Getting back to CHF and asthma triggers-cleaning products (heavy bleach or ammonia to name a few), aerosol cans (cleaning products, hairspray), beauty products that are sprayed (hair items, perfumes, etc.), air fresheners-can all play a part in causing our HCM cats to develop trouble breathing. Decrease the use of heavy smelling items; limit where you use them; run fans or as in the bathroom, the exhaust fan; and close off the cat (as long as the smell doesn't congregate in that room) until things are better. And remember to damp dust, damp mop-but don't let water sit on the floor (can create humidity) and vacuum floors and furniture regularly. It all helps.
Our cat Myrna Loy, born March 22, 2009, died of HCM 8/19/15. We will continue the blog and FB page. With five cats, we often have a variety of medical issues. Please share your information. Please check the Archives, Categories, Search, and Tabs for more information.
Showing posts with label feline HCM and asthma. Show all posts
Showing posts with label feline HCM and asthma. Show all posts
Friday, April 10, 2015
Monday, September 8, 2014
Myrna's Heart Develops New Complication-AFib
Myrna had her regular check-up with the cardiologist today. She has developed an arrhythmia due to atrial fibrillation. This is a new complication that will make management of the disease and congestion difficult. And there's very little we can do. Yet, while this is a new complication, it comes after almost five years of the disease. Many cats develop it sooner or die of HCM too soon to develop a fib. And she continues to battle congestion or Congestive Heart Failure. The cardio reiterated that Myrna is the only patient she and her practice partner Dr. Brown has ever seen with the heart size of Myrna (2.2) that continues to live as long as she does and do as well as she does with the ongoing CHF. (Good vitamins and supplements, plenty of meds and correct dosing and adherence to the strict schedule, and vigilance on our part as to changes in her physical condition and reactions, and the best damn cardio team all play their part.)
She has been suffering with congestion all summer long. It comes and goes and we deal with it by determining when she needs extra lasix: usually it is when her breathing is above her "normal" breathing rate of 32 a minute (a cat is usually around 24) or when she is breathing hard, making a hard push through the chest cavity. When she is breathing steadily at 32 and it is not difficult but has a third "bump" in the chest cavity (in, out, BUMP; in, out, BUMP) then we know she needs the inhaler. That BUMP shows up near the back, near the end of the ribs as she physically makes an effort to exhale. There have been times when she is breathing above 8 or hard AND has that third BUMP in the breathing process through the chest cavity. That's when we not only give extra lasix but give a dose of the inhaler as well. And that is the most effective protocol for us to follow.
There are concerns with the inhaler as it can be contraindicated with atenolol, the beta blocker that slows down the heart rate. The inhaler is inhaled and absorbed into the bloodstream. If it builds up, it can increase blood pressure and have a negative interaction with atenolol (a process that involves antagonists, beta 1 or 2 receptors, bronchodilators and constrictors,etc.-a process I do not understand well enough to explain.) We are to give it in the a.m. and p.m. and only in between as needed, which we have been doing. But the cardio hopes that with cooler weather, the need for it twice a day may decrease.
The arrhythmia was heard via stethoscope and was confirmed via ECG. The echo showed atrial fibrillation, a process by which too many electrical impulses disturb the heart rate making it erratic. The heart cannot pump or contract (systole, diastole) correctly. This allows blood to flow between chambers but without the heart muscle reacting. This means the unused heart muscle will over time become potentially weak like any muscle that is unused. This will create a myriad of complications: will make it difficult to fight congestion; will cause a lack of efficient and sufficient circulation of blood and oxygen; will lead to weakness in her body, etc. From Pet Place website:
"Atrial fibrillation (AF) is a common electrical disturbance or arrhythmia of the heart, marked by rapid randomized contractions of the atrial heart muscle causing a totally irregular, often rapid , ventricular rate. In this arrhythmia the normally coordinated electrical activity in the upper heart chambers, the right atrium and left atrium, is lost. The muscle of these chambers begins to wiggle like a "bag full of worms." Atrial flutter is similar to AF, but the atrial contractions are rapid but regular. Both rhythms are very abnormal and reduce heart function."
This weakness is already showing up. She has lately been lacking an ability to jump up and down and to land well enough depending on the angle of the jump. I was afraid her rear leg pulses were getting weak but they are now strong at 130. But that is also due to her heart racing at 150-190 (as it was today in the office.) No, I don't know how a heart cannot contract sufficiently and yet produce a high heart rate.
Because the heart rate is up, and we need to prevent a racing heart, the cardio prescribed additional daily atenolol and she will begin to take it twice a day or BID-1/4 of a tab BID. Her lasix medication levels will change as well from 15, 13,15,18 mg to 18, 13,15,18mg a day. (She receives lasix four times a day.)
