Re: [FH] Pulmonary embolism - any one have experience?
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
Hope this helps.
--- 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
> 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
> 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
> Thank you.
> Ellen & Ms P
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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