Sunday, September 15, 2013

Myrna’s Visit to the Cardiologist Friday Where We Find She Had a Heart Attack on Wednesday Before the ER Visit

We found out Friday at the cardiologist visit, that Myrna had had a heart attack, probably on Wednesday when she seemed to be more tired than usual, didn’t use the litter box for over eight hours before going to the ER, and hid under the bed late in the day around 6 p.m. 

Here is what we know:

1)       Her breathing rate at home had hit 10-12 breaths per 15 seconds in the days prior and on Wednesday stayed all day at 12 breaths per 15 seconds even after I had given her extra lasix.
a.       The xrays showed slight congestion but the ER vet thought it hadn’t changed since the last time we saw the cardiologist in August.
b.       Since congestion wasn’t a concern but her breathing rate was up, they injected lasix into her.
c.        We increased the daily lasix meds from 10mg per dose to 12.5 mg tabs per dose.

2)       The blood work showed high creatinine from 1.7 to 2.7 and BUN from 30 to 35. 
a.       Phos and bicarb (other kidney value indicators) were normal as was protein. 
b.       Potassium was low at 3.9 but we’ve had that go up and down before.
                                                               i.      But since the other values are high, potassium becomes a concern because it helps support kidney function, while the other values reflect kidneys’ ability to function.   
c.        Vet suggested more potassium added to diet and I said I would also add banana to her food. (Great source of potassium.)

3)       The ER vet suggested feeding KD, a low protein diet to keep the kidneys from having to process too much protein in the body. 
a.       That is the function of the kidneys-to filter almost everything that goes through the body.
b.       Protein is a difficult substance and too much can be taxing on weak kidneys, making them even weaker.  (For a fuller, more medical explanation of kidney function, please Wikipedia or Google as all of my explanations here are going to be simple.)

4)       They withdrew a ton of urine from her bladder with a needle to help her feel better.

5)       Called the cardio Thursday because the breathing rate was still 48 breaths per minute at home (the norm is 24.)  
a.       With the additional lasix and lasix injection, I had expected it to decrease.
b.       Vet said since Myrna was doing well, had good energy, etc. to let her recover and come in Friday.

6)       Saw the cardio on Friday who did an echo of the heart, took her blood pressure, and rechecked her xrays from Wednesday.
a.       Echo showed that Myrna had had a heart attack.  We’re not sure when. It wasn’t what usually happens to other cats-crying, foaming at the mouth, falling over.
b.       There is a large clot in Myrna’s heart in the left atrium that was not there three weeks ago.
                                                               i.      The clot probably formed in the last week during the time that I saw Myrna’s energy decline and her breathing rate increase.
                                                              ii.      A part of the clot broke off and lodged in the heart valve causing a mild infarction.
                                                            iii.      The clot isn’t there any longer but the larger one is there and a piece could break off and stop in the heart or in the legs.
c.        The left ventricle wall has decreased in size from 1.11 to .95 due to a LOSS of blood supply and oxygen to the heart due to the effect of the clot and heart attack.
                                                               i.      There is a decrease in strength and function. 
1.       The wall is not contracting as strongly as it should.  
                                                              ii.      Heart attack or CHF or clots in the legs (typically in rear legs but front can also be affected) could result because of ischemia-the part of the heart that is starved for oxygen weakens and dies, and the heart cannot function as well.  Clots in legs and even in the heart often lead to death.  Symptoms of clots in legs will appear causing great pain, lameness, or the cat may be seen cleaning and picking at the foot and leg.

**It is probably due to the med she takes Enalapril that she did not have much difficulty with the heart attack (aside from the possibility that the clot was also small enough to pass through after initially blocking the heart and causing the attack.)
                                         *Enalapril keeps blood veins opened in the event of an attack, (preventing the ACE properties from taking place which close off all peripheral veins and keep open only the central heart/brain/kidney route, causing the heart to pump faster as the blood circulates in a much smaller area of the body.) allowing blood to flow normally, the heart to pump normally, keeping blood pressure from raising,  This is just one property of Enalapril. 

7)       **What then happened that changed her breathing rate to make it rise?
a.       Due to the clot, the damage to her heart, her heart rate is UP to 170 (should be around 150) but her blood pressure is DOWN to 90 (norm should be around 110.)
                                                               i.      It is the increased heart rate that is reflected in the increased breathing rate.
                                                              ii.      Low blood pressure has caused her gums, paw pads, and tongue to appear pale as if she was dehydrated.
1.       But the gums are wet and the skin tenting test shows the skin-when pulled or tented up, quickly returns to its place. Dehydrated skin remains in the up position.  So, she is not dehydrated.

8)       The Cardiologist made additional changes to Myrna’s care and medicine routine.       
a.       Despite her kidney values being high, Myrna was and still is producing a lot of urine and excreting it often. 
                                                               i.      This shows that her kidneys are functioning well.
                                                              ii.      This shows that we may not need to worry too much about how much protein she eats.
b.       But because her kidney values are high, we will cut back on the Enalapril from 1 ½ tabs a day to ½ tab twice a day, which is what it was before August.
c.        Since she does not have any more congestion that she did in August, the extra lasix isn’t needed.
                                                               i.      We will return to 10mg four times a day of lasix.
                                                              ii.      This should help her kidney values.
d.       Due to clots, we will continue giving aspirin twice a week along with the daily Plavix despite her kidney values being high.

9)       The high breathing rate will make it difficult to determine the difference between a heart attack and congestion.
a.       If she has another mild attack, we may never know for sure, only notice a higher breathing rate and a lack of energy unless she has harsher symptoms when she has a heart attack.
b.       We can only try to give more lasix if we believe it is congestion and wait to see if it works.
c.        If she has harsher symptoms, we will need to take her to the ER and the cardiologist.

10)   Xrays and a complete CBC/chem panel will be done in two weeks to recheck kidney and other values. 

11)   To lower the heart rate, she may need additional atenolol but the vet wants to give time for the heart to recover and the heart rate to decrease normally on its own.
a.       We hope that this will also slow the breathing rate.

12)   The vet wants us to try to prevent Myrna from running up and down the stairs and from running when she plays. We are not to promote play time.
a.       Not promoting playtime will be easy.  But not running especially up the stairs? Right!

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