Suggested guidelines for suspected feline cardiac cases Algorithm Critical Care

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.