View source for Small Animal Soft Tissue Surgery Q&A 03

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'''A four-year-old cat is diagnosed with hypertrophic cardiomyopathy.'''

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<FlashCard questions="4">
|q1=What is a common vascular complication associated with this disease process?
|a1=
Aortic thromboembolism. Thromboemboli commonly lodge at the aortic trifurcation and extended into the branches. 

Peripheral thromboemboli may originate from cardiac thrombi which dislodge and pass into the aorta. 

Occasionally, cardiac thrombi are detected using ultrasound.
|l1=
|q2=What are three commonly noted clinical or physical examination findings associated with this condition?
|a2=
Common abnormalities include paraparesis, pain, hypothermia and ischemia of the hindlimbs; and auscultation of a murmur, gallop sound or arrhythmia. 

Absent or weak femoral pulses indicate presence of a thrombus. 

Dyspnea and tachypnea may also be observed.
|l2=
|q3=Is surgery useful for treatment?
|a3=
Treatment includes supportive therapy with fluids and diuretics, use of a vasodilator such as acepromazine, and an anticoagulant such as heparin, aspirin, or warfarin. 

Heparin is generally used in the acute phase, and warfarin for long-term anticoagulant therapy. 

Clot dissolution has been achieved using streptokinase and urokinase. 

Surgical removal of aortic thromboemboli has not been rewarding. It is best performed within four hours of embolization. 

Amputation of the left atrial appendage has also been suggested to eliminate the nidus for thrombus formation. 

In most cases, surgery is not rewarding and medical management is preferred.
|l3=
|q4=What is the prognosis?
|a4=
A recent study showed that affected cats had a 34% chance of surviving the initial thromboembolic episode; those that did had an average survival of 11.5 months. 

Reembolization was common. 

Prognosis varies with the severity of the embolic event, degree of ischemia, evidence of abdominal organ infarction and severity of the underlying cardiac disease.
|l4=
</FlashCard>

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