Page 23 - Feline Cardiology

14 Section A: Clinical Entities

Is it syncope?

Episodic change in mentation and
Clinical Entities yes Tonic-clonic movements of the limbs
strength (weakness or collapse)

not sure/
and/or head and neck?
infrequent occurrence
→ Seizures (may no
be cardiogenic or
noncardiogenic)
Recumbency and not sure/ Have owners record
unconsciousness lasts episodes with home
>30 seconds? infrequent occurrence video
→ Systemic disorder
(anemia, abdominal
hemorrhage, polycythemia, yes no owner able
other)
→ Partial seizures owner not
SYNCOPE able
→ Narcolepsy/cataplexy
→ Behavioral abnormality
-Systemic disorder
(anemia, neoplasia, other)
abnormal
Minimum database
-Structural heart disease
Clinical neurologic exam and fundic exam
Electrocardiogram -Pathologic bradycardia
rd
nd
CBC, serum biochemical profile, UA, FeLV/FIV serology; (2 /3 degree AV block,
serum T4 if > 6 years old often with poor or absent
abnormal
Thoracic radiographs ventricular escape
rhythm; atrial standstill;
Echocardiogram
sick sinus syndrome)
normal
-Pathologic tachycardia
Advanced testing* abnormal (rapid, sustained
ventricular tachycardia)
®
Cardiac event monitor – portable (King of Hearts )
Cardiac event monitor – extended duration, implanted
®
(Reveal ) Consider transient extracardiac disorders:
-Hypoglycemia
normal
-Primary neurologic disease
*If only one episode of syncope has occurred, advanced testing may -Intermittent hypotension (mast cell tumor
or may not be performed, based on advantage (additional diagnostic degranulation, other)
information obtained quickly) versus drawbacks (cost, availability of
equipment). Severity of underlying and/or concurrent illness and
owner’s concern and perception of risk also are essential factors that
determine whether to wait for recurrence — if any — or proceed with
advanced testing. The decision for advanced testing after a single
syncopal event is a matter of frank and open discussion between
veterinarian and client.
Figure 2.1. Diagnostic algorithm for transient episodes suspected of being syncope.

discharge (peripheral arterial hypotension eliciting a tion (rise in arterial pressure in response to elevated
decrease in parasympathetic tone), the central nervous intracranial/cerebrospinal fluid pressure) (Guyton and
system ischemic response (sympathetically mediated Hall 2006). The nonchalance with which cats walk away
arterial constriction originating from hypercarbia in the from a syncopal episode and resume their activities is
vasomotor center of the medulla), and the Cushing reac- often striking to owners. A substantial exception is the