Tuesday, September 24, 2013

Article: Taking Care of a Cat That Has Heart Disease

Myrna Loy
Feline heart disease often seems to suddenly appear in a cat.  Cats that seem well one minute can suddenly collapse from the disease.  Or pet owners will come home to find that their cat has suddenly died.   Some cats will begin to cry out in pain while they have a heart attack or as a clot blocks an artery in the body.   As owners of an HCM cat, we know too well the overwhelming shock of finding out that your precious cat has the fatal disease.  There is no heart transplant or valve replacement possible.   However, with medications, supplements, diligence, and attention to detail, the progression of the disease can be slowed.

Our four year old cat, Myrna Loy, had always been the picture of health and was tough, energetic, and fast on her feet, tumbling and running with all of her siblings and showing no signs of any complications.  The only thing ever noted at two weeks old, four weeks old, and at 12 weeks old was that she had a heart murmur.  The vet said keep an eye on her and to watch her breathing.  When she developed an infection on her lip,  the vet put her on steroids and antibiotics.  A week later, she stopped eating.  When I took her to the vet, xrays showed she had congestion in her lungs.  The vet decreased the steroids and the antibiotics but did not prescribe anything for the congestion.  Then Myrna began to breathe more heavily and to lie around and not play with her siblings.  I called the vet when Myrna developed rapid chest heaving and the vet said to keep an eye on her” and bring her back if it continued the next day.  Late that night, Myrna collapsed.   We rushed her to the animal emergency where, over night, they stabilized her.  The next day, we transferred her to the regular vet for follow-up care and the vet arranged an appointment with the cardiologist in Novi.  Meanwhile, I was in shock.  But no one had yet to actually say that our eight month old kitten was dying of congestive heart failure (CHF).   At the cardiologist’s office, the tech took the history and I had copies of records from emergency and current xrays, as well as her other medical records.  Then the cardiologist did the echo.  I expected to hear that the issue would be resolved but the truth was that Myrna had Hypertrophic Cardiomyopathy (HCM), a chronic and fatal heart disease and might live for another 2 to 5 years. The reason for the collapse was congestive heart failure brought on by the steroids. We didn’t know that due to her heart murmur we should have avoided steroids, which promote fluid retention, and that we should have seen the cardiologist to determine the cause of the murmur.

Cardiomyopathy is the measurable decline in the function of the myocardium or heart muscle. Hypertrophy describes the thickening of the heart valve walls.  It may affect both the left and right sides of the heart or be concentrated on one side.  But the effect and the dangers are the same.  As the heart valves thicken, the heart is unable to take in and pump out fluid.  The remaining fluid begins to back up into the lungs or chest or abdomen, depending on the disease.  As it closes to pump out the fluid, not all of the fluid can be pumped out, leading to the possibility of clots forming.  As fluid fills the lungs (pulmonary edema) or surrounds the lungs (pleural effusion), congestion forms and the breathing rate increases. If it goes unnoticed and untreated, the cat may die of CHF due to the lungs drowning in fluid.  As the heart increases in size due to the hypertrophy, the heart will eventually begin to lose the ability to contract effectively, leading to low blood pressure and weakness and putting the cat at risk of developing clots or having a heart attack.  

Hypertrophic cardiomyopathy is just one type of heart disease.  There is also dilated cardiomyopathy which in the past was due to a lack of taurine and which has almost disappeared from the cat population because cat food manufacturers add taurine to commercial food; restrictive cardiomyopathy where the heart muscle has fibrosis or scar tissue building up in the heart; and arrhythmogenic right ventricular cardiomyopathy which affects the right side of the heart.  The disease is mostly congenital but sometimes heart damage can be related to thyroid issues.  

How does a pet owner know if a cat has heart disease?   The only sure way is a heart echo done by a certified veterinary cardiologist.   While almost any cat can have heart disease, certain breeds such as Maine Coon, Persians, and Siamese cats are prone to the disease and should be tested.   There is a genetic test called My BPC3.   However, studies show that some HCM cats do not have the gene and some cats that have the gene may not develop HCM.   And if the test is positive for the gene, an echo is still needed to determine if heart disease is present. If a cat presents with signs of heart disease or with a heart murmur, a genetic test is unnecessary as only the echo can determine the extent of the heart disease.  

