Cardiac emergencies are common in the small animal emergency room, notably:
- Congestive heart failure (CHF)
- Pericardial effusion (PE)
- Aortic thromboembolism (ATE)
Here are 5 pearls to remember when evaluating patients with cardiac disease.
1) Regardless of the presenting complaint, an important concept to remember when approaching any emergency patient is a rapid primary survey, keeping in mind the ABCDs of evaluation and resuscitation:
2) More often than not…patients in true, left-sided heart failure will be tachycardiac. Remembering that Cardiac Output (CO) is the product of heart rate (HR) and stroke volume (CO = HR x SV), patients in fulminant CHF cannot dramatically improve their stroke volume (SV). As a result, to improve their cardiac output, they must increase their heart rate. So, if that patient with crackles has a normal heart rate, I would look for other causes (e.g., respiratory disease like pulmonary hypertension, bronchitis, pneumonia, pulmonary thromboembolism, etc.).
3) Coughing cats are NOT cardiac. While I do not like using the words “always” or “never”, coughing cats most likely have asthma, not heart disease.
4) If you have a cat with cold rear leg extremities and hind limb paresis, consider aortic thromboembolism (ATE); this is seen most commonly as a consequence of hypertrophic cardiomyopathy (HCM). Conversely, dogs with aortic thromboembolism (ATE) more commonly are hypercoagulable from another condition such as PLN, chronic steroid use, IMHA, neoplasia, or hyperadrenocorticism.
5) Not every arrhythmia needs to be treated. In my clinical practice, ventricular tachycardia is one of the most common arrhythmias seen. With that said, I don’t treat every ventricular rhythm. I consider pharmacological therapy if signs of hemodynamic compromise are present, notably with ECG findings including tachycardia (HR >160bmp), multiform QRS configurations, R on T phenomenon, and or hypotension.
Patients presenting with evidence of emergent cardiac disease should be triaged quickly and treated immediately to reduce morbidity and mortality. For more information, check out our VETgirl webinar on cardiac emergencies!