Liz Bode
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Replying to Nicholas K. 16/11/2022 - 10:48
Hi Nick,
So sorry that this slipped form my radar too! In answer to your echo related questions:
For fractious cats I would use gabapentin initially – it takes the edge off them and has little effect on echo parameters so is fine to use. It will only allow you to echo those cats that are anxious and not the ones that are very aggressive – in my experience you still need something stronger for this. In cases where gaba is not enough I would use butorphanol and alfaxalone – IV if you can get access with gaba but if not IM – only issue is that IM does seem less reliable but it is only a small number of cats where you would need something other than IM butorphanol and alfaxalone.
Liz
Replying to Thaleia M. 27/11/2022 - 19:55
Hello Thaleia,
This is a good question. Cats are so tricky – we always joke that we should echo EVERY cat (or perform NTproBNP) as you never know which one has heart disease and which doesn’t. However, if you have no abnormalities on auscultation at all, and the cat is otherwise healthy, then I wouldn’t be inclined to do anything further. Then if things change later in the cats life you could always perform NT-proBNP at that point (or echo if you can).
Liz š
Hi both,
Great to see you guys on here too š I hope you get something from it. Last year we had another ESAVS candidate and she really enjoyed it, so fingers crossed!!
Absolutely, ask about other certificates in the UK. I am module coordinator for the Improve Distance learning Cardio Cert and for the Liverpool CertAVP but I have limited knowledge of any others. Sadly, none combine theory with practical echo as far as I am aware.
Liz
Replying to Laura T. 14/11/2022 - 16:07
Hi Laura
Great to have you joining us. I hope that you find the course useful and I look forward to working with you over the coming weeks.
Liz
Replying to Kathryn B. 01/11/2022 - 11:59
Hi Kathryn (and everyone)
I made this little video running through the x-rays, so here it is. Let me know if you have any questions š
Liz
https://drive.google.com/file/d/18AKFZw4OHuoMYZbtNyW7fUjuPaa4ID6o/view?usp=sharing
Replying to Kathryn B. 26/10/2022 - 08:18
In that case itās this one! Sorry I couldnāt spot where Iād mentioned it.
https://onlinelibrary.wiley.com/doi/10.1111/jvim.15854
Liz
Replying to Kathryn B. 23/10/2022 - 20:25
Hi Kathryn,
Sorry for the delay and it was nice to ‘meet’ you last night. I’ve looked through my slides and my recording and I cannot see where I mention VHS and a paper, sorry! I do mention the VLAS score in association with a paper. It is:
https://avmajournals.avma.org/view/journals/javma/253/8/javma.253.8.1038.xml
It says you can tell if there is LA enlargement with a VLAS of >2.3 in the abstract but in the paper it is more accurate at >3.
In terms of osteomata/ vessels and neoplasia. This can be tricky. Osteomata tend to have a ventral distribution and are mineral opacity whereas vessels and neoplasia are usually soft tissue opacity. Ostemoata are also very small and there tends to be multiple of them. With vessels you can usually trace back to the origin or they overly a vessel as they turn the corner and come towards you. I guess the real solution is that if you are not sure to repeat the radiographs again in 3-4 weeks to see if there are any changes.
Liz
Replying to Sybil Dryburgh 23/10/2022 - 23:14
Hi both
Yes, this group originally did a retrospective study on this (although Iām not sure how you do a retrospective study about applying pressure and the presence or absence of a murmur!). They then went on to prove the concept with this prospective study.
In some cats, usually older and thinner cats, it is possible to place your stethoscope on the right parasternum and cause a low grade systolic murmur. The same goes with echo in some cats. When looking at the right ventricular outflow tract from the right side you can cause a dynamic obstruction due to the pressure of the probe. Another study (before we knew that some of these could be iatrogenic) back in 2004 showed that cats with dynamic right ventricular outflow tract obstruction didnāt have associated pathology or heart disease that would cause it. So, putting two and two together (and hopefully making 4) I think it would be safe to say that these cats probably donāt have pathology but due to their chest conformation you can push the heart against the opposite wall of the chest and deform the right outflow tract resulting in a murmur. When you release the pressure the murmur should disappear. Obviously, if it doesnāt disappear then another cause of the murmur might be present and if youāre not sure then echo is indicated.
I donāt think we know about dogs but I think the majority of dogs have too big a chest for this to be an issue (think how narrow cat chests are compared to a chihuahua even!)
