Sunday, August 22, 2010

Myrna's First Visit to the Cardiologist November 2009

The day following her first congestive heart failure, Myrna and I drove up to Novi to see Dr. DeSana at the Novi Animal Emergency Clinic.  The clinic staff was friendly and helpful. Myrna was much improved over the previous evening and walked around the examining room checking everything out before hiding under the bench and coming out only to be petted.  First, the tech came in to get a history and to take a pulse and check the heart beat.  Then we met with Dr. DeSana who also checked Myrna over and asked about her history and what had led up to the incident.  Since I had all of her past vet records, it was easy to fill in the blanks.  Dr. DeSana took more x-rays to see how congested Myrna was today and took a cardio ultrasound to determine the condition of the heart.  We were hoping that the issue would be easy to solve, that it would not be life threatening, and that recovery would be simple.

Here are her findings:
Myrna Loy has severe thickening of the heart walls (0.73cm, normally less than 0.6 cm) and a dynamic obstruction to blood flow caused by abnormal movement of the mitral valve (systolic anterior motion or SAM of the mitral valve.)  Indicates hypertrophic obstructive cardiomyopathy or HOCM. This condition makes Myrna very sensitive to increased fluid volume in her body.  The increased fluid volume caused by steroid administration has resulted in congestive heart failure.  Myrna's x-rays indicate that she continues to have congestion within her lungs which requires additional lasix therapy.  Myrna should also be started on spironolactone which will further help to resolve the pulmonary congestion and to conserve the body's potassium reserves.  (My note: adequate potassium levels are required in humans and in animals to maintain proper use of heart and kidneys. Too little and too much can cause damage to organs.) Once Myrna's congestive heart failure has resolved, a medication atenolol (a beta blocker) will be recommended to slow the resting heart rate and to improve cardiac filling.

It wasn't easy hearing about Myrna's heart condition.  We were told that we could still lose her and that she might not recover.  Or, if she did, she might have 2-5 years to live depending on how quickly she responds to treatment and how vigilant we were about her treatment. 

Myrna was put on lasix and spironolactone.  Because she is allergic to plastic, liquid versions of any medication could not be prescribed.  Instead, we had to cut up the tablets and administer them twice a day.  She took lasix 1/2 tab of 12.5 mg tab q 12; and spironolactone 1/4 tab of a 25 mg tab q 12.  

We had to close her off from the other cats for a few days to discourage activity.  I called the vet every few days to give her updates on Myrna's response to the medications.  I had to watch her activity level and her breathing rate and try to calculate it (number of times the chest rises per 15 seconds x4=breath rate per minute.)  But cats have strange breathing patterns.  They will run and breathe hard; they will sit and look calm and breathe hard; they will rest and barely breathe; they will sleep and breathe at ease.  We had to calculate the rate; time how often/duration she seemed to breathe heavily; we had to calculate her rate while sleeping which should be when she was most relaxed and therefore, her breathing normal.   Any change in pattern, any shallow breathing, any duration of faster breathing might necessitate a vet visit.  We also had to make sure she was still eating and was able to get around.

We were to return to her vet in two weeks for more x-rays to check for congestion and again in a month and if she had improved, she could begin the third medication atenolol.

We returned on 11/24 for more x-rays and for a blood test to check for renal function due to the medications that she was on.  Her renal panel proved to be normal so that the medications that she was on could continue.  The congestion had decreased greatly and she was improving. 

12/22 we again saw the vet and her condition had improved and she was placed on atenolol 1/4 tab of a 25 mg tab q 12.   Again, I used a knife to cut the tabs into quarters.

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