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Pulmonary embolism - any one have experience?

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  • Ellen
    Hi everyone, My cat was breathing open-mouthed last Monday night (11/22) and I took her into the ER vet. She also has dilated pupils with one larger than the
    Message 1 of 3 , Nov 30, 2004
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      Hi everyone,
      My cat was breathing open-mouthed last Monday night (11/22) and I
      took her into the ER vet. She also has dilated pupils with one
      larger than the other, and I know I had read somewhere (CRF list?)
      that sometimes that can mean a clot (which I mentioned to the vet
      and she said, no since she has no history of heart disease). Vet
      took x-rays, said it was asthma attack (she has bronchitis and
      coughs, never dyspnea, but I think once the vet heard she had
      asthma, she went down the wrong diagnostic path), gave her
      epinephrine, morphine, brethine & she was in oxygen cage. Seemed to
      help, but once out of oxygen she began the breathing open-mouthed
      again. Another x-ray showed pulmonary edema & enlarged heart, she
      gave lasix and dexamethasone, she was by now gasping for air and
      they said, she's going to die, do you want to ventilate. I say,
      yes. That was over a week ago. She's still here, still in the ICU,
      off the ventilator but still on oxygen, and her PCO2 and ph are
      finally normal. They think it may have been pulmonary embolism.
      She has been on heparin, brethine, dex, low-dose lasix continuous
      drip. Her biggest problem now though, is anemia. She's had low-
      grade anemia, probably from chronic inflammatory disease (IBD and
      liver, but both under control), but it keeps falling shortly after
      blood transfusion, and I don't know why. She's also developed a
      transient gallup rhythym, which is maybe from the anemia? A cardiac
      ultrasound done today (by the traveling cardiologist) ruled out
      heart disease - some slight enlargement but nothing to cause current
      symptoms of difficulty breathing.

      I guess that's a short history. She's a 14 or so year old calico
      (she was a stray so we are not sure) who is 2+ years in remission
      from nasal lymphoma. Oncologist does not think it's a return of
      cancer and neither do I. She is eating well, on 1/2 maintenance
      fluid and has had to have extra potassium added as it keeps
      dropping. She's off the lasix for now, her BUN was going up
      (creatinine is normal, was slightly high mid week). I have been
      with her at the ICU from 9am-10pm every day (much to the dismay of
      the techs there) and watch her breath. They tried to take her off
      the oxygen a few times, I think too soon, but at some point we need
      to wean her off (unless I get oxygen at my house which has crossed
      my mind!)

      I guess it's not technically a heart problem, but I don't know much
      about clots and how they start etc - any insight or advice
      appreciated!

      Thank you.
      Ellen & Ms P
    • Susan
      Ellen, With such a complicated history I would send this to another Yahoo Group called Pet Vet Cafe. It has at least 4 vets, some techs and a few vet students
      Message 2 of 3 , Dec 1, 2004
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        Ellen,

        With such a complicated history I would send this to
        another Yahoo Group called Pet Vet Cafe. It has at
        least 4 vets, some techs and a few vet students and a
        buch of laypeople as members. The vets are pretty good
        at answering questions.

        There is also a UK vet with a yahoo group called
        Ask-Evet

        Hope this helps.

        Susan
        --- Ellen <emoore@...> wrote:

