Page 62 - Problem-Based Feline Medicine

54 PART 2 CAT WITH LOWER RESPIRATORY TRACT OR CARDIAC SIGNS

(2 mg/kg IV) and terbutaline (0.01 mg/kg IV) q30 Differential diagnosis
minutes for up to 4 h until a response is observed.
Acute marked dyspnea is most often associated with sta-
● Once stabilized cats are discharged with fluticas-
tus asthmaticus and is differentiated from cardiogenic
one (Flovent®) 220 mcg q 12 h and albuterol
dyspnea on signs, expiratory push, wheezing, prior his-
(Proventil, Ventolin) q 6 h as needed
tory of coughing and radiographic findings.
● See page 94 The Coughing Cat for details of acute
and chronic therapy
Treatment
Oxygen therapy (O chamber or tents).
2
CARDIOMYOPATHY**
Furosemide (1–2 mg/kg IV or IM).
Classical signs Provide sedation if the cat is frantic (morphine 0.1
mg/kg IM prn, or butorphanol 0.2–0.4 mg/kg IM q 4–6
● Dyspnea – mild to acute and severe with
h as needed).
cyanosis.
● Abnormal heart sounds (murmurs, gallops, If there are signs of pleural effusion, emergency tho-
arrhythmias). racocentesis in cats with severe respiratory distress
● +/- Signs of pleural effusion or pulmonary may be life saving.
edema. ● A butterfly set on a 60 ml syringe is introduced at
the 5th–7th intercostal space (ICS) on the right,
See main reference on page 128 for details (The Cat just above the costochondral junction. Remove as
With Abnormal Heart Sounds and/or an Enlarged much fluid as possible, or until breathing
Heart). improves.
Definitive therapy is based on ultrasonographic charac-
Clinical signs terization of the type and severity of the cardiomyopathy
present. See page 130 for treatment details (The Cat
Dyspnea varies from mild and associated with reduced With Abnormal Heart Sounds and/or an Enlarged Heart).
activity levels and reluctance to play, to acute, fulminant
air-starvation with open-mouth breathing and cyanosis.
PLEURAL EFFUSION**
Abnormal heart sounds (murmurs, gallops, arrhyth-
mias) may be present, or may be difficult to assess in
Classical signs
the distressed patient.
● Muffled heart and/or lung sounds ventrally.
Pleural effusion is occasionally present especially with
● Dyspnea characterized by excessive chest
DCM, and results in increased chest excursions with lit-
excursions with poor airflow.
tle airflow (can be detected by listening close to the
● Orthopnea (positional dyspnea).
muzzle during breathing) and muffled ventral sounds.
Pulmonary edema is more common especially with See main reference on page 71 for details (The Cat
hypertrophic and restrictive/intermediate cardiomy- With Hydrothorax).
opathies, and results in increased adventitial lung
sounds such as crackles.
Clinical signs
Diagnosis
Marked chest wall excursions and minimal airflow.
Definitive diagnosis is based on ultrasonographic char-
acterization of the type and severity of the cardiomy- Orthopnea (worsening dyspnea in lateral recumbency)
opathy present. and reluctance to lie in lateral recumbency.