A cat can present with many symptoms early in life or be asymptomatic for years until an older catA cat will begin to change their activity level and not be as active as usual. They may begin to hang out in quiet places or hide in places away from the family more often than usual.  They might look as if in pain or discomfort.   They may continue to eat and use the litter box or may begin to avoid both.   If not a lap cat, they may suddenly be one and come to you for comfort.  Cats will begin to have difficulty breathing as congestion forms.  Some cats might pant, some might seem to wheeze or cough but mostly, a cat will have rapid chest heaving as it breathes.  An owner can count the breathing rate for a cat at rest by counting how many up and down chest movements occur within 15 seconds.  One up and down is one count.  If a cat breathes six times in 15 seconds, then the breathing rate is 6x4=24 per minute, a normal rate.  Cats’ breathing rates vary when sleeping and when they walk, run, or even as they look out of the window.  That is why the rate should be counted a couple of different times as the cat sleeps to see what is normal or to see if it is high.  A cat that presents with a breathing rate nearing 30 when at rest and over 30 when awake will need to see the vet or animal emergency as soon as possible as that is a sign of CHF.  Other signs that a cat is sick are if a cat is suddenly lame, screaming in pain, fainting or falling over, or is acting dazed and confused.  Immediate treatment is necessary.

Medications can slow the progression of the disease and improve heart function and prevent CHF.  A cat with heart disease should take lasix, a diuretic, to reduce the fluid level in the body and to decrease the chances of congestion.  Beta blockers such as Atenolol slow down the heart rate, reducing the work of the heart and lowering blood pressure.  ACE inhibitors such as Enalapril have multi-functions: they prevent blood veins from becoming restricted, thereby lowering blood pressure and keeping veins opened if a heart attack were to occur; aid in the body’s restriction of salt retention, and therefore, fluid retention.  Plavix is a blood thinner, decreasing the work of the heart, and preventing blood clots from forming.  Aspirin can be given to cats but only every 72 hours, using a buffered 81mg children’s aspirin.  This also aids in clot prevention.  Spironolactone acts as a diuretic while also preserving some potassium that the kidneys need.   Not all cats will respond well to the medications and some additional complications such as kidney disease might occur.   Blood work is needed to monitor the kidney and liver values.  

Depending on the strength of the medication or the form which will be used (pill, liquid, gel, etc.) these medications can be purchased at the local pharmacy with a script from the vet and do not need to be purchased at the vet’s office where prices are often higher.  Most are available as generics.  Locally, Kroger offers many as part of their $4.00 generic drug program.  And if pilling a cat is difficult, a liquid oral or cream transdermal version might be possible. Ask your vet about what is possible to use with your pet.  Putting pills into pill pockets works with some cats, while we simply dip a pill into wet cat food to coat it and place it into Myrna's mouth.  For medications that are in liquid or gel form, a compounding pharmacy such as the online Road Runner  or the local Clark Pharmacy on Washtenaw can mix these medications.

Taking care of cat with heart disease requires many meds, supplements, and other supplies. In order to feel that the house is not overloaded with cat things, and in order to better organize Myrna's medications, I use many organizing tools.  Cat supplies such as wipes, brushes, nail clippers, etc. go in stackable containers that fit neatly into the cupboard.   Her medications and supplements go into lidded boxes and stackable trays in the kitchen cupboard for easy daily access.  Once a week, I prepare her medications by using a good pill cutter and a pill organizer that has four daily compartments in individual trays for all seven days.  I cut the prescribed dose and place it in the correct pill compartment. Then each day, I set out that day's tray of pills and we dose as scheduled.  There is also a tray for refrigerated supplements and medications that prevents those from getting lost in the frig.  Being organized decreases the stress of and speeds up the care of taking care of a cat with heart disease.   

Additional supplements improve the overall health of the cat.  Since diuretics promote excretion of fluid which has electrolytes, a good vitamin and a good potassium supplement are required.  We use a feline vitamin paste purchased online.  We use a national brand of potassium gluconate sold for human consumption but safe for animals that is purchased from local stores.  There are feline specific potassium supplements that can be purchased at pet stores or online at websites catering to pet care.  But a bit of mashed banana in wet food, if the cat will tolerate it, is also an excellent natural source of potassium.   (Also helps to curb diarrhea along with rice/rice water.)  We also give Myrna a national brand of COQ10 purchased from local stores and we pierce the orange capsules and mix it into her food.  She is given 100mg per meal three times a day.  COQ10 is naturally produced by the body and aides in cell growth and maintenance as well as acting as an antioxidant.   Other supplements we give to Myrna and our other cats are Methigel, Lysine, and Forta Flora which are ordered  from various websites catering to pet care such as 1-800 Pet Meds, Amazon, Road Runner Pharmacy, Dr. Foster and Smith, and Valley Vet Supply.   

