Treatment of Cats with Acquired CV Disease Flashcards
What four classes can cats with acquired CV disease be split into, for treatment purposes?
At risk, Asymptomatic, Post or Present heart failure, chronic refractor HF.
Is treatment of cats with acquired CV disease based on type of cardiomyopathy or stage of the disease?
Stage of disease, treat most cardiomyopathies the same way depending on the stage.
What cats may be considered at risk of cardiomyopathies? Do these cats need treatment? How can you test them?
Maine coones, ragdolls etc may be at an increased genetic risk of HCM. Mutation testing can be done on Maine Coones, may check NT-proBNP as an initial step. No treatment needed.
If a cat has a cardiomyopathy but is asymptomatic, do they need treatment?
Usually low risk factors in these cats. They usually do not require treatment. May give ACEi if LA dilated, Diltiazem, or a B-blocker for control of LVOTO but not good evidence for these drugs.
If a cat has a cardiomyopathy but is asymptomatic, what signs would you expect to be normal (i.e. what are the risk factors for these cats)?
No gallop, no arrhythmias, normal LA size, low NT-proBNP. If have any of these may consider treatment.
If a cat has a cardiomyopathy and presents with an acute, life threatening heart failure, what are your initial treatment steps? Would you give IV fluids?
Administer oxygen (oxygen cages), sedation (as dyspnoeic cats get very distressed), IV furosemide to effect, thoracocentesis if necessary (significant pleural effusions are more common than in dogs). AVOID I.V. Fluids!!!
If a cat has a cardiomyopathy and presents with mild-moderate heart failure, what treatments would you consider? Would you hospitalise these patients?
Usually treated as out patients. Furosemide is important (give initially to clear congestive signs then have to continue), ACEi also used to eliminate abnormal fluid retention.
Would you give a cat with cardiomyopathy and presents with mild-moderate heart failure drugs to decrease HR?
May give atenolol or diltiazem which help to improve relaxation. However, it is controversial, as they are also negative inotropes which may worse CHF.
If a cat has a cardiomyopathy and recurrent chronic refractory heart failure after being given furosemide and an ACEi, what treatments would you consider?
Increase the dose of furosemide. If this doesn’t work, consider adding other diuretics e.g. Spironolactone, Thiazides. For cats with systolic dysfunction, may give Pimobendan, BUT NEVER TO CATS WITH LVOTO.
What are the risk factors for a cat with a cardiomyopathy developing an aortic thromboembolism (ATE)?
Any cat with a cardiomyopathy is at risk of an aortic thromboembolism, especially when LA is dilated and poorly contractile.
What can be done to try prevent a cat with a cardiomyopathy developing an aortic thromboembolism (ATE)?
Aspirin, low molecular weight heparin, WARFARIN IS NOT RECOMMENDED.
What is the treatment protocol in managing acute aortic thromboembolism?
Analgesia (methadone, fentanyl CRI), manage acid-base abnormalities, heparin (stop thrombus extension). Pulses should return within 72 hours.
What is the prognosis for a cat with acute aortic thromboembolism?
Grave prognosis <45%
