Saturday, August 31, 2013

Myrna Loy Cardio Checkup Reveals Heart Enlarging Again, Change in Meds Warranted, Lesions Continue to Heal

Myrna had a check-up with the cardiologist on Thursday. As always, some good news but increasingly there is more bad news.

Congestion has returned and it is due to an increase in her heart size.  After all she’s been through since June-some congestion, the injection of lasix process, the lesions which appeared after three weeks of injections, the inflammation of the lesions, the fever from the inflammation, the antibiotics, the diarrhea from the antibiotics, the Proviable given to combat diarrhea that made her gag, followed by a month of healing-she again has slight congestion.  It is enough to increase her breathing rate and to decrease her energy and strength.   So, we’re back to where we were in early June.  Because she is still healing from the lesions (although they are almost invisible) we will hold off beginning the injection process for awhile longer.  We will combat the congestion with an increase in her Lasix dose as well as an increase in Enalapril.  The next time we begin injections, we will try a different Lasix brand just in case the last one was the cause of the lesions.  And we will resume giving her buffered 81mg of aspirin (to prevent clots) twice a week which we give on Wednesdays and Saturdays (aspirin should be given 72 hours apart because it remains in the bodies of cats’ before it is metabolized fully.  Too much aspirin can be toxic for cats.)

The change in Lasix will be a ½ tab or 10mg in the a.m., ½ tab at lunch which for her is around 2:30 p.m., ½ tab again at 6:30 p.m., and ¼ tab at bedtime or about 11:30 p.m.  For Enalapril, she will now receive one tab or 2.5 mg in the a.m. and ½ tab with her dinner meds.   
One of the features of Enalapril is the diuretic quality, hence the increase.  The diuretic quality comes from the fact that as an ACE inhibitor, it suppresses the body’s water retention ability.  Without ACE inhibitors  Stimulation by AII of the adrenal cortex to release aldosterone, a hormone that acts on kidney tubules, causes sodium and chloride ions retention and potassium excretion. Sodium is a "water-holding" ion, so water is also retained, which leads to increased blood volume, hence an increase in blood pressure.  Stimulation of the posterior pituitary to release vasopressin (antidiuretic hormone, ADH) also acts on the kidneys to increase water retention.”-Wikipedia.  So, the cats need Enalapril not only to help the body get rid of fluid but another effect is that in times of heart attacks (cats or humans) it keeps the blood veins opened and from being restricted which would drive up blood pressure and the heart rate, overworking an already distressed heart.

Myrna's left atrial (which was 2.48 in June) is now 2.47 (normal is about 1.30)  but the left ventricular walls which measured 0.91cm in June are now 1.11cm (normally less than 0.55cm).  This progressive left ventricular thickening is due to the natural progression of her HCM and it is the primary underlying cause of her recurrent congestion.

We thought she had a fever on Thursday as her temp was 103 at the vet’s but her white blood count (WBC) was normal, not indicating an inflammation (with fever or inflammation the WBC will be high.)  The temp was back to normal at 100.3 at home later that evening.

She will not be able to receive Revolution or her vaccines just yet. We will reevaluate her condition in a month.   Whenever a cat is very sick, you should hold off meds such as Revolution until the cat is stronger. Revolution is a strong med, as is any flea/tick barrier med. So, if a cat developed a fever, had serious vomiting, etc. didn't seem as well as usual, you wouldn't want to give any med that might compromise the immune system further.  If like Myrna, a cat has developed a skin infection especially serious lesions of unknown origin from which it is still recovering, you'd want to hold off until the lesions were gone.  With HCM cats, you want to make sure that around the time of the dose, the cat hasn't had any breathing issues, hasn't seemed lethargic or sick in any way, seems energetic/strong/stable. You should also review with the vet at each checkup-and for sure Myrna sees her vet more often than others might-if the cat is still well enough to receive Revolution. While well enough to receive it, you should have a discussion with your vet as to how much longer the vet thinks the cat can receive Revolution. We had had this discussion with the cardio ages ago and at each visit that applied to Revolution dosing (we give Revolution March or April through November.)  She had breathing issues in June but was well enough for Revolution. She received it in July because the injections of lasix had improved her condition (just before lesions appeared.)  

