STEPs | FELINE CARDIAC Suggested guidelines for suspected feline cardiac cases Algorithm Critical Care Cat with respiratory distress Provide oxygen therapy & minimise stress Consider thoracocentesis if pleural effusion or pneumothorax seems likely SNAP® Feline proBNP NORMAL ABNORMAL Heart disease is likely Clinically significant heart disease is unlikely cause of respiratory distress Obtain thoracic radiographs* Perform echocardiography, thoracic radiographs, ECG and blood pressure measurement* Measure TT4 and Chemistry SNAP ProBNP can also be increased in cats with hyperthyroidism and severe azotaemia, so chemistry and TT4 measurements are necessary *N.B. Cats with respiratory distress should be handled with extreme care. Any form of restraint could lead to decompensation or death. Animals with respiratory distress should not be placed in lateral recumbency for radiography. STEPs | FELINE CARDIAC Suggested guidelines for suspected feline cardiac cases Algorithm Monitoring Cardiac Function in “at risk” patients Cat with cardiac murmur Obtain blood for SNAP® Feline proBNP NORMAL ABNORMAL Significant cardiac disease is unlikely at this time Cardiac disease likely so additional tests are required to determine clinical significance Perform echo & thoracic radiographs and check renal parameters. +/- TT4 (if >10 years of age) Measure Cardiopet® Nt proBNP to gain quantative number at Reference Laboratory if echo is declined Recheck Cardiopet® Nt proBNP levels based on clinical guidance below Monitor patient on medication as per pharmaceutical data sheet SNAP ProBNP can also be increased in cats with hyperthyroidism and severe azotaemia, so chemistry and TT4 measurements are necessary. STEPs | FELINE CARDIAC Suggested guidelines for suspected feline cardiac cases Monitoring – Clinical Guidance For Cats The Cardiopet® proBNP Test measures NTproBNP, which is released from the heart muscle in proportion to the severity of heart disease, and detects the presence of cardiomyopathy in cats with or without clinical signs. < 100 pmol/L 100 – 270 pmol/L > 270 pmol/L Clinically significant cardiomyopathy is highly unlikely. Clinically significant cardiomyopathy is unlikely, but early disease may be present. Consider repeat NT proBNP in 3 – 6 months or an echocardiogram. If the cat has clinical signs, it is unlikely that these signs are associated with cardiomyopathy. Clinically significant cardiomyopathy is highly likely. Further cardiac workup including an echocardiogram is recommend. Therapeutic decisions should be based on results of a cardiac workup. NTproBNP concentrations may decrease with cardiac medication. Arrythmias may result in higher NTproBNP concentrations. Cats with severe respiratory disease can have increased NTproBNP due to pulmonary hypertension which creates myocardial stress. Severely azotemic cats may have increased NTproBNP concentrations. STEPs | FELINE CARDIAC Suggested guidelines for suspected feline cardiac cases Applicable – IDEXX Products & Services Event Suggested Protocol IDEXX Workflow Key: In-Clinic or Ref-Lab Ref-Lab only In-Clinic Only Diagnosis CBC Chemistry profile Electrolytes TT4 Feline proBNP Chemistry Profile: Chem15 Chem15 ALB,ALB, ALB/GLOB, ALT, BUN, BUN/CREA, Ca,CREA, CHOL, CREA, GGT, ALB/GLOB, ALKP,ALKP ALT,,BUN, BUN/CREA, Ca, CHOL, GGT, GLU,GLU, PHOS,PHOS, TBIL, TP GLOB, GLOB, TBIL, TP Electrolytes: LyteLyte 4 4 Cl, K,Cl, K,Na/K Na, Na/K Na, Haematology: Comprehensive Comprehensive Haematology – (Code Haematology – (Code FBCS)FBCS) ® ® LaserCyte CBC or ProCyteDx LaserCyte® CBC or ProCyteDx® CBC CBC TT4: SNAPshot SNAPShot™ Dx T4 Total T4 Dx® Total TotalTotal – (T4FM) T4 –T(T4FM) 4 Feline proBNP: Cardiopet® SNAP® Nt Feline proBNP proBNP – (Code FBNP) Monitoring NSAID Feline proBNP Chemistry Profile: For assistance with interpretation of ECG’s and / or Imaging IDEXX Telemedicine Service – visit www.idexx.co.uk/telemedicine Additional Diagnostic Tests NSAID: ALP,ALP , ALT, Urea, Creatinine ALT, AST,AST, Urea, Creatinine Feline proBNP: Cardiopet® Nt proBNP – (Code FBNP) Cardiopet® Nt proBNP – (Code FBNP) VetConnect™ PLUS – Client communication suggestions Monitoring Cardiac function in “at risk” patients • Show your client the diagnosis results • Discuss next STEPs • Discuss the requirement to monitor Cardiopet® Nt proBNP levels •Use Client Friendly Summary to outline future monitoring requirement · Discuss organ functions Use Notes function to add in details specific to the Pet Use the calendar function to set date for next check-up / monitoring visit •When monitoring Cardiopet® Nt proBNP levels use the trending graph to communicate to your client; · Changes in stability Great News! – “your pet is doing great. Continue the good work” If you have questions regarding diagnostics or treatment for any of your patients, please contact our Internal Medicine team on 00800 1234 33 99 (option 1, option 2) © 2014 IDEXX Laboratories, Inc. All rights reserved. 1406050-0914-UK All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries. The protocols / information presented in this document are a general overview to help guide the diagnosis and treatment of routine cases. Diagnostic and treatment decisions for an individual animal remain the responsibility of the attending veterinary surgeon and decisions should never be based solely on laboratory results or general literature. One-Lab. You choose.
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