When is an echocardiogram warranted before a dental?

[baztien]

Hello! I posted earlier but have a more specific question now.

Lily, my 12 year old cat, has her dental scheduled for this Wednesday and I'm currently an anxious wreck, Googling all things dental related constantly.

From what I'm reading, most anesthetic complications come from heart issues. Lily had bloodwork done at the end of December, and everything came back within normal limits, aside from her USG being lower. Her kidney values were higher than a month prior as well, but still within the normal range. We added on the CardioPet NT-proBNP test, which came back at 76 (normal values are >100). The test isn't perfectly accurate but is apparently a common and accepted screening for heart disease.

She's also had issues with mild asthma throughout her adult life, with maybe a few wheezing fits per year. She had two in February, with the previous ones being in November, and before that, July. She has also lightly coughed, I'm talking 4 quiet coughs, on 3/4 and 3/6. Aside from that, breathing has been normal, and no wheezing fits since 2/29.

Our vet (who is cat only) said we could proceed with the dental if these infrequent fits are normal for her and we just happened to have one two weeks before her dental. But he also said we could delay it and try an inhaler on her. She had a chest x-ray last summer, which did show signs of asthma, but from what I'm seeing, asthma and heart disease can often show the same symptoms. She's also diabetic and in remission, so if we can avoid any steroid use, that is more ideal.

She's never had a murmur detected and her proBNP level was normal in December. On the day of the dental, they'll also do extra pre-anesthetic blood testing and a chest x-ray, in addition to a snap proBNP test. Do you think this is sufficient? I'm just worried I'm not covering all of my bases and I would be devastated if something happened to her. Should I have scheduled at echocardiogram before agreeing to the dental? She will have an EKG monitoring her during the procedure, but with my limited medical knowledge, I'm not sure what that really means.

Her teeth issues are not great but not emergency level bad, according to my vet, (photos here), so I guess I'm terrified something would happen to her when right now, she's so playful and eats well and seems happy. She does have stinky breath and is a bit of a messy eater. In addition, this is my parents cat mainly, and I'm the one suggesting the dental (off of our vet's recommendation of course), so I would feel insanely guilty if it went poorly. I know dentals provide better quality of life and help keep her diabetic remission in check, in addition to preventing bacteria from reaching her other organs. It's just weighing the pros and cons that's bothering me.

TLDR - Bloodwork is decently normal aside from early stage CKD, proBNP test is WNL, but suspected asthma that is mild/infrequent. Should a cardiogram happen before the dental?

Thank you so so much to anyone that's able to read this all and respond.

 

[silent meowlook]

The most important things to monitor is blood pressure, heart rate, respiration, cO2, temperature and careful monitoring during recovery. most anesthetic deaths occur during recovery.

It is a good idea to get chest x-rays before anesthesia, as well as a baseline, blood pressure reading, and bloodwork.

Often EKG is done during anesthesia, which is also very helpful, provided the people monitoring anesthesia know how to read EKGs.

Really it comes down to the competency of the people monitoring the anesthesia and the recovery.

 

[baztien]

Hi again S silent meowlook ! You answered my other recent questions but appreciate the answers here as well.

Pasting this from my vet again in case any new eyes are on this: "We administer IV fluids to every anesthetized patient and take pains to maintain their blood pressure and reduce stress to the kidneys. We also closely monitor all patients while under anesthesia with multiple parameters including: blood pressure, end-tidal CO2, oximetry, ECG, respiration, temperature and more. We keep them under a warm-air heated blanket, as well. For very excited patients, we will also have them on gabapentin prior to coming in.

Dental radiographs are taken during the procedure, but can only be done on anesthetized patients. Of course, we only extract teeth when appropriate. All healthy teeth are left in place. We base the decision on visual evaluation, dental radiographs and probing with dental instruments."

I've seen a lot online about how echocardiograms aren't usually called for unless a murmur is detected, or an abnormal proBNP test result. Given the slight concerns for what may be mild asthma though, I guess I'm wondering whether it should be required for Lily before her procedure. Or would the chest x-ray be a good alternative in addition to the snap proBNP test?