This Spot Check is based on information from drip.vet’s continuing education course: Feline Hypotension.

Patient Signalment & Presenting Complaint:

• Leo, an 11-year-old neutered male domestic shorthair weighing 4.8 kg, was presented to you for acute dyspnea

Primary Survey:

• Airway: patient
• Breathing: tachypnea (46 rpm)
• Circulation: diffusely harsh bronchovesicular sounds, muffled heart sounds, hypokinetic femoral pulses, pale oral mucous membranes, CRT = 3 seconds
• T: 98.6 °F / 37 °C
• BP: 68 mmHg via Doppler

Initial Diagnostic Tests

• Thoracic point-of-care ultrasonography (POCUS): moderate volume bilateral pleural effusion, moderate volume pericardial effusion, B-lines seen at bilateral chest tube and peri-hilar sites
• Lactate: 3.8 mmol/L
• proBNP: abnormal

B: Perform pericardiocentesis/thoracocentesis.

Rationale

Leo is living with congestive heart failure (HCM), presumably secondary to hypertrophic cardiomyopathy (HCM). A comprehensive echocardiogram is required to confirm your clinical suspicion. Intravenous fluid therapy is contraindicated, as he has a primary cardiogenic cause of his hypotension. His hypothermia should be addressed through passive and active surface rewarming strategies; active core rewarming strategies are not indicated. His hypotension is primarily due to obstruction of venous return caused by his moderate volume pericardial effusion, so relieving this obstruction is your top priority. You are also justified in administering furosemide (2 mg/kg IV), a loop diuretic, concurrently to address Leo’s CHF. Inotropic support may ultimately be needed, but Leo’s pericardial and pleural effusion should be removed first.