Friday, November 15, 2013

Is it Feline Heart Disease, or is it Feline Lung Disease?

Is it Heart Disease, or is it Lung Disease?
Distinguishing cardiac disorders from pulmonary disorders is about to get a whole lot easier,
thanks to a new blood test.

Zilpha’s Dilemma
A client of ours, Jo M., wasn’t too worried when her 15 year-old tortie, Zilpha, stopped eating and became lethargic.  She had been through this scenario a year earlier, when Zilpha was diagnosed with chronic pancreatitis, and she suspected that this was another flare-up. 

I examined Zilpha, and her clinical signs were indeed compatible with pancreatitis, but more worrisome to me was the observation that Zilpha was breathing hard.  I knew that Zilpha was asthmatic, but she had always been well-controlled on her medication.  I asked Jo how long Zilpha’s breathing had been labored like this. She told me at least a few days.

Intravenous fluid therapy is an important aspect of the therapy for feline pancreatitis, so I admitted Zilpha to our hospital to begin treatment.  However, I was concerned about fluid administration, because if Zilpha’s heavy breathing was due to heart disease rather than lung disease (i.e. the asthma), aggressive fluid therapy could make things worse.  To gather more information, I took x-rays of Zilpha’s chest.  

The images were not challenging to interpret, however.  The radiographic pattern in the lungs fit with asthma, but pulmonary edema (accumulation of fluid within the lungs, a cardinal sign of heart failure) can have a similar appearance. The changes in the lungs caused the silhouette of the heart to be obscured, preventing an accurate assessment the size of the heart.  Cardiac ultrasound is the most informative test to determine if heart disease is present.  Unfortunately, this procedure requires the expertise of a veterinary cardiologist.  With no clear cut diagnosis and Zilpha’s breathing getting a little worse, I had no choice but to send Jo and Zilpha to a nearby referral center for cardiac ultrasound.  If there was a quick and simple blood test to distinguish lung disease from heart disease, I could have begun treating Zilpha promptly. Is such a test even a possibility? 

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