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Elke Rudloff, DVM, DACVECC, Lakeshore Veterinary Specialists, Glendale, Wisconsin
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The utility of clinical history and initial examination of cats presented with acute dyspnea (n = 108) to differentiate between cardiac and noncardiac causes were assessed in the present study. A study protocol was provided to participating clinicians to standardize the data collected. A triage algorithm was created using the data taken from the study participants’ clinical examination findings, which were highly specific for excluding or diagnosing cardiac dyspnea.
One of the main statistical parameters found to be associated with cardiac-related respiratory distress was tachycardia (heart rate, >200 bpm), although this may be discordant with common clinical impressions. In addition, 10% (6/60) of the cats in the cardiac group were later definitively diagnosed with hyperthyroidism. It remains unclear whether all cats in the cardiac group were tested for hyperthyroidism and whether this might have affected the range and median heart rate used in building the algorithm.
The study essentially recommends that, if a cat with acute respiratory signs has a gallop rhythm and an increased heart rate or respiratory rate or hypothermia, furosemide should be administered before performing additional diagnostics. This approach seems benign, as long as the clinician also evaluates the respiratory pattern and auscultates the lungs and, if pleural effusion or pneumothorax is possible, performs an immediate thoracocentesis.1 Including instructions for sedation/anxiolysis in the study algorithm may also be worthwhile to reduce patient anxiety caused by dyspnea.
Of note, the term dyspnea, which in veterinary medicine refers to difficult or labored breathing, is a term derived from human medicine, in which it is used to describe a subjective, sensory experience of breathing discomfort; this is an experience rather than a clinical sign.2 Veterinarians should describe the clinical signs of respiratory distress (ie, respiratory rate, respiratory effort, breathing pattern, open-mouth breathing) to accurately convey what a nonverbal patient is showing rather than assume what it is feeling. A more valid measure of response to treatment can then be determined.
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Key pearls to put into practice:
A gallop rhythm and the presence of hypothermia or increased respiratory rate in a cat with acute respiratory difficulty should alert the veterinary team to the possibility of congestive heart failure.
Institution of therapy with furosemide before a definitive echocardiogram is obtained is reasonable when congestive heart failure is suspected.
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