How should I triage and stabilize a cat presenting in acute cardiac decompensation?

Question

Accepted Answer

The immediate priority in a cat presenting in acute cardiac decompensation is oxygen supplementation and anxiolysis before any diagnostic procedures. Oxygen is administered via flow-by, mask, hood, nasal cannula, or oxygen cage, and should be started immediately upon recognition of respiratory distress. 2 Respiratory pattern and auscultation direct the first therapeutic decision. The location of pathology — pleural space versus lung parenchyma — is determined by observing the breathing pattern and auscultating the thorax. Absent or muffled lung sounds over a hemithorax indicate pleural space disease; diffuse changes suggest parenchymal disease. 2 Stressful diagnostic procedures, including thoracic radiography, can cause rapid decompensation in a dyspneic cat and should be deferred until the patient can tolerate them. 2 Pleural space disease with rapid cardiovascular decompensation, absent lung sounds throughout the thorax, and a barrel-shaped thorax indicates tension pneumothorax, which requires an intercostal incision or placement of a large-bore catheter rather than routine thoracocentesis. 2 Pleural effusion from cardiac disease is managed with thoracocentesis once the patient is stable enough to tolerate positioning. Lung parenchymal disease is treated with oxygen supplementation and sedation to relieve anxiety, with specific therapy directed at the underlying cause. 2 Butorphanol (0.2 mg/kg IV) has been used for anxiolysis and stabilization in a dyspneic cat with suspected cardiac disease. 5 Point-of-care diagnostics support rapid triage without destabilizing the patient. A positive feline N-terminal pro-B-type natriuretic peptide (NT-proBNP) ELISA result supports underlying cardiac disease as the cause of respiratory signs. 5 Abdominal FAST ultrasound can identify gallbladder wall edema, which is associated with cardiac disease — most commonly pericardial effusion, but also dilated cardiomyopathy and right-sided systolic failure — and should prompt integration