Hopefully this answers your question but let me know if there are any others.
Liz
Replying to Kathryn B. 17/10/2022 - 18:15
That’s so sad! The last Golden I saw was a 3year old with pericardial lymphoma presenting as pericardial effusion, took me completely by surprise and had a similar outcome as they do very badly š I hope your run of sad cases changes soon.
Replying to Kathryn B. 17/10/2022 - 16:19
Hi Kathryn,
Ooh drainage of big dogs like this can take AGES!!! Iād use a Mila chest drain in these cases as youāll find them much faster and should reach further into the chest cavity as it probably was the length of your needle that was the limiting factor. You can suture them in for a few days. However, if youāve drained the chest and it keeps recurring for longer term management Iād use a pleural port ideally (depending on the source of the effusion). A haemorrhagic effusion in a golden retriever doesnāt sound great šReplying to scott@vtx-cpd.com 17/10/2022 - 13:52
Hi Scott
Thanks for this and providing the hydrocodone dose.
I was at a stenting course recently and the course leader used lofenoxal @ 0.2-0.5mg total dose BID as a cough suppressant. Have you used this before? I believe itās very effective but now needs an import licence?Liz
Replying to Emma Holt 06/10/2022 - 15:49
Hi Emma,
The cut-off for myocarditis is unclear, but I would be more suspicious if the cTNI was >1. I think most cardiologists go by this too. Generally they are well above this in the acute stages. It is good to be mindful that chronic myocarditis (at least in people) may have normal or only mildly elevated cTnI, but they usually have a DCM phenotype.
Liz
Replying to leonique v. 05/10/2022 - 15:33
Hi Leo,
Sure no problem (probably my accent and slurring the words). What we want in pulmonary hypertension is a PDE5 inhibitor as this increases level of nitric oxide resulting in vasodilation of the arteries. This is what sildenafil does in particular within the pulmonary vasculature. Pimobendan is a PDE3 inhibitor and cause arterial dilation via changes to calcium levels in systemic and probably pulmonary vessels. The recent consensus statement on pulmonary hypertension states that pimobendan should be used in cases of post-capillary pulmonary hypertension, ie that caused by left heart disease, but itās use in pre-capillary hypertension (pul hypertension due to airway disease) has not been studied so itās use in this situation is unclear. I was referring to cor pulmonale in the lecture – where pulmonary hypertension causes right sided cardiac remodelling and in this instance pimobendan is likely indicated, especially when systolic dysfunction of the right ventricle is present.
Does that make sense?
Liz šReplying to Kelly M. 27/09/2022 - 09:17
Hi
Thanks for the great questions and sorry for the delay in replying.
I think mediastinal disease is very difficult to identify too. If thereās fluid you get the Christmas tree appearance but solid masses either cause distortion of the mediastinum in specific regions or move things like the trachea (big lymph nodes for example). Iām afraid I donāt have any examples, I rarely encounter this probably because we CT most chests.
When laryngeal paralysis is secondary to hypothyroidism the signs may improve slightly with treatment but would rarely resolve completely. I donāt think we know enough about the mechanism of the disease to understand the relationship. Iād treat the hypothyroidism and monitor the laryngeal paralysis (unless very severe) but warn the owner itās unlikely to resolve and may still get worse.
Historically we would have chosen metronidazole as part of a āfour quadrantā approach to severe AP. These days covering with co-amox will be sufficient for most pathogens and if severe cases or very poorly we would add in a fluoroquinolone. We rarely see pure anaerobes infecting the airways hence the lack of need for metro.
Hope that helps š
Liz
Hi Louise,
Poor little guy! Do you think it could be associated with small thromboembolic events? ATE is quite common in these cats sadly and micro-infarcts could be common and cause angina or pain elsewhere. It might be worth giving him rivoroxaban or apixaban alongside frusemide and clopidogrel if the LA is huge and there is smoke (if owner can manage etc). For pain Iām not aware of any great analgesic for this particular problem. Atenolol would only help if there was an arrhythmia or HOCM and as you said is contraindicated in CHF.
Gabapentin might help a little. I checked with an anaesthesia colleague of mine too and that is what he suggested as minimal
Cardiovascular side effects. Although how good it would be for visceral pain in a case like this is debatable. Might be worth a shot though?Liz
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