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Questions and Answers
What is the meaning of the abbreviation 'ATE'?
What is the meaning of the abbreviation 'ATE'?
What type of cardiovascular disease is often associated with FATE?
What type of cardiovascular disease is often associated with FATE?
What is the most likely source of thrombotic material in a case of cardiogenic arterial thromboembolism?
What is the most likely source of thrombotic material in a case of cardiogenic arterial thromboembolism?
What is the most likely diagnosis for Sparky based on history and physical examination?
What is the most likely diagnosis for Sparky based on history and physical examination?
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Which of the following medications was Sparky not prescribed on intake?
Which of the following medications was Sparky not prescribed on intake?
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What is the most likely reason Sparky was treated with furosemide prior to being seen by the veterinarian?
What is the most likely reason Sparky was treated with furosemide prior to being seen by the veterinarian?
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What is the most likely reason Sparky was prescribed Plavix prior to being seen by the veterinarian?
What is the most likely reason Sparky was prescribed Plavix prior to being seen by the veterinarian?
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What is the likely cause of the spontaneous echogenic contrast within the left auricle?
What is the likely cause of the spontaneous echogenic contrast within the left auricle?
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Given the clinical signs and bloodwork results, which of these is most likely to be the primary concern?
Given the clinical signs and bloodwork results, which of these is most likely to be the primary concern?
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Which of the following medications is being used to address the hypokalemia?
Which of the following medications is being used to address the hypokalemia?
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Based on the bloodwork results, which of these conditions is most likely present?
Based on the bloodwork results, which of these conditions is most likely present?
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Which of these medications is likely being used to address the hyperthyroidism?
Which of these medications is likely being used to address the hyperthyroidism?
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What is the likely cause of the ventricular bigeminy observed on the ECG?
What is the likely cause of the ventricular bigeminy observed on the ECG?
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Based on the content, what is the most likely cause of the non-weight-bearing lameness?
Based on the content, what is the most likely cause of the non-weight-bearing lameness?
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Which of the following medications is most likely being used to address the pain?
Which of the following medications is most likely being used to address the pain?
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Study Notes
Myocardial III/ Arterial Thromboembolism
- Myocardial III/ Arterial thromboembolism (ATE) is a serious condition.
- Feline arterial thromboembolism (FATE) is a form of ATE.
- A multi-center study looked at peripheral lactate and glucose differences in diagnosing FATE.
- Affected limb lactate levels are significantly higher (median 11.5 mmol/L) than unaffected limbs (median 3.5 mmol/L).
- Affected limb blood glucose levels are lower (median 103 mg/dL) than unaffected limbs (median 250 mg/dL).
- There is a significant difference between affected and unaffected limbs in both lactate and glucose levels.
Infrared Thermography
- Infrared thermography can help diagnose problems.
- Color differences between body parts (like forelimbs and hindlimbs) can show imbalances or problems.
- This is useful in cases where other parts of the body are injured (pelvic fracture).
Clinical Case Studies Website
- This website provides access to clinical case studies for learning about diagnosis and cases.
Abbreviations
- ATE = arterial thromboembolism
- FATE = feline arterial thromboembolism
- LA = left atrium
- RV = right ventricle
- tPA = Tissue plasminogen activator
Feline Arterial Thromboembolism Review
- Feline arterial thromboembolism (FATE) is a serious condition and clinically devastating in cats.
- In FATE, the thrombotic material comes from a cardiac chamber, most often the left atrium/auricle.
- FATE is commonly associated with underlying heart conditions such as cardiomyopathy.
- Examples of cardiomyopathies that might cause FATE include hypertrophic cardiomyopathy, restrictive cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy.
- Neoplasia is a less common cause of FATE.
- FATE can be present with congestive heart failure in approximately 60% of cases.
Sparky Case Study
- Sparky is a 12-year-old MN Sphynx cat.
- Sparky presents with right forelimb lameness and tachypnea.
- Sparky had been treated with furosemide, buprenorphine, and Plavix 5 days prior at a primary veterinarian.
- Sparky currently takes prednisolone for inflammatory bowel disease and methimazole for hyperthyroidism.
Physical Exam
- Sparky is quiet and alert.
- Heart rate = 190 bpm
- Respiratory rate = 30, mild effort
- Temperature = 100.6°F
- MM pink, CRT < 2 sec
- Regular heart rhythm; no murmur
- Femoral pulses are normal
- Normal lung sounds
- No jugular distension
- Non-weight-bearing lameness on the right forelimb; swelling below the carpus, necrosis, and bruising on the right front paw.