She also presented with a touch of pleural effusion-fluid around the heart and lungs-in the pericardial-but not enough to aspirate. But they gave a lasix injection and additional lasix at home may be warranted. But again, this is a troubling sign and due to the new complication.
"Pericardial effusion, sometimes referred to as "fluid around the heart," is the abnormal build-up of excess fluid that develops between the pericardium, the lining of the heart, and the heart itself."
The blood work comes back tomorrow and I'll know more then how her kidney values are doing and if the supplements I've been giving are helping.
She still has a clot in the heart but nothing has broken off that can be seen. So far, so good.
Here are the cardio's notes:
The new complication that myrna is presenting us with is an arrhythmia (irregular heartbeat) called atrial fibrillation. A fib is a persistently irregular heartbeat that results from severe output (amount of blood circulated to the body.) This can result in a relapse of congestive heart failure, generalized weakness, and/or blood clot development. I am happy to say that it does not appear as though Myrna has experienced a blood clot [Editor's note: In the rear legs. There is one in the heart.]. There were none of the hallmark abnormalities during her examination today and she had normal blood pressure in both of her hind limbs. (130mmHg on the right and 126mmHg on the left.) [Editor's note: I had been concerned that her rear legs were weak due to low pulses.] Rather, it appears that her weakness is a result of the new arrhythmia. Unfortunately, the arrhythmia will persists throughout her life-we cannot eliminate it entirely. However, we can improve control of her heart rate by increasing her dose of atenolol. She is a good candidate for this adjustment because her heart rate is higher today (190/min on the ECG) and her blood pressure is normal. There is a small amount of fluid accumulation around her heart and lungs today (pericardial and pleural effusion), indicating that we're not keeping up with her congestive heart failure treatment as well as we would like. We will need to increase her dose of lasix to better manage her heart failure."
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| Myrna Loy |
There are concerns with the inhaler as it can be contraindicated with atenolol, the beta blocker that slows down the heart rate. The inhaler is inhaled and absorbed into the bloodstream. If it builds up, it can increase blood pressure and have a negative interaction with atenolol (a process that involves antagonists, beta 1 or 2 receptors, bronchodilators and constrictors,etc.-a process I do not understand well enough to explain.) We are to give it in the a.m. and p.m. and only in between as needed, which we have been doing. But the cardio hopes that with cooler weather, the need for it twice a day may decrease.
The arrhythmia was heard via stethoscope and was confirmed via ECG. The echo showed atrial fibrillation, a process by which too many electrical impulses disturb the heart rate making it erratic. The heart cannot pump or contract (systole, diastole) correctly. This allows blood to flow between chambers but without the heart muscle reacting. This means the unused heart muscle will over time become potentially weak like any muscle that is unused. This will create a myriad of complications: will make it difficult to fight congestion; will cause a lack of efficient and sufficient circulation of blood and oxygen; will lead to weakness in her body, etc. From Pet Place website:
"Atrial fibrillation (AF) is a common electrical disturbance or arrhythmia of the heart, marked by rapid randomized contractions of the atrial heart muscle causing a totally irregular, often rapid , ventricular rate. In this arrhythmia the normally coordinated electrical activity in the upper heart chambers, the right atrium and left atrium, is lost. The muscle of these chambers begins to wiggle like a "bag full of worms." Atrial flutter is similar to AF, but the atrial contractions are rapid but regular. Both rhythms are very abnormal and reduce heart function."
This weakness is already showing up. She has lately been lacking an ability to jump up and down and to land well enough depending on the angle of the jump. I was afraid her rear leg pulses were getting weak but they are now strong at 130. But that is also due to her heart racing at 150-190 (as it was today in the office.) No, I don't know how a heart cannot contract sufficiently and yet produce a high heart rate.
Because the heart rate is up, and we need to prevent a racing heart, the cardio prescribed additional daily atenolol and she will begin to take it twice a day or BID-1/4 of a tab BID. Her lasix medication levels will change as well from 15, 13,15,18 mg to 18, 13,15,18mg a day. (She receives lasix four times a day.)
She also presented with a touch of pleural effusion-fluid around the heart and lungs-in the pericardial-but not enough to aspirate. But they gave a lasix injection and additional lasix at home may be warranted. But again, this is a troubling sign and due to the new complication.
"Pericardial effusion, sometimes referred to as "fluid around the heart," is the abnormal build-up of excess fluid that develops between the pericardium, the lining of the heart, and the heart itself."
The blood work comes back tomorrow and I'll know more then how her kidney values are doing and if the supplements I've been giving are helping.
She still has a clot in the heart but nothing has broken off that can be seen. So far, so good.