        >
        >
        > Hi everyone,
        > My cat was breathing open-mouthed last Monday night
        > (11/22) and I
        > took her into the ER vet. She also has dilated
        > pupils with one
        > larger than the other, and I know I had read
        > somewhere (CRF list?)
        > that sometimes that can mean a clot (which I
        > mentioned to the vet
        > and she said, no since she has no history of heart
        > disease). Vet
        > took x-rays, said it was asthma attack (she has
        > bronchitis and
        > coughs, never dyspnea, but I think once the vet
        > heard she had
        > asthma, she went down the wrong diagnostic path),
        > gave her
        > epinephrine, morphine, brethine & she was in oxygen
        > cage. Seemed to
        > help, but once out of oxygen she began the breathing
        > open-mouthed
        > again. Another x-ray showed pulmonary edema &
        > enlarged heart, she
        > gave lasix and dexamethasone, she was by now gasping
        > for air and
        > they said, she's going to die, do you want to
        > ventilate. I say,
        > yes. That was over a week ago. She's still here,
        > still in the ICU,
        > off the ventilator but still on oxygen, and her PCO2
        > and ph are
        > finally normal. They think it may have been
        > pulmonary embolism.
        > She has been on heparin, brethine, dex, low-dose
        > lasix continuous
        > drip. Her biggest problem now though, is anemia.
        > She's had low-
        > grade anemia, probably from chronic inflammatory
        > disease (IBD and
        > liver, but both under control), but it keeps falling
        > shortly after
        > blood transfusion, and I don't know why. She's also
        > developed a
        > transient gallup rhythym, which is maybe from the
        > anemia? A cardiac
        > ultrasound done today (by the traveling
        > cardiologist) ruled out
        > heart disease - some slight enlargement but nothing
        > to cause current
        > symptoms of difficulty breathing.
        >
        > I guess that's a short history. She's a 14 or so
        > year old calico
        > (she was a stray so we are not sure) who is 2+ years
        > in remission
        > from nasal lymphoma. Oncologist does not think it's
        > a return of
        > cancer and neither do I. She is eating well, on 1/2
        > maintenance
        > fluid and has had to have extra potassium added as
        > it keeps
        > dropping. She's off the lasix for now, her BUN was
        > going up
        > (creatinine is normal, was slightly high mid week).
        > I have been
        > with her at the ICU from 9am-10pm every day (much to
        > the dismay of
        > the techs there) and watch her breath. They tried
        > to take her off
        > the oxygen a few times, I think too soon, but at
        > some point we need
        > to wean her off (unless I get oxygen at my house
        > which has crossed
        > my mind!)
        >
        > I guess it's not technically a heart problem, but I
        > don't know much
        > about clots and how they start etc - any insight or
        > advice
        > appreciated!
        >
        > Thank you.
        > Ellen & Ms P
        >
        >
        >
        >
        >
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      • jen
        Hi Ellen, I m sorry to hear about your kitty, she sounds very sick. Pulmonary embolus usually presents with dry lungs (ie no edema) and a very fast heart rate
        Message 3 of 3 , Dec 1, 2004
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          Hi Ellen,

          I'm sorry to hear about your kitty, she sounds very sick.

          Pulmonary embolus usually presents with dry lungs (ie no edema) and
          a very fast heart rate with dyspnea. The presence of the pulmonary
          edema has me leaning away from an embolus. The fact that her red
          count keeps dropping after transfusions, especially combined with
          the low potassium, which is involved in blood clotting, has me
          wondering if she is bleeding somewhere. Have they done an abdominal
          ultrasound and tested her stool for blood?

          The clots for pulmonary embolus are formed in the body and travel to
          the right side of the heart and lodge in the lungs. They can also
          be formed in the right side of the heart due to arrthymias or
          enlargement issues. Since most HCM kitties have mostly left sided
          involvement, a pulmonary embolus is not a common complication of HCM.

          The gallop rhythm might related to her anemia. If her red blood
          cells are very low, they cannot always get enough oxygen to the
          heart to fully oxygenate it, so areas can become "irritated" and
          fire off before they should. If her blood pressure is low the same
          thing can happen. Potassium is also essential to normal heart
          rhythm, so her hypokalemia may also be a contributing factor. Her
          dilated pupils were likely a response to the stress of not being
          able to breathe - it is part of the fight or flight response.

          These are just some ideas; I'm not a vet or MD just a paramedic, so
          I deal with acutely life threatening situations, not the ongoing
          illnesses. It sounds like she is getting the best of care by vets
          who are able to observe her directly and have the whole picture.

          Good luck, Ms P will be in our thoughts. Keep us updated.

          jen, deagan and kira the dog
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