Feline HCM Cardiologist Checkup Reveals Stable Condition but with Congestion-Need to Increase Lasix

Myrna Loy

Myrna had a checkup with the cardiologist on Thursday.  She has been battling congestion for a month, with almost a daily need for 3-5mg of extra lasix, sometime from the afternoon to evening. I think the a/c units and fans are too noisy for her and she can no longer tolerate a lot of noise.  Her breathing also increased during storms earlier in May.  She has been run down this past week, typically in the morning and then bouncing back to energetic life by the late afternoon.  

The cardiologist said her heart seemed steady and stable with a slight change and increase in size (keeping in mind how enlarged her heart is and how damaged it is.)  The clot in the heart may be decreasing!  She has slight fluid in the lung and the cardio wasn't sure if that was congestion or pneumonia.   Myrna had a higher than normal temp at 103.5-but she always had a high temp of 102.9 to 103 when at the vet, induced by stress. Her temperature at home-if it is accurate-is always around 101.9 to 102.   But she has been run down this week so that is why the cardio thought it could be pneumonia-although no other typical symptoms (coughing and not eating, etc.) were presenting.

However, the blood work did not show any signs of illness-electrolytes were normal; white blood cell count normal, etc.  Potassium is 3.8-low normal-but decent given the amount of lasix she is taking (56mg a day.)  And that level is after we give her a potassium supplement of 595mg a day and give her Gerbers First Foods Sweet Potatoes or real banana in her food at least twice a day (excellent sources of potassium and they blend well with wet food.)    Her kidney values are good.  The BUN is normal at 34 and creatinine is 2.7-again 1/10 up from last time, slightly above normal but decent.   Her albumin is slightly high which usually indicates dehydration which is normal considering the amount of lasix she takes. BUT she is also congested so being dehydrated and congested at the same time is possible and to me confusing. 

 Her urinalysis was perfect but her pH is 6.5-all normal but when she gets to be 6.5 or greater, that is when she begins to go out of the box which she had done a couple of times lately.  The pH can go up due to dehydration. I give her Methigel-an acidifier-to bring down the pH level and it seems to work. And she takes a small amount of Max cat food (with acidifier) and S/O in her food to help obtain a balanced pH.   

The cardiologist wanted to increase her lasix to combat congestion and we hypothesized that perhaps she needs more at bedtime to combat any overnight development of congestion which could be the reason that she is run down in the morning. That 11 p.m. to 8 a.m. stretch is the longest she goes without getting additional lasix (and that is IF I'm able to get her by 8 a.m. to dose her.)  We decided to give her 5mg more at the 11 p.m. dose for a total of 18mg at 11 p.m.   That will increase her daily total to 61mg. 

She has had-which I was unaware of-weak rear leg pulses for sometime.  But the cardiologist isn't concerned and the pulses are not interfering with Myrna's ability to jump or walk and are due not to clots but to the obstruction in the mitral valve or SAM (systolic anterior motion of the mitral valve-when part of the septum blocks flow of blood during systolic motion-when the heart valve opens and pushes out fluid:  From Medicine.Net "Systolic: The blood pressure when the heart is contracting. It is specifically the maximum arterial pressure during contraction of the left ventricle of the heart. The time at which ventricular contraction occurs is called systole."  When the heart has trouble contracting, not enough blood flows through the body at a fast enough rate, therefore, pulses are weak.

Blood pressure was down to around 100, down from 130 in March.  Heart rate is 160 which is o.k. I think it's a bit too high but the cardiologist said it was fine. 

Here are her notes: Today’s thoracic radiographs revealed a focal area of congestion in her right middle lung field.  Because pneumonia has been comfortably ruled out based on the bloodwork results, we know that this congestion is a result of recurrent congestive heart failure.  We can increase her evening dose of Lasix to address this congestion and to hopefully improve her energy level when she wakes in the morning.  The laboratory testing did not reveal any new concerns.  Her electrolytes and BUN are normal.  Her creatinine is 2.7 which has not changed compared to her last evaluation.