Felix Flashcards
Discuss felixs history?
History
- Male neutered 10 year old domestic shorthair cat
- Inside and outside cat who loves hunting
- Marked weight loss over the last 4 weeks despite eating normally
- Owner noticed Felix was panting when he came in from the garden yesterday
Discuss felix’s physical exam and clinical examination?
Physical examination
- Thin body condition score of 2/9
- Depressed
Clinical examination
- Pale, cyanotic mucus membranes
- Severe dyspnoea
- HR 190
- Muffled heart and lung sounds
- Gallop sounds
- Decreased chest compressability
- Weak, irregular, bilateral femoral pulses
What are felix’s clinical problems?
Clinical problems:
1.Dyspnoeic
Ddx: URT disease: FB,
LRT disease: pneumonia, pleural effusion, pulmonary oedema, heart failure
2.Cyanotic
Ddx:
URT disease: laryngeal paralysis
LRT: pneumonia other: thromboembolism, cylothorax, haemothorax, pyothorax, pleural effusion, hypoventilation, poisoning.
What does Felix’s ultrasounds show?
Felix was treated for congestive cardiac failure secondary to myocardial disease as detailed on the next slide – can you see the rationale for this?
Clinical signs of HCF
What treatment was given and why to felix?
- 150ml of pleural fluid was drained to make it easier to breath
- An i/v catheter was placed
- 2mg/kg of furosemide was given intravenously causing immediate reduction in volume overload (vasodilation)
- Felix was put in an oxygen cage and monitored closely
- 1mg/kg furosemide was given an hour later
As RR fell, intravenous furosemide continued TID.
Blood was taken after 12 hours for biochemistry and haematology
Results from his blood tests:
Routine haematology – WNL
Routine biochemistry - ↑urea
T4 normal
Hypokalaemic, K+ - 3.2 (Ref. Range 3.5-5.5))
What would you do next?
- Hypokalaemia a result of furosemide administration (not a K sparing drug) ~ lost in urine
- Urea is high ~ unspecific, could be due to dehydration or…
- …CO low, could explain why urea is high in blood as not enough to excrete via kidneys
- NB care with furosemide administration as with HCM cats are preload dependent, therefore could reduce the CO further
- Taper furosemide dose
- Give a K sparing diuretic ~ spironolactone (aldosterone antagonist)
24 hours later he is much more stable
An echocardiogram was performed
Comment on the principle features evident on the echo, in particular the relative sizes of the cardiac chambers and the thickness of the ventricular walls.
Do you know how these images might be generated?
- RPLA view
- Pericardial effusion (arrowed)
- Dilated LA
- Hypertrophied IVS and LVFW with thickened CH ~ HCM
- Smokey appearance in the RA ~ risk of thromboembolism due to slow/ static blood flow
24 hours later he is much more stable
An echocardiogram was performed
Comment on the principle features evident on the echo, in particular the relative sizes of the cardiac chambers and the thickness of the ventricular walls.
Do you know how these images might be generated?
- RPSA view at the level of the papillary muscles including chordae tendinae
- Reduced diameter of LV lumen due to hypertrophy of ventricular wall
- Pericardial effusion (arrowed)
- Irregular endocardial border
24 hours later he is much more stable
An echocardiogram was performed
Comment on the principle features evident on the echo, in particular the relative sizes of the cardiac chambers and the thickness of the ventricular walls.
Do you know how these images might be generated?
D/d:
- Haemangiosarcoma
- Myxosarcoma
- Rhabdomyosarcoma
- Thrombus
- Cyst
Could lead to atrial rupture and pericardial effusion - acute (poor prognosis)
Discuss Felixs ongoing treatment?
Furosemide ~ loop diuretic: control oedema formation, increased excretion of fluid in urine
Benazepril ~ ACEi: inhibits RAAS system, venous and arterial vasodilation, decreased salt and water retention
Kamminox ~ K supplement (liquid form for cats)
Aspirin ~ platelet aggregation inhibitor (don’t use much anymore because of GI ulceration risk)
Clopidogrel ~ platelet aggregation inhibitor
He stabilised and was able to go home 3 days following admission and is now back chasing rabbits!