Here are the cardio's notes:
The new complication that myrna is presenting us with is an arrhythmia (irregular heartbeat) called atrial fibrillation. A fib is a persistently irregular heartbeat that results from severe output (amount of blood circulated to the body.) This can result in a relapse of congestive heart failure, generalized weakness, and/or blood clot development. I am happy to say that it does not appear as though Myrna has experienced a blood clot [Editor's note: In the rear legs. There is one in the heart.]. There were none of the hallmark abnormalities during her examination today and she had normal blood pressure in both of her hind limbs. (130mmHg on the right and 126mmHg on the left.) [Editor's note: I had been concerned that her rear legs were weak due to low pulses.] Rather, it appears that her weakness is a result of the new arrhythmia. Unfortunately, the arrhythmia will persists throughout her life-we cannot eliminate it entirely. However, we can improve control of her heart rate by increasing her dose of atenolol. She is a good candidate for this adjustment because her heart rate is higher today (190/min on the ECG) and her blood pressure is normal. There is a small amount of fluid accumulation around her heart and lungs today (pericardial and pleural effusion), indicating that we're not keeping up with her congestive heart failure treatment as well as we would like. We will need to increase her dose of lasix to better manage her heart failure."
Monday, September 1, 2014
Feline HCM Cat-When Myrna Loy was in the ER June 16-Leading to a Finding of Asthma
Myrna saw the cardio for a regular checkup on June 14 and everything was fine but she was congested and this issue had been ongoing for a couple of weeks. By the weekend, she was again breathing fast and yet nothing worked: not extra lasix, not a lasix injection. So, I took her to the ER. This is the Facebook post from June 16:
In the ER with Myrna at 2 am. We've not been here this early since 2009. Breathing rate increased to about 12 around 8 pm and we gave extra lasix. Then she wouldn't urinate when she was due and then she laid under the bed about 10pm. When she came out to get a drink, she was still breathing fast and her next dose of lasix was due at 11pm. I decided to inject her with .3ml of lasix. Also gave .1ml buprenex pain med. Normally, in half an hour or less she'd use the box and in about an hour the breathing rate would decline and eventually would be normal. Tonight, she laid under the bed until after midnight when she came out to drink. She drank for an hour , never leaving the bowl, resting against the bowl, and pawing at the water. When I picked her up to try the litter box, she was wet. I assume she urinated at the bowl. By then it was 1:20 am and I gathered her up to go. Too many symptoms are similar to the heart attack in September. She'll be here next few hours and cardio will see her in am.
Update on Myrna: she's only breathing about 42 per minute-still high, should be about 32 or less; still on oxygen. Lungs are a tad clearer than xrays from Thursday's cardio checkup so it's not true CHF. BUT lower lung lobes are inflamed. They suspect she's asthmatic. Gave abutererol (an inhaler placed over the mouth and pressed and air forced into mouth) and her breathing rate was less forceful but still at 42 but lungs are less harsh sounding. Echo did NOT show a heart attack (there would be scar tissues and there are none, none as they saw in September after that heart attack.) They will try to take her off of oxygen about 1 p.m. to see how she does. They will decrease oxygen overtime to wean her. She did well not in oxygen when they did the echo. So, if all goes well, she'll be home later this evening. BUT she might also be on yet ANOTHER med, this time an inhaler, which will be fun to administer I'm sure. In discussing it with the vet as to when I should have taken her to the ER, she said since all seemed normal and I knew the protocol and followed it-more lasix, a lasix injection, wait for breathing to decrease-and she was eating and drinking, that it would be hard to say how much sooner she should have been to the ER. The only thing there they could do for her was give oxygen since we could have continued lasix injections as needed had it just been simple CHF. While a lack of response to the lasix indicated a need for the ER, it was realizing that she was urinating on herself while sitting for an hour drinking that prompted me to go right then. In truth, gut instinct said around 11 p.m that she wasn't well. Looking back, that was when I should have taken her even if two hours sooner wouldn't have made a difference in the outcome THIS time since it wasn't a heart attack. But what if it had been? Then she would have needed oxygen and ER care two hours sooner. Lesson learned-go on gut instinct. If the sick cat bothers you, leave right then, don't hesitate. By the way, a one hour drive to the vet ER is cut down to 30 minutes at 1:30 a.m.! But by the time I left the ER it was 3:30 a.m. and by the time I was back in bed, it was after 4 a.m. Leaving two hours sooner would have meant that I would have been back in bed two hours sooner. Keep that in mind the next time you hesitate at 11 p.m. to take the cat to the vet. Think-do I want to be up at 4 a.m. or 2 a.m.?????
She's home, she's well, we thank you for your prayers and kind words, and this is how you