- Blood pressure = 115 mmHg systolic
Case Question
- Based on history and physical exam, the most likely diagnosis is Brachial thromboembolism
Case 1 - Sparky in Heart Failure?
- Sparky is quiet and alert.
- Heart rate = 190 bpm
- Respiratory rate = 30, mild effort
- Temperature = 100.6°F
- MM pink, CRT < 2 sec
- Regular heart rhythm; no murmur
- Femoral pulses are normal
- Normal lung sounds
- No jugular distension
- Non-weight-bearing lameness.
Next Steps
- Further diagnostic steps are necessary.
- An ECG (electrocardiogram) should be examined, along with possible echocardiogram results.
ECG Diagnosis
- A possible diagnosis is functional tricuspid regurgitation.
- Dilated ventricles, dilated atria, decreased ventricular wall thickness, and functional mitral regurgitation are also possible conditions.
Bloodwork Abnormalities
- PCV/TP = 33%/9.0
- Hypokalemia = 3.0 (low)
- BUN = 65 (high)
- Creatinine = 1.4
- Hyperphosphatemia = 6.8 (high)
- Hypoalbuminemia = 3.1 (low)
- T4 = 4.25 (high).
Echocardiogram
- Normal left ventricle wall and interventricular septum thickness
- Mildly dilated left ventricle chamber
- Moderately dilated left and right atria
- Normal systolic function
- Spontaneous echogenic contrast in the left auricle.
Echocardiogram - Left Atrium/Auricle
- Images of the heart show detail of the left atrium.
Anesthetic Considerations
- Preanesthetic medications (methadone, midazolam)
- Induction agent (propofol)
- Fluid type (lactated Ringer Solution, LRS)
- ECG monitoring (single VPCs, ventricular bigeminy)
- Treatment for ventricular arrhythmia.
Sparky Anesthetic Protocol
- Preanesthetic medications (methadone, midazolam)
- Induction agent (propofol)
- Fluid (LRS 2 ml/kg/hr)
- ECG monitoring: single VPCs, ventricular bigeminy
- Treatment for ventricular arrhythmia possible.
Wound debridement
- The necrotic tissue needs to be removed to promote healing and avoid infection.
Aerobic and anaerobic culture
- This is tested to identify any bacteria causing the problem
Medications
- Furosemide (diuretic)
- Potassium gluconate (Electrolyte)
- Gabapentin (Analgesic)
- Methimazole (Antithyroid)
- Clavamox (antibiotic)
- Prednisolone (steroid)
- Buprenorphine (opioid analgesic)
Culture Results
- Aerobic culture: Light growth of Staphylococcus felis and moderate to heavy growth of Streptococcus canis.
- Anaerobic culture: no organisms.
Recheck 4 Days Post
- Images showing the progress of the wound after treatment
1-Week Recheck
- Images showing a follow-up after initial treatment
Recheck
- Images showing the progress of the wound after treatment
Bloodwork Recheck (2 months later).
- Data showing a bloodwork recheck 2 months after initial treatment.
- Specific values for sodium, potassium, chloride, etc., are listed here.
Management Strategies - FATE
- Treatment of life-threatening congestive heart failure (CHF)
- Assess neurologic, muscular, and vascular function
- Assess metabolic status
- Medical therapy: -Pain medication (opioids or fentanyl) -Anticoagulants and antiplatelets -Thrombolytics (rare in cats)
Which of these disease/s can lead to FATE?
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Non-specific cardiomyopathy
- Arrhythmogenic right ventricular cardiomyopathy
- Dilated cardiomyopathy
Summary
- Feline arterial thromboembolism (FATE) is a serious, potentially fatal condition.
- Cats with cardiomyopathy are predisposed to forming intracavitary thrombi (blood clots inside the heart chambers) due to blood stasis, endothelial injury (damage to the inner lining of blood vessels), or a hypercoagulable state.
- Treatment includes anti-thrombotic drugs (antiplatelets and anticoagulants) to improve blood flow, pain relief, and treatment for congestive heart failure if present.
- Survival rates are low.
Questions
- The purpose of the questions is not readily apparent from the provided information.
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Description
Explore the serious condition of Myocardial III and Feline Arterial Thromboembolism (FATE). This quiz covers diagnostic factors like lactate and glucose levels in affected limbs, as well as the use of infrared thermography for identifying imbalances. Test your knowledge with clinical case studies related to these conditions.
