right heart filling (ventricular interdependence).

HCM is top of the list at any age really, but I’ve learned in cats never to guess. And it generally makes little difference what flavour of disease the cat has.

Give diuretics, give clopidogrel and probably for now that’s enough. For those listening in there actually is evidence that pimo is harmful in HOCM (presented at a conference, currently in review) so unless you are convinced there isn’t an outflow obstruction then I’d hold off for now.

The key is to get the CHF under control and not overwhelm the cat and owner with meds. CHF and clots kill cats so tackle those first. Other meds are only icing on the cake.

Dave

RE: pericardial effusion in cat

David Mills — Fri, 27 Sep 2019 23:11:29 GMT

Males far more predisposed than females to hcm.

7mls unlikely to cause tamponade. If the pressure is high enough then you'll see RA collapsing first. Ventricles rarely affected.

La of 20mm is chf regardless of cause.

Add in pimo, 1.25mg per cat sid. There's an academic thing about contraindication in hocm which isn't borne out by evidence at all.

Bonus points if you can name the anatomical difference in cats vs dogs that mean they get pce and pleural effusion in chf where dogs don't...

RE: pericardial effusion in cat

Beats — Fri, 27 Sep 2019 22:58:35 GMT

Thanks David.

Cat is male (neutered).

I've just been giving it furosemide this evening.

I've only knowingly seen about half a dozen pericardial effusions before, and were all in dogs. I assume the major difference then with this being a cat and probably having CHF as cause, is that avoid iv fluids and give furosemide (opposite of dogs then?)

Cat seems fairly stable with only 7ml drained off pericardium, and I strongly suspect that pulmonary edema is cause of increased respiration (while pericardial effusion was probably cause of pallor noted) - I'm not planning on draining any more fluid presently, will this resorb over time with furosemide treatment alone or does it tend to need drained a bit better?

I made the LA about 20mm (OK, hardly a standard view, but I assume if anything should be small with a pericardial effusion of non-CHF cause?) - the myocardium certainly looks thick, but I guess this could be false appearance (pseudohypertrophy) with poor filling of ventricles if degree of tamponade?

RE: pericardial effusion in cat

David Mills — Fri, 27 Sep 2019 22:32:28 GMT

Vast majority of pce in cats due to heart failure (think cat anatomy and why they develop pleural effusion with chf).

Cardiomyopathy very possible in young cats, there are many congenital forms. Seen many. Is the cat male?

RE: pericardial effusion in cat

Beats — Fri, 27 Sep 2019 22:17:02 GMT

the estimation of protein content by refractometer was 2.2g/dL (and poorly cellular) and I don't think FIP would explain what I believed to be an enlarged LA [I'm assuming that's not a normal finding as a result of pericardial effusion rather than cause?] - I'll see if it's possible to get any pictures, but probably not. There were no other body cavity effusions (that I'm aware of) and I believe that the basic blood sample taken was unremarkable.

Can't rule it out, but I didn't think it was terribly likely.

RE: pericardial effusion in cat

Kate Richardson — Fri, 27 Sep 2019 20:46:51 GMT

FIP?