feline arterial thromboembolism Flashcards
pathophysiology
thromus forms within left side of heart
thrombus dislodges and carried throughout systemic vasulature until it becomes lodged
obstructs affected artery preventing perfusion of all tissues downstream
collateral vessels constrict as well (serotonin or thromboxane)
etiology
formed in left atrial due to Virchow’s triad (alterations of endocardial surface, blood flow or composition of blood)
blood stasis secondary to atrial enlargement
can be associated with any cardiac disease
site of thromboembolism occlusion
saddle locatin at aortic trifurcation (71%)
smaller TE may lodge further downstream causing unilateral limb paresis
brachial artery-forelimb affect
cerebral, renal or mesenteric arteries
occlusion of limb perfusion
acute onset of lameness, plegia or paralysis of affected limbs
painful
musculature firm
pulses are weak/not there
nail beds and pads-pale to cyanotic
cool to touch
manifestation of shock and pain
maldistributive, cardiogenic or both
rectal hypothermia
azotemia-pre renal azotemia due to lack of perfusion
congestive heart failure
radiographic or necropsy evidence of CHF is common
diagnosis
Five P’s: pulselessness, pain, pallor, paresis and poikilothermia
presence of cardiac disease
increases in AST and CK due to muscle damage
DDx of acute loss of limb function
spinal cord disease (IVDD, spinal neoplasia, embolism, trauma, FB)
peripheral neuropathies
acute intracranial disorders (embolism, trauma, shock, neuroglycopenic crisis, toxicity)
treatment
analgesia
systemic perfusion and additional support
CHF management-furosemide, cage rest, oxygen supplementation, thoracocentesis
thrombolytic therapy (tissue type plasminogen activator, streptokinase, urokinase)
anticoagulant therapy
predictors of survival to discharge
1 limb affected
some motor function
higher rectal temperature
higher heart rate
lower serum phosphorous
prevention
thromboprophylaxis
recommended for previous ATE events, all cats with left atrial enlargement, hypercoagulable states
