Acute presentations of hypertension in cats - Recognizing a hypertensive Therapeutics - Feline Inspiration ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021‐04‐12
Acute presentations of
hypertension in cats
Susan Little, DVM, DABVP (Feline)
n
Bytown Cat Hospital, Ottawa, ON, Canada
@catvetsusan
a
catvet@vin.com
u s
1
e t s
a t v
c
@ Recognizing a
hypertensive Therapeutics
crisis
Target organ
damage
4
1
2021‐04‐12
What kind of hypertension?
a n
s
Secondary Age-related Situational
t s u
e
5
a t v
c
@
Bijsmans et al, J Vet Intern Med, 2015
6
2
2021‐04‐12
http://www.iris-kidney.com
a n
u s
7
e t s
a t v
c
@
Blood pressure assessment videos: YouTube
8
3
2021‐04‐12
What’s a
hypertensive crisis?
• Acute onset ocular, neurologic,
cardiovascular signs
n
• Must have an index of
suspicion!
s a
t s u
e
9
a t v
c
@
Eyes
Central Nervous System
Cardiovascular System
Kidneys
10
4
2021‐04‐12
a n
u s
11
e t s
a t v
c
@
Panoptic (Welch Allyn)
12
5
2021‐04‐12
Effects of hypertension on
the fundus
Retinal Optic
detachment Retinal edema Retinal hemorrhage
neuropathy
Risk of permanent From subretinal Ischemia of optic Can extend to
photoreceptor
n
fluid accumulation. nerve head. vitreal hemorrhage
damage. & hyphema
s a
t s u
e
13
a t v
c
@
Retinal edema,
Partial retinal hemorrhage,
detachment detachment,
vessel
tortuosity
Complete Hyphema
retinal
detachment
Sanders NA. Recognition & treatment of hypertensive crises,
August’s Consultations in Feline Internal Medicine, Vol 7
14
6
2021‐04‐12
Intact menace & pupillary light Blindness, bilateral mydriasis, hemorrhage, large
response = possibly reversible areas of detachment = probably permanent
a n
s
167 mmHg, visual eye
s u
Sanders NA. Recognition & treatment of hypertensive crises,
ISFM Consensus Guidelines on the Diagnosis and Management of
t
August’s Consultations in Feline Internal Medicine, Vol 7
Hypertension in Cats
Article Copyright © 2017 Authors, Source DOI: 10.1177/1098612X17693500.
e
15
a t v
c
@
Pre-treatment, 200 mmHg
Normotensive for 6 weeks
Courtesy Dr. Steve Bailey
16
7
2021‐04‐12
Eyes
Central Nervous System
n
Cardiovascular System
s a
u
Kidneys
17
e t s
a t v
c
@
Forebrain and/or
brainstem
• Edema
• Hemorrhage
• Brainstem herniation
18
8
2021‐04‐12
Hypertensive encephalopathy
Often acute onset
Absent menace response, absent
pupillary light reflex, anisocoria, blindness
Altered mentation ranging from dull to comatose
n
Seizures or seizure-like episodes
s a
u
Circling, ataxia
19
e t s
a t v
c
@
Eyes
Central Nervous System
Cardiovascular System
Kidneys
20
9
2021‐04‐12
Cardiovascular signs are
less common than
neurologic or ocular signs
• Congestive heart failure
• Dissecting aortic aneurism
n
• Severe left ventricular
a
hypertrophy
u s
21
e t s
a t v
c
@
Eyes
Central Nervous System
Cardiovascular System
Kidneys
22
102021‐04‐12
Least common presentation
• Acute kidney injury
• About 50% are hypertensive
• Not associated with degree of
n
kidney injury
a
• Acute-on-chronic
u s
23
e t s
a t v
c
@ EMERGENCY
MANAGEMENT OF
HYPERTENSION
24
112021‐04‐12
WHO
Cats with acute onset of
neurological, cardiovascular,
ocular signs WHERE
In hospital
WHEN
Now! Don’t delay
n
WHY
a
Minimize target organ damage
s
Prevent more damage
t s u
e
25
a t v
c Goals of therapy in human medicine
@
Monitor Next 4 hours First 1-2 hours
Every 3-4 hours until Reduce to 160 Reduce BP by up
target, then 2-4 mmHg to 25%
times/day until stable
ISFM Consensus Guidelines on the Diagnosis and Management of
Hypertension in Cats
26
122021‐04‐12
Emergency drug of choice – oral amlodipine
START ADD
0.625–1.25 mg/cat Short acting parenteral drug
Based on severity, presence if amlodipine alone not
of hypokalemia effective
n
REPEAT EXPECT
a
Within 4-8 hours Onset of action within 4 hours
s
Maximum of 2.5 mg in 24 Duration up to 30 hours
hours
t s u
e
27
a t v
c
@
ISFM Consensus Guidelines on the Diagnosis and Management of
Hypertension in Cats
Article Copyright © 2017 Authors, Source DOI: 10.1177/1098612X17693500.
28
132021‐04‐12
Hyphema
Amlodipine plus
• topical prednisolone acetate (1%) or
topical dexamethasone (0.1%)
• 1 drop every 4-6 hours
• +/- 1 drop of topical atropine 1%, repeat
in 12-14 hours if needed
a n
u s
29
e t s
a t v
c
@
Abrupt reductions in BP or
hypotension may lead to
myocardial, cerebral, or
renal ischemia
Caution
30
142021‐04‐12
a n
u s
31
e t s
a t v
c
@
RESOURCES
32
152021‐04‐12
2018 ACVIM consensus statement: Guidelines for the
identification, evaluation, and management of systemic
hypertension in dogs and cats
acvim.org
a n
u s
33
e t s
a t v
c
2017 ISFM Consensus Guidelines on the Diagnosis and
@
Management of Hypertension in Cats
journals.sagepub.com/home/jfm
34
162021‐04‐12
a n
u s
35
e t s
a t v
c
https://catvets.com/hypertension-toolkit
@
36
172021‐04‐12
Final thoughts …
• Evaluate blood pressure in cats with acute
onset of neurologic, cardiovascular, ocular
signs
n
• Evaluate the fundus on every cat – early
lesions more amenable to treatment
a
• Use the most effective drugs for emergency
s
management
t s u
e
37
a t v
c Reading list
@
• Carter, J. Hypertensive ocular disease in cats: A guide to fundic
lesions to facilitate early diagnosis. J Feline Med Surg, 2019.
• Church, M. Neuropathology of spontaneous hypertensive
encephalopathy in cats. Vet Pathol, 2019.
• Oricco, S. Aortic dissection in four cats: clinicopathological
correlations. J Vet Cardiol, 2019.
• Brown, CA. Hypertensive encephalopathy in cats with reduced
renal function. Vet Pathol, 2005.
38
182021‐04‐12
catvet@vin.com
@catvetsusan
@purrpodcast
n
purrpodcast.net
a
bit.ly/CatBites
u s
drsusanlittle.net
39
e t s
a t v
c
@
19You can also read
