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VETgirl Veterinary Continuing Education Podcasts

Differentiating Cardiac and Noncardiac Causes of Nonhemorrhagic Ascites with NT-proBNP, cTnI and POCUS in dogs | VETgirl Veterinary Continuing Education Podcasts

Mon May 20 2024
diagnostic toolsascitesbiomarkerspoint-of-care ultrasound

Description

This episode discusses the diagnostic tools available for non-hemorrhagic ascites in dogs, including physical examination, echocardiography, biomarkers, and point-of-care ultrasound. A study on biomarkers and point-of-care ultrasound is reviewed, highlighting the differences between cardiac and non-cardiac causes of ascites. The limitations of the study are discussed, along with key take-home points for clinical practice.

Insights

Physical examination is crucial

The presence of jugular pulsation and distension can help differentiate cardiogenic ascites from non-cardiogenic ascites.

Biomarkers and point-of-care ultrasound are valuable tools

NT-ProBNP concentrations and point-of-care ultrasound findings can provide additional insight into the cause of non-hemorrhagic ascites.

Differentiating pericardial disease from other causes is important

Point-of-care ultrasound can help rule out pericardial disease, which requires immediate intervention.

Chapters

  1. Diagnostic Tools for Non-Hemorrhagic Ascites
  2. Study on Biomarkers and Point-of-Care Ultrasound
  3. Limitations and Take-Home Points
Summary
Transcript

Diagnostic Tools for Non-Hemorrhagic Ascites

00:00 - 02:52

  • Differentiating cardiac from non-cardiac causes of non-hemorrhagic ascites can be challenging.
  • Physical examination may not always show strong indicators to suggest the most likely cause of the ascites.
  • Echocardiography is the definitive method for detecting and quantifying heart disease in dogs, but it may not always be included in the initial workup for non-hemorrhagic ascites due to cost and availability.
  • Other diagnostics such as complete blood count, chemistry, urinalysis, chest radiographs, and abdominal ultrasound are often performed first.
  • Assessment of cardiac biomarkers and point-of-care ultrasound may provide additional insight into the cause of non-hemorrhagic ascites.

Study on Biomarkers and Point-of-Care Ultrasound

02:52 - 14:31

  • A study by Moray et al. from the University of Missouri assessed the ability of biomarkers and point-of-care ultrasound to differentiate cardiac versus non-cardiac causes of non-hemorrhagic ascites.
  • The study found that NT-ProBNP concentrations were significantly higher in the cardiac group compared to the non-cardiac group.
  • Point-of-care ultrasound analysis showed that hepatic vein distension and caudal vena cava distension were more common in the cardiac group.
  • Cardiac troponin I levels did not differ significantly between the cardiac and non-cardiac groups.
  • Pericardial disease subgroup had normal NT-ProBNP levels.
  • Biomarkers and point-of-care ultrasound can help differentiate among different causes of non-hemorrhagic ascites.

Limitations and Take-Home Points

14:31 - 18:00

  • Limitations of the study include small sample size and various treatments received by the patients.
  • Physical examination, particularly the presence of jugular pulsation and distension, can help differentiate cardiogenic ascites from non-cardiogenic ascites.
  • Biomarker testing, such as NT-ProBNP, and point-of-care ultrasound are helpful complementary tests.
  • Pericardial disease and structural right heart disease have different mechanisms for causing ascites.
  • Circulating cardiac troponin I is not a good differentiator between cardiac and non-cardiac causes of non-hemorrhagic ascites.
  • Point-of-care ultrasound can be used to rule out pericardial disease and guide further diagnostic workup.
  • Biomarkers and point-of-care ultrasound can help differentiate pericardial disease, right heart failure, and non-cardiogenic causes of ascites.
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