Potential clinical signs of FATE
• Heart murmurs
• Gallop sounds
• Tachypnoea
• Tachycardia
• Bradycardia
• Irregular cardiac rhythm
• Abdominal pain
• Lack of anal tone
• Distended bladder
• Hypothermia
• Absence of deep pain response
• Firm to hard cranial tibial and gastrocnemius muscles
• Absence of limb motion below the upper thigh
• Absence of femoral pulses
Reviewing the patient ' s clinical parameters may include monitoring serum potassium and creatinine levels [ 8 ] . This may also include marked elevations in creatine kinase ( sometimes > 100,000 mg / dl ) [ 9 ] or elevations in other muscle enzymes , which can indicate muscle damage or disease . Serum potassium is measured to identify whether hyperkalaemia is present , as reperfusion hyperkalaemia can be life-threatening [ 9 ] . Continuous observation is important to ensure this is not missed , as a thrombus cutting off circulation to the hindlimbs can cause serious tissue damage . Many toxic biochemicals form in the damaged tissue . Once the thrombus has been broken down and dissolved by anticoagulant medications , these toxic biochemicals are released into the blood circulation , and this can have a fatal outcome [ 10 ] .
Nursing considerations in the care of these patients include assessing pulse quality , bladder management , skin care and investigation of pleural effusion due to cardiac failure . Reviewing nutritional aspects of the nursing care plan is pivotal for recovery ; if patients are anorexic on initial assessment , placement of a nasogastric tube for feeding may be an essential part of acute management . Any assisted feeding via a nasogastric tube should be accounted for in the daily fluid calculations [ 10 ] .
During hospitalisation , dietary modifications will be needed once the patient ' s pain is managed . A nutritional assessment and body and muscle condition scoring should be completed to identify any deterioration , as cats with heart disease may develop cachexia . This is due to severe , progressive weight loss and muscle wastage caused by the increased workload on the respiratory system as a result of the heart disease [ 11 ] .
Nursing considerations
• Assess pulse quality
• Assess pleural effusion
• Continual or intermittent electrocardiography
• Blood pressure monitoring
• Assess response to medications
• Bladder management
• Skin care
• Pain assessment
• Wound management
• Nutritional requirements
The therapeutic goals of treatment [ 8 ] for these patients will involve addressing the cardiac disease and providing a calm environment to reduce stress . Oxygen should be provided in a way that maximises efficacy while minimising stress to the patient . Cardiac patients will often present with fluid retention , poor tissue perfusion and high blood pressure , and the treatment plan will aim to manage the clinical signs .
Therapeutic treatment goals [ 8 ]
• Reduce fluid retention
• Improve tissue perfusion
• Increase cardiac contractility
• Reduce cardiac filling pressure
• Increase rate of myocardial relaxation ( lusitropy )
• Reduce blood pressure
• Normalise coagulation status
Patients with cardiac disease will also benefit from enforced rest , the provision of a calm environment , and suitable temperature and humidity in their housing during hospitalisation . While recumbent and recovering , the patient will require appropriate bedding , frequent turning to avoid decubitus ulcers and bladder management [ 12 ] .
Cats that have experienced one episode of FATE are at an increased risk of an additional episode [ 13 ] . As a consequence , the prognosis for FATE is poor , and a survival rate of 25 – 35 % has been reported for cats with bilateral pelvic limb infarction [ 14 ] .
52 Veterinary Nursing Journal