So, now because of lesions and some congestion, and the increase heart size, we're holding off for now, both Revolution and her annual rabies and the triannual distemper shot which is due this year.  I’m not concerned about the rabies shot.  The protocol for getting bit by a bat or rabies infected animal is to receive treatment for rabies despite getting the annual shot.  However, distemper is airborne and can be tracked into the house very easily.  But no one knows for sure what is the danger level of contracting distemper.

I am to let the cardiologist know in a week how Myrna seems to be doing. If she is breathing fine and is energetic, then further xrays and increase in lasix or injections will not yet be warranted.  If however, I feel she is less energetic-how she has been this past week-then the cardiologist might ask for xrays and reevaluate what to do next. 

GOOD news-potassium levels are good at 4.3 and BUN and creatinine and ALT, AST and all blood values are normal.

While at the cardio, there was an emergency ahead of us. A dog had developed fast breathing at home, was brought in, and had collapsed in the office.  In the office (which is part of the vet ER where the dog was placed) it was on oxygen but the cardio wasn't sure if it would rebound. It was there for another two hours before it died.  The dog had fluid around the heart and in the lungs.   I overheard the vet talking to the owners who of course were terribly upset. They were in shock and angry with the regular vet who ignored the fast breathing and congestion that had earlier been detected (however I don't know the exact details and how long ago it had been detected.)  But the vet had apparently-per the owners-done nothing. NEVER ignore heavy, fast, or labored breathing.  A cat at least (not sure of dogs) does not necessarily breathe through an open mouth when in CHF.  Never let a cat seem in distress from anything without seeing the vet especially when you know your cat has HCM.   AND never let the vet do nothing.  If xrays show congestion, increase lasix or get lasix started if not already on it and get on a regime of a couple doses or so a day. If the vet says that isn't warranted, ask how else to get rid of congestion and why wouldn't an HCM cat need lasix to rid of congestion.  If the vet says it doesn't need it, the vet doesn't know enough about HCM and the cat should get another vet.
Myrna Loy watching outdoor life


  1. Thank you for your posts. My cat Spike was diagnosed with HCM and late stage, left ventricle congestive heart failure. He was completely asymptomatic but fainted when he went in to have a cyst removed. He's only 9 and was given 6 months to a year to live. It's only when the vet told me to look for rapid breathing that I even noticed it. It looks like your vet is more aggressive in treatment. Mine has prescribed vetmedin, lasix, benazapril, and aspirin. I have no idea how enlarged Spike's heart is or how thick the wall. I wonder if it's worth finding out or if the additional vet-visit stress isn't worth it.

  2. Sorry to hear about your cat. Checking breathing is key. Being organized in the care is key. Giving meds as prescribed and on the same schedule is crucial. And getting all the meds the cat needs is even more crucial. If you want the cat on a med, talk to the vet and insist. A good cardiolgist will know exactly what your cat needs but you're right that not all are as aggressive as mine. And we're blessed that she is. If you've had an echo, the vet will have the results of the heart size on file. Call and check. Always get copies of blood work and visits, take notes. It's worth knowing because if you know how far away from "normal" is the heart, you'll understand how far along the disease has progressed. That being said, when Myrna first had CHF at 8 months in '09, she only had 1.64 heart size, up from the avg. normal of 1.3. Now she's at 2.47. And yet, she's not had CHF since 2011 but has had slight congestion since this January and we are fighting off CHF. And along the way, yes, the cardiologist has given her the meds needed to fight the progression of the disease by keeping away symptoms, improving heart function: Plavix and aspirin to thin blood to prevent clots, thin blood is easier for heart to pump; enalapril is the ACE inhibitor which acts as diuretic as well as keeps veins from being restricted, which lowers BP and eases heart function; atenolol is the beta blocker which in it's own way also lowers BP, slows heart rate by easing heart function; lasix is the diuretic; spironolactone helps keep potassium as it acts as a diuretic; isosorbide which I still don't understand, does send more oxygen to the heart. Then there's COQ10, potassium, and a good balanced vitamin. She takes Valium for litterbox issues. And lysine because the cats were exposed to a virus when kittens. Did I get it all? Good luck!