Liz Bode
Forum Replies Created
-
AuthorPosts
-
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
Replying to Rosanna Vaughan 11/05/2023 - 14:28
Hi 👋🏻
Yes, an echo would be the best method. However, a normal NT-proBNP would make you more confident that there wasn’t a heart issue (or thyroid was causing the elevation) and if it was raised then an echo is definitely indicated. NT-proBNP is only ever good in cases with significant heart disease though and doesn’t detect mild to moderate disease well. Not sure that succinctly answers your question lol!
LizReplying to Sarah Noponen 25/04/2023 - 19:24
Hi Scott,
The age old thyroid conundrum.
In people, there is a link between DCM phenotype and hypothyroidism. In veterinary medicine there are case reports of dogs that have DCM (some with AF) that then resolve after treatment with thyroid hormone. As you point out the only paper that looked at causation in the Doberman did not show that hypothyroidism caused DCM, but that dobermans get DCM AND hypothyroidism and that this might just be a coincidence.
That being said, in a dog with DCM it is an easy screening test to do, and occasionally you do pick up the odd hypothyroid dog. Treatment may not normalise the heart size or function but certainly having low thyroid hormone will not help the heart at all. I don’t think it is worth looking at the hearts of all hypothyroid dogs though.
In terms of NTproBNP monitoring, hypERthyroidism elevates this biomarker. Hypothyroidism can change the levels in people (some reports showed increased levels that then normalised after treatment), but there are no studies looking at NTproBNP in dogs with hypothyroidism as far as I am aware.
Liz
Hi Scott and everyone on this course,
I thought I would also jump on here and say hi! It would be lovely to get to know as many of you as possible throughout the duration of this course, what you are up to, where in the world you are and so on.
I am very excited about this course and am also hoping to learn lots of new things from the variety of excellent and knowledgeable speakers that we have joining us.
Please do ask questions as you go, or save them for our final Q and A session.
Liz 🙂
Hi Scott,
Sounds like an interesting case…I’d be keen to see an ECG and echo. I would assume that the echo will show MR due to MMVD given the age, breed and type of murmur. Grade 2/6 wouldn’t worry me in this case, if other things weren’t going on, but given the other signs an echo is indicated.
I’d definitely be repeating bloods here, 2 months is a long time. SSS is still a possibility, even with a HR of 75bpm, but the absence of response to theophylline possibly makes high vagal tone the cause of any bradycardia, although I would want an ECG and usually a Holter too…
So, for me, repeat bloods inc electrolytes, ECG, urine analysis, possibly a holter, echo
Liz
Replying to scott@vtx-cpd.com 13/04/2023 - 10:29
Hi Scott,
Yes, a Holter is still the gold standard. The study above hasn’t been validated in terms of application to the aim of a 24 hour heart rate <125bpm (although it would appear that there is likely to be a good correlation), plus many dogs have ventricular arrhythmias that a Holter picks up that the above method wouldn't.
Liz
Hi Scott,
Great question – the relationship between the heart and thyroid hormones is fascinating in terms of physiology/ pathophysiology.
At Chestergates we currently scan all cats coming through for radioiodine treatment. I would say that the majority have some degree of hypertrophy, how much of this is primary HCM vs secondary to hyperT4 is difficult to know until you scan them again post treatment. It would be a small minority that have a dilated LA and even evidence of new onset CHF, but these are the ones that we worry about in terms of putting them through treatment as we can’t handle them for a few days once they become radioactive! Hence why we look at them all, regardless of clinical examination findings.
In general, we should investigate at least the ones with a murmur, gallop rhythm or arrhythmia. As you know, a murmur is a relatively soft finding in a cat and doesn’t mean it has heart disease. In fact some cats without a murmur can be in CHF. However, in this instance if funds allow then an echo should be advised. Another test to consider would be NT-proBNP, but hyperthyroidism can increase this without significant cardiac changes and so it isn’t as reliable in these cats.
I’d be interested to hear other people’s experiences with the above.
LizHi Emma,
Fetal heart rates in a dog will be similar to a cat’s adult rate. So frame rate of your machine won’t be a limiting factor in measuring it. I also doubt that it will be a limiting factor in a cat’s foetus eithet. When they look at the fetus in human ultrasound they never count the rate, I think they just have a feel that it’s fast (which is usually good) or slow (which usually isn’t).
Hope that answers your questions?
Liz
-
AuthorPosts