Plus-Hex CLINICAL
Learning outcomes
• Identify the clinical signs of FATE
• Evaluate the VN ' s vital role in patient care
• Understand the importance of pain management
Patient signalment
Species Breed Age Sex Weight
Background
Cat Domestic shorthair 8 years Male 3.26 kg
The patient was referred following radiography , which identified a fractured pelvis with a mildly displaced left-sided sagittal sacral fracture with an additional fracture immediately caudal to the left acetabulum , ventral pelvic fractures and a minimally displaced right-sided sacroiliac luxation . The patient was also reported to be hyporexic and depressed , with sudden onset of bilateral paraplegia . He had been medically managed due to previously identified cardiac murmurs and efforts to minimise potential cardiac complications with surgical intervention .
Assessment and admission
On clinical examination , the patient was quiet , alert and responsive . His mucous membranes were pink and moist , and his capillary refill time was < 2 s . He had a body condition score of 3 / 9 . He had cold extremities , was tachypnoeic and was open-mouthed breathing .
Thoracic auscultation revealed a left parasternal grade III / VI systolic murmur and a regular heart rhythm . The murmur radiated to the right side ( grade III / VI ). Femoral pulses were bilaterally absent and the hindlimb extremities were cold . The patient was normothermic and had marked atrophy of the pelvic musculature . A neurological examination showed bilateral hindlimb ataxia with right-sided proprioceptive deficits and reduced skin sensation in the lateral distal limb and the medial proximal region of the right pelvic limb .
Before further examination , the patient was administered oxygen and pain relief ( methadone 0.2 mg / kg ) to make him more comfortable and reduce the risk of distress from handling . He was tachypnoeic at presentation , with a respiratory rate of 52 breaths / min , potentially due to pain and a stress response to travel ; this reduced to 28 breaths / min following analgesia and flow-by oxygen .
Haematology indicated mild lymphopenia , likely due to stress ; the haematology results were otherwise unremarkable ( Appendix 1 , Table 1 , see page 55 ).
Biochemistry results ( Appendix 1 , Table 2 , see page 55 ) identified elevated serum amyloid , indicative of systemic inflammation . Elevated alanine transaminase and creatine kinase activities indicated muscle damage , which was likely to be associated with the thromboembolic disease process .
The patient also underwent abdominal ultrasonography ( Appendix 2 , Figures 1 and 2 , see page 55 ), which indicated a 1 cm hyperechoic lesion within the aorta , with interruption to blood flow , at the level of the bifurcation of the aorta . Findings were consistent with a thromboembolism event at the bifurcation of the aorta .
Echocardiography ( Appendix 3 , Figure 3 , see page 55 ) revealed a small volume of anechoic pericardial effusion , an enlarged left atrium and a thickened left ventricle with poor systolic function . Mitral valve regurgitation and systolic anterior motion were present , causing dynamic outflow obstruction . These findings are consistent with hypertrophic cardiomyopathy [ 15 ] .
Treatment
The patient was in the intensive care unit ( ICU ) for 4 days , with continuous monitoring of his heart rate , respiratory rate and effort , and pulse quality . Initially , the patient had full-parameter monitoring , with electrocardiographic observations until he was stable .
Pain scoring , using the Glasgow Feline Composite Measure Pain Scale ( CMPS-Feline ), was carried out every 4 hours to ensure the patient was receiving appropriate analgesia . Pain relief was achieved using intravenous ( IV ) opioids ( methadone 0.2 mg / kg IV q4h , switched to buprenorphine 20 µ g / kg IV q6h once comfortable ). An antiemetic ( maropitant 1 mg / kg IV ) was also administered to encourage normal eating behaviours . In addition , the patient received a combination of oral clopidogrel ( 18.75 mg / cat ) and aspirin ( 5 mg / kg ) antiplatelet agents to prevent further thromboembolism .
The findings were consistent with aortic thromboembolism ( leading to right-sided sciatic neuropathy ) caused by underlying hypertrophic cardiomyopathy . The patient ' s clinical signs improved during hospitalisation and the femoral pulses returned to both hindlimbs after 48 hours . His mobility also significantly improved during this time .
A follow-up assessment was scheduled 7 – 10 days post hospitalisation to review the patient ' s progress , neurological status , cardiac function and medication . On discharge , the medications prescribed for administration at home included clopidogrel 18.75 mg SID and aspirin 75 mg every 3 days ( Appendix 4 , Figure 4 , see page 55 ).
Volume 40 ( 1 ) • February 2025
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