Thursday, March 27, 2014

Cooper Returns to ER with CHF Almost a Week After Leaving Hospital-Turns Out He Has Rare Disease

Myrna and Cooper were to see cardiologist today-a recheck for Cooper after being in the hospital last Friday night for CHF; and a regular checkup for Myrna.   He had slowly bounced back from being in the ER with CHF last Friday.  He came home Saturday looking miserable and slept in the basement.  But Sunday he was more alert and more social, choosing to sleep in our bed.  He continued to be more social, eat more and more often, and take his heart meds as the week went along.  However, his breathing rate ran 10-14 and continued to be around 12-14 by Wednesday night.  By 1 a.m. the breathing rate was 20 in 15 seconds.  He was breathing very fast but not panting, not looking uncomfortable.  I gave him 10mg lasix. By 1:25 a.m. the rate came down to 15 where it remained until morning.  We decided he wasn't getting better because despite 10mg at 1 a.m. and 10mg at 7:30 a.m., he had only urinated once.  So my husband took him to the cardio's office, which is connected to the ER. They put him on oxygen.  When I took Myrna in for the 3 p.m. appointment, I discussed Cooper with the cardiologist.  He unfortunately, has CHF again and will remain overnight in the ER on oxygen and IV lasix.  

Dr. DeSana did a new echo today.  As reported Friday, he has cardiomyopathy but today she was better able to see the heart.  He does NOT have HCM.  He has a rare disease called
 Moderator Band Cardiomyopathy.  There is NO clot nor thickened section of a valve wall. What he has are bands of muscle tissue that connect themselves to sections in a chamber of the heart.  They don't belong there.  They are restricting blood flow and ability of the valve to work. The connective bands make it look as if the chamber is segmented when it's not.  I need to research this more.  But here are some links:

He's not in danger of having heart failure any time soon. He has NO clot which is great news. He is at risk-as are all cardio patients-of getting clots, arrhythmias, low or high blood pressure, and congestion, which he is battling now. 

She said his lungs are worse with congestion than Myrna's have ever been.  And she fainted and had trouble breathing, and was in pain and lethargic when she had CHF. Cooper has not fainted, grown weak or lethargic, or looked in great pain and discomfort. We don't know why he has congestion.  It could be that his lungs were not that clear when they released him Saturday. They listened to his lungs but did not take new films. LESSON LEARNED:  if fighting congestion, always get new xrays taken when you think the lungs sound clear to make sure they are clear. 

The problem is that he's not responding well to lasix.  His kidneys are perfect. The blood values are fine; he concentrates urine; his specific gravity is normal.  And strangely enough, he's actually dehydrated!  The only fluid in his body is in his lungs.  But for some reason, the lasix isn't causing the body to send fluid to the kidneys to be excreted as quickly as it should, certainly not as quickly as it works for Myrna.  The vet will now be more aggressive.  He will receive IV lasix tonight in the ER.  

His breathing rate at noon was 72; by 4 p.m. it was down to 42-better.  He was able to come out of oxygen to get an echo without collapsing or without an increase in breathing rate which is good news.

At home, we will use higher doses or dose more often of lasix.  We may need to do injections, supplies we still have for Myrna.  

His condition is very odd.  It's also very rare. It's the first case the cardio has ever seen.  She read about it in vet school but has not treated a case. The cause is unknown.  The research mostly believes that the condition is congenital (unless there's new research) because most cases have occurred in cats that had not had heart echos when the hearts were healthy, prior to being diagnosed. So, researchers assumed the condition was always present when it might not have been.  When he ever does pass away (and he's not expected to any time soon) we will donate his heart to research and the vet may write a paper on it.  

Since the condition is rare, treatment with medications and effects or symptoms of the disease are not well known.   Lasix is needed for sure.  For him, right now, an ACE inhibitor or a beta blocker are not recommended because his heart rate is high, blood pressure is low, and contractility is weak.   She does want to put him on Vetmedin a.k.a. Pimobedan to improve heart contractility.  

She also suggested seeing a holistic vet.  He apparently is very good with difficult cases. I'll look into it.

Cooper will hopefully come home in the morning.  She will call after 9 a.m.  By the way, Cooper looks pissed off in the cage today.  And he hisses whenever the vets or techs open the cage for anything.  He only hisses at home at the other cats, never at us or visitors. (But
 he always hides from visitors.)


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