Upgrade to Pro — share decks privately, control downloads, hide ads and more …

Feline Medicine Module 1 - Case

Feline Medicine Module 1 - Case

VetIndex

March 02, 2021
Tweet

Other Decks in Education

Transcript

  1. Signalment: 2-year-old MN Oriental. Indoor/outdoor, preventative healthcare up to date.

    History: 2-week history of tachypnoea, mild lethargy and inappetance. Presenting signs: Arrived at clinic dyspnoeic, respiratory rate 80 breaths per minute, open mouth breathing. You get called to the waiting room to deal with the case. QUESTION 1: Describe your initial actions in managing this case > Go to next page for answers Module 1 Case – Zulu
  2. QUESTION 1: Describe your initial actions in managing this case

    ANSWER: A cat that is so tachypnoeic may be very unstable so should be moved to a quiet area, and oxygen provided before attempting further diagnostic tests. Depending on the response an IV catheter may be placed, and sedation with butorphanol may be required. EMLA can be used prior to catheter placement. Consider stress and noise around the cat and balance observation vs stress of busier areas of the clinic. After putting the cat in an oxygen cage and moving all other animals into another area to reduce stress, his respiratory rate settles a little, he stops mouth breathing, calms down and you can observe the respiratory pattern. It is rapid and shallow, with equal inspiratory and expiratory phases. He has stopped open-mouth breathing. QUESTION 2: What are the most likely causes of this respiratory pattern and why? > Go to next page for answers
  3. QUESTION 2: What are the most likely causes of this

    respiratory pattern and why? ANSWER: This respiratory pattern is described as restrictive and seen in cases of pleural space disease or severe pulmonary parenchymal disease such as pulmonary oedema, severe lower airway disease, infection etc. Zulu has settled enough for a full examination. Significant results are as follows: • Systolic grade heart murmur audible on both sides of the thorax, grade 4/6 • Occasional arrhythmia • Soft crackles on pulmonary auscultation • Tachycardia (HR 210) • Temperature 36.9oC QUESTION 3: Is it likely this cat has heart disease? Why or why not based on your physical exam? > Go to next page for answers
  4. QUESTION 3: Is it likely this cat has heart disease?

    Why or why not based on your physical exam? ANSWER: The cat has a loud heart murmur. Whilst many cats without heart disease may have a murmur, they are usually of lower intensity. Additionally, this cat has an arrhythmia and a temperature below 37.5oC which the RAPID cat study showed was consistent with cardiac disease. The soft crackles also fit with pulmonary oedema although any fluid in the alveoli will produce this finding. QUESTION 4: What diagnostic tests will you perform first and why? > Go to next page for answers
  5. QUESTION 4: What diagnostic tests will you perform first and

    why? ANSWER: The cat is unstable and restraint for radiography or positioning in lateral recumbancy could cause acute decompensation. Ultrasound would be the least stressful and would identify effusion, the LA could be examined, and the presence of B lines on pulmonary ultrasound may be identified. Other tests would include DV thoracic radiograph, and measurement of NT-proBNP (if a bench side test is available). QUESTION 5: What conclusions can you draw without any further echocardiographic measurements? > Go to next page for answers Echocardiography was performed with the cat standing, this image was obtained (right parasternal long axis view). Thoracic ultrasound was performed and showed multiple B lines throughout the thorax (see image).
  6. QUESTION 5: What conclusions can you draw without any further

    echocardiographic measurements? ANSWER: More than 3 B lines is consistent with a ‘wet lung’ due to pulmonary oedema (less likely bronchopneumonia/contusions). The echo view shows a large, rounded left atrium, that would not fit once into the left ventricle consistent with left atrial enlargement. There is no evidence of pleural effusion. The left atrium even without measurement can be seen to be rounded (rather than square) and certainly you could not fit 2 inside the left ventricle. The short-axis view may have confirmed the finding that the LA was >1.5 times the diameter of the aorta and allowed accurate measurement of the LA – but it is not necessary during this emergency treatment. QUESTION 6: How will you treat this cat? (Go to next page for answers)
  7. QUESTION 6: How will you treat this cat? The cat’s

    clinical signs and the enlarged LA are consistent with congestive heart failure. As there is no pleural effusion to drain, pulmonary oedema is assumed and should be treated, initially with furosemide IM (could be IV but due to the cat’s instability restraint for IV placement is not ideal). The cat was treated with 2mg/kg furosemide IM and placed back into the oxygen cage. There was an improvement, with inspiration becoming less shallow. The furosemide was repeated 30 minutes later at 1mg/kg. QUESTION 7: What are the risks of giving higher doses of furosemide to cats? > Go to next page for answers
  8. QUESTION 7: What are the risks of giving higher doses

    of furosemide to cats? ANSWER: Doses of up to 8mg/kg are mentioned in some textbooks, but cats are sensitive to furosemide so using increments of 1-2mg/kg and assessing response is advised. Additionally, changing to oral furosemide as soon as possible may prevent complications such as dehydration and hypokalaemia. A vicious cycle can be dehydration, inappetence, inability to medicate, deterioration and so on. Once the cat became more settled a full echocardiogram was performed and he was diagnosed with hypertrophic cardiomyopathy and congestive heart failure.