Myocardial III and Feline ATE Overview

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.