A cat with heart disease will need frequent cardiology and regular vet visits depending on the extent of the disease and if any complications arise.  The cardiologist will do the xrays and echo while the regular vet can do the blood work and annual check-ups and take care of any other issues.  Coordination of care, especially concerning other drugs that might be needed (pain meds, antibiotics, etc.) should be done between the cardiologist and the regular vet.   Annual vaccines can be given to the cat unless the cat is beginning to have other complications.  Always ask the cardiologist if the cat is well enough to get vaccines or even monthly flea medications such as Revolution.  Myrna has always been able to receive vaccines, other drugs, and Revolution until this summer because of various issues concerning HCM.  

A word on other medications: steroids should be avoided unless needed for cancer or other disease treatment and always with the coordination of the cardiologist.  Many pain meds cannot be given but Buprenex or buprenorphine can be tolerated.  It might be needed to relieve pain or inflammation, and can be used as an anxiety medication.  If a cat is taking Plavix, per the FDA warning, a cat (or human) cannot take Prozac or other psychotropics or Prilosec and other stomach medications because Plavix needs an enzyme that is inhibited by these other medications.  A cat or human is at risk of clots or heart attacks because Plavix cannot work as prescribed.  If a cat has upset stomachs from the heart medications (and Myrna has recently), the use of club soda in wet food will reduce the stomach acid.  It works for Myrna. The only safe psychotropic in this case is Valium.  While Valium may cause liver disease in cats, if a cat is highly anxious or going out of the box, it might be necessary to use.  Myrna has been on it for over two years and so far, is tolerating it very well.  Blood tests are needed to monitor liver values.  And surgery must be avoided because cats cannot receive anesthesia. But again, coordination of care must be made with the cardiologist if surgery is warranted. 

Care must be taken to decrease stress in a cat’s environment as stress can lead to congestion.   A cat with HCM needs to be kept warm in winter and cool and free from humidity in summer because the diseased heart cannot work keep a body warm or cool effectively.  Hot, humid or even cold weather coming in through windows can lead to congestion.  Avoid loud noises in and outside of the house, make sure other pets do not fight with the sick cat, make sure children do not play too roughly with the cat, and even be wary of stress that visitors might cause.  If work is being done inside the house, try moving the cat to the opposite side of the house and close the doors.   If noise is outside of the house, close the windows.  When it storms, close the shades and maybe take the cat to the basement or give it food or treats to distract it.  And if the cat is an outdoor cat, begin keeping it in for longer periods of time.  A cat with heart disease will need medications at different times of the day and if it goes outside, it might miss a dose.  An outdoor cat is also prone to injury, disease, even things like bee stings for which it cannot receive steroid medication because steroids retain fluid.

The cost of care for a pet with a chronic disease can be expensive.  There are many different pet health insurances available online to consider.  Another option is to get a line of credit called Care Credit that can help cover expenses.

If you are interested in taking your cat for an echo, these are the choices with which I am familiar.  There is Michigan State University Veterinary School and Oakland Veterinary Hospital.  Myrna Loy sees the Veterinary Cardiology Consultants in Novi which also has an office in Rochester Hills.  Her wonderful cardiologist is Dr. Joanne DeSana.  The other cardiologist is the wonderful Dr. Brown who can be seen once a month at the Ann Arbor Cat Clinic and weekly at the Ann Arbor Animal Hospital on Liberty Rd. 

While heart disease is fatal, the progression of the disease can be slowed if the condition is caught early and treated aggressively from the start by both the cardiologist as well as the pet owner.  The owner must be vigilant about correct medication dosing and adhere to the dosing schedule as prescribed by the vet.   Additional vitamins and supplements are often warranted to improve the overall health of the cat.  Attention to details about the cat’s day to day living, how it is affected by the medications, and especially the breathing rate and overall physical ability, will also help the cardiologist make better  care giving decisions.  While Myrna’s disease is progressing, she continues to be stable even as we continue to fight congestion.

For more information, there are hundreds of websites that give basic information about feline heart disease, such as  Cardiomyopathy In Your Cat ,and  Harpsie’s Website .  For information regarding blood tests and results, as well as kidney disease, HCM, and other related issues, read Tanya’s Comprehensive Guide to Chronic  Kidney DiseaseWikipedia and Drugs.com are great sources to learn more about medication uses and side effects.  

-Joanne Marbut

Blog:  Cat Living with Hypertrophic Cardiomyopathy

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