Liz Bode
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Replying to scott@vtx-cpd.com 29/08/2023 - 16:56
Hi Scott
Unfortunately for the owner it was detected 3 weeks after he rescued him at a routine vaccination. The dog is asymptomatic at present 🙂
Liz
Hi Lauren
Great to have you join us and I’m pleased you’re enjoying it so far.
For a PDA you can see them both on the right parasternal short axis view optimised for the PA and the left cranial view again optimised for the PA. I find the left cranial view gives you much clearer images than the right sided ones though. The trick is to put your probe right where you feel a thrill and then with a few small adjustments it usually comes into view. If you can’t see the whole thing you can often appreciate the flow across it on colour or with continuous wave Doppler.
Liz
Hi Nadine,
Thanks for the question. I tend to avoid it because it increases the risk to the cat (albeit small) and the cost for the owner. I find that 75% of cats will tolerate a complete echo with 2 handlers in a quiet dark room fine. About 15% will need gabapentin prior to the echo, a small number will benefit from butorphanol on top and then the remainder will need the combination you describe. We know that the combination affects very little systolic function etc but it will make HOCM more challenging to identify.
Liz
Replying to Steph Sorrell 21/08/2023 - 09:51
Hi everyone,
Very excited to be on this course with the lovely and knowledgable Steph 🙂
Any cardio questions I’m more than happy to answer.
Liz
Replying to scott@vtx-cpd.com 19/08/2023 - 07:09
Hi Fran
Good question! I’m not 100% sure about the reason but several studies have demonstrated that it is poor at detecting patent infections, unless used in combination with an ELISA. This is presumably due to the amount of DNA present in blood when the adult worms are there vs when the larvae are migrating through the body.
Liz
Replying to Nadine S. 08/08/2023 - 10:41
Hi Nadine,
Welcome to the course.That’s great with regards your echo, congenitals are more complex overall so makes sense to refer these, and I am glad you enjoyed the first lecture.
Liz
Replying to scott@vtx-cpd.com 15/07/2023 - 17:53
Hi all,
Here is a little run through I prepared.
https://drive.google.com/file/d/1mz1gEYAvGt_TpE2HX7ghhz31t4Ul5tU8/view?usp=sharing
Liz
Replying to Emma Middleton 29/07/2023 - 14:42
Hi Emma,
Thanks for the suggestions. I absolutely agree, we want to be using ultrasound to look for any evidence of CHF in a cat with respiratory distress (with or without a heart murmur). The FAST scan showed a normal left atrium but multiple coalescing B-lines. How would you interpret this, what could be the cause for the B-lines? Then what would your next steps be (I see you said thoracic radiographs which I completely agree with), would you do anything else?
I look forward to hearing your thoughts.
LizHi Fran,
It certainly does have some confusing terminology associated with it!The PA is measured at the annulus, so where the valve hinges and at the point where the PA is at its widest (in systole). The Ao I measure as I would for a LA:Ao so following the line between the non- and left-coronary cusps.
Yes, certainly. In that case if money won’t allow a work-up then trying sildenafil is definitely worth it. In my experience it has little side effects, only issue being if the animal has left-sided heart disease. However, being pragmatic most of these old Westies have horrible disease and are less affected by MMVD generally!
Best wishes
Liz
Replying to Francesca Lamb 06/07/2023 - 09:17
Thanks Fran 🙂 great!
I have made a little video explanation so will post that soon, once anyone else who wants to has had a try too.
Liz
Replying to scott@vtx-cpd.com 23/05/2023 - 17:38
Hi Scott,
Sorry, I missed this one! My differential list would be a bit shorter for this type of murmur 😉
It would consist of
Mitral valve regurgitation, most likely degenerative (less likely dysplasia)
Other causes of MR could be considered, but would be rare in this case – endocarditis, DCM etc
Possibly aortic stenosis (although usually left base)
Physiological (although again usually basilar)And that is about all…
PS is left base
VSD right sternal
TR right apicalLiz
Replying to Kerry Doolin 25/06/2023 - 05:08
Hi Kerry,
Very excited to have you on board 🙂
Liz
Hi Scott,
Some nice bloods here 🙂
I’ll be interested to hear from people and you, as I am a bit rusty with anaemia cases these days 😉
Liz
Replying to scott@vtx-cpd.com 23/05/2023 - 11:51
Hi Fran,
I would agree with you and Scott. If you think how fruosemide works, it increases sodium and water loss to reduce circulating volume. In CHF we have too much circulating volume, and so this makes sense. However, non-cardiogenic pulmonary oedema is not associated with increased circulating volume and so it doesn’t make sense to use it in this case. Dehydration will definitely occur and possibly pre-renal/ renal issues. I think in people they treat the underlying cause and use only supportive treatment, oxygen, ventilation etc.
They can be challenging cases to manage and diagnose.
Liz
Replying to Francesca Lamb 15/05/2023 - 16:46
Hi Fran,
Some great questions. I’ll answer each one in turn:
Hi Liz,Do you have a maximum amount of saline that you would use in a larger dog or a cat? It is rare that we have to perform a BAL in dogs this large, coughing tends to be a problem of small-medium sized dogs. However, in the instance that we do need to do this (if there was EBP for example) then I would use a smaller volume as getting 2ml/kg in a syringe etc isn’t practical. So, I would go with 0.5ml/kg in that instance, knowing you could increase the volume if you didn’t get much back. A good sample will have froth (surfactant, demonstrating sampling of alveoli) and mucus in it.
Are you using rivaroxaban in all cases or is there a criteria for its use? There is no set protocol here. I tend to use it in cats that are particularly high risk – thrombus in the LA and very low LA fractional shortening.
Is this as a dual therapy with clopidogrel and is it used longterm? In cats that are high risk I will use both together. It depends on how easily the cats can be medicated. As we have evidence for clopidogrel, but not rivaroxaban, I would use clopidogrel first then add in the other if coping OK.
What dose do you use? 2.5mg/cat/day. There is a liquid form in the UK too, which can be helpful as it is bitter. However, this is a special and is quite expensive.
Is there evidence that cats given other anti-thrombotics have better outcomes than cats just being given clopidogrel? We don’t have evidence yet. The preliminary results from SUPERCAT (comparing rivaroxaban and clopidogrel) will be released this year so watch this space…
Best wishes
Liz
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