Gnosi is a 9 year old Domestic Cat that went to the local emergency clinic in severe respiratory distress.
X-rays indicated pulmonary edema. Labs were mostly unremarkable.
Gnosi was treated with cage rest, oxygen and furosemide and enalapril. No other medications were administered
After 48 hours of treatment Gnosi was discharged. The emergency clinic told the owners the pulmonary edema was most likely cardiogenic in orgin.
Gnosi is a 9 year old Domestic Cat that went to the local emergency clinic in severe respiratory distress.
X-rays indicated pulmonary edema. Labs were mostly unremarkable.
Gnosi was treated with cage rest, oxygen and furosemide and enalapril. No other medications were administered
After 48 hours of treatment Gnosi was discharged. The emergency clinic told the owners the pulmonary edema was most likely cardiogenic in orgin.
I looked at the x-rays and I agree this cat did indeed appear to have pulmonary edema. The cardiac silhouette did not appear enlarged.
When I examined Gnosi he appeared to be normal in all respects with a RRR of 36.
I did an echo on Gnosi and the heart looked fine to me.
I am posting a couple of jpegs with measurements.
I suspect this is a case of non cardiogenic pulmonary edema. I was wondering if others have seen this and can give me some guidance. I would like to wean him off the medications if possible- but I am concerned about a recurrence.
Comments
Here are my bullet abvp notes
Here are my bullet abvp notes on NCPE. Maybe there is somethign here that fits with your case. The LA size is normal so the heart is not a player.
NCPE: no elevation of LA pressure
Pulmonary hemorrhage can mimic NCPE
NCPE Causes:
Increase capillary permeability or hydrostatic pressure
Caudal lung interstitial pattern
PCWP< 18 mmHg
Causes:
Post obstructive: POPE: negative pressure edema: laryngeal dysfunction, aspiration pneumonia, brachycephalic: stenotic nares, elongated sp, reverted laryngeal saccules, Everted tonsils, hypo plastic trachea> acute stress heat exercise intubation POPE aspiration pneumonia>> negative pressure hypoxia sympathetic overstimulation> increase pulmonary vascular volume and pressure > NCPE > surfactant depletion + hypoxia & sympathetic stim > blood pooling > Hypoxia
–hypoxia during a POPE event may damage the alveolar epithelium and cause pulmonary vasoconstriction through endothelin
POPE Parameters
paO2<80mmHg
Sao2 <95%/93%
Compensatory hyperventilation can increased PaO2 to normal levels
Sedation removes compensatory hyperactivity of upper airway dilating muscles in brachycephalic breeds
Neurogenic NCPE: seizures, electrocution (NCPE manifests after 1 hour) head trauma CNS hemorrhage creates hydrostatic and permeability changes with a catecholamine storm initiated by the medulla. Volume shift from systemic circulation to pulmonary circulation occurs. Neuro peptide y and endothelin one cause Edema through permeability and vasoconstriction respectively
-An acute increase in hydrostatic pulmonary capillary pressure and secondary damage to tight junctions of the alveoli
ALI/ARDS induced NCPE: sirs, pancreatitis, neoplasia, pneumonia, sepsis, uremia, parvo
Diffuse inflammatory reaction causes pulmonary endothelial and epithelial disruption, edema progresses to fibrosis
Criteria: arterial hypoxia, acute onset, pulmonary Edema, pulmonary inflammation, known risk factor.
Cough with pink foamy sputum in severe cases
All lung fields affected not just caudal dorsal lung***
Drowning NCPE: transfusion related acute lung injury 2-6 hours post-transfusion
Smoke inhalation NCPE:
tissue hypoxia, thermal damage, irritation> secondary pneumonia
OTHER NCPE:
Drug reaction
Anaphylaxis
O2 toxicity
PTE
Thanks EL
I’m not sure we
Thanks EL
I’m not sure we will ever find out. I will questions the owners more thoroughly for a more complete history.
If this were your case would you try to wean him off the Enalapril and Furosemide?
I dont see a reason for
I dont see a reason for enalopril here and lasix may dry up the PE and work as a bronchodilator to some extent but minimal effective dose is what I would do.. Caviat I have a limited data base on this one but based on a normal la i can’t advocate a cardiac protocol.