Felix

Question 1

Discuss felixs history?

Answer 1

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

Question 2

Discuss felix’s physical exam and clinical examination?

Answer 2

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

Question 3

What are felix’s clinical problems?

Answer 3

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.

Question 4

What does Felix’s ultrasounds show?

Answer 4

Question 5

Felix was treated for congestive cardiac failure secondary to myocardial disease as detailed on the next slide – can you see the rationale for this?

Answer 5

Clinical signs of HCF

Question 6

What treatment was given and why to felix?

Answer 6

• 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

Question 7

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?

Answer 7

• 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)

Question 8

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?

Answer 8

• 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

Question 9

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?

Answer 9

• 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

Question 10

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?

Answer 10

D/d:

• Haemangiosarcoma
• Myxosarcoma
• Rhabdomyosarcoma
• Thrombus
• Cyst

Could lead to atrial rupture and pericardial effusion - acute (poor prognosis)

Question 11

Discuss Felixs ongoing treatment?

Answer 11

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!