How to handle feline aortic thromboembolism - Veterinary Medicine
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How to handle feline aortic thromboembolism
A blocked artery caused by a thromboembolus occurs in almost one-third of cats with heart disease, resulting in devastating consequences that often start with pelvic limb paralysis. These clinicians help you detect the blockage, explore newer treatment options, recognize which treatments are not recommended, and identify prevention strategies.


VETERINARY MEDICINE


INITIAL TREATMENT CONSIDERATIONS

Often before specific treatment for ATE can begin, more life-threatening conditions need to be addressed.

Congestive heart failure

Critical initial treatment most often involves treating CHF. Standard treatment for CHF involves oxygen and furosemide. Most cats are tachypneic, but tachypnea does not always correlate with the presence of CHF. In one study, tachypnea or panting was present in 88% of cats without CHF.2 Pain and anxiety likely play a role in tachypnea in patients without CHF. Perform a thoracic radiographic examination to confirm pulmonary edema or pleural effusion before initiating treatment since diuresis caused by furosemide could impair perfusion.

Pain management

The ischemic neuromyopathy that results from ATE is extremely painful, so pain control is a priority. Most cats require an opioid to achieve adequate pain control. Hydromorphone (0.1 mg/kg intravenously every two to four hours),29 buprenorphine (0.02 mg/kg intravenously every six to eight hours),30 and fentanyl (2 to 3 μg/kg intravenous bolus followed by 2 to 3 μg/kg/hr continuous-rate infusion)31 are good choices. Butorphanol (0.2 to 0.4 mg/kg intravenously, intramuscularly, or subcutaneously)32 provides minimal analgesia but does have some sedative and anxiolytic effects.

Fluid therapy

Maintaining perfusion to the liver and kidneys will help counteract the toxic byproducts produced during ischemia. Fluid therapy may be needed in cats that do not have CHF, especially if the patient is dehydrated. Administer the fluids judiciously since most of these cats have cardiac disease and may be susceptible to the development of fluid overload. Nasoesophageal tube trickle feeding not only provides a source of nutrition but also is a source of free water that will maintain hydration without the risk of intravenous fluid overload.

Other supportive therapy

Positive inotropic agents or vasopressors may be needed in severely affected patients with depressed cardiac function or refractory hypotension, but they should be used with caution and with the full understanding of any impact on the underlying cardiac disease.

Treatment of severe hyperkalemia (serum potassium concentration > 8 mEq/L or symptomatic bradyarrhythmia) involves administering an intravenous bolus of 1 ml/kg 25% dextrose with or without an intravenous injection of 0.5 U/kg regular insulin. Refractory hyperkalemia may require the cautious administration of sodium bicarbonate at a dose of 0.5 to 2 mEq/kg given intravenously over 30 minutes.33


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Source: VETERINARY MEDICINE,
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