Heart Disease of the Cat: Aortic Thromboembolism

Aortic thromboembolism (sometimes referred to as “saddle thrombus”) is a devastating disease inHeart Disease of the Cat: Aortic Thromboembolism cats, and is a life threatening emergency.  As seen in the picture, a blood clot lodges where the aorta (the largest artery in the body) branches into the arteries that feed the hind limbs (called the aortic trifurcation).  These clots typically form secondary to heart disease.  They will remain in the heart for a period of time before dislodging and getting stuck in the aortic trifurcation.

This immediately stops all blood flow to the hind limbs.  Very quickly, the muscles of the hind limbs begin to break down which is a very painful process.  A cat in this condition will typically cry out excessively.  The hind limbs become paralyzed, and the cat will typically drag itself around by its front limbs.  Many times, cats lose control of their bowels.

Because this disease is closely related to heart disease, it is often seen in conjunction with respiratory changes.  Fluid backs up into the lungs (pulmonary edema) and causes difficulty breathing.

Diagnosis of Aortic Thromboembolism in the Cat

Diagnosis is mainly based on physical exam and xrays.  The limbs will be stiff, painful, and cold to the touch.  Xrays are taken to assure there are no underlying fractures in the vertebrae.

Management of this disease is challenging.  The most recent research suggests that the survival rate for cats with saddle thrombus is 30%, and the prognosis is even worse in the face of current cardiac disease.  The mainstays of treatment are proper hydration, significant pain management, and balancing the blood electrolytes as the body tries to get blood to the damaged tissues.

There has been significant debate and research into this specific disease.  To this author’s knowledge, nothing has been proven to speed recovery or prevent future recurrences.  Treatment options ranging from low dose aspirin to Plavix (clopidogrel) to attempt to dislodge the clot have not shown any additional benefit.  The FAT CAT initiative is currently looking into therapies to help this terrible disease, though preliminary results are not promising (not yet published).  In theory, surgery to remove the clot may provide some benefit if performed early, but the surgery is technically demanding.  In addition, these cats do not make the best anesthetic candidates due to their concurrent diseases.

Cats who do recover may have residual hind limb abnormalities that range in severity.

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Dr Roger Johnson and Dr Kyle Marano

Roger K. Johnson, DVM, Diplomate ACVIM (internal medicine) is a board-certified veterinary internal medicine specialist. His professional interests include cardiology as well as using advanced diagnostics to help his patients. His particular favorites include echocardiography, abdominal ultrasonography, and endoscopy. Kyle Marano, DVM is a small animal veterinarian practicing out of Northern Colorado. He has written pieces ranging from sports commentary and analysis to quips on the every day life of veterinary medicine. His furry family includes a chocolate lab mix and an overly nosy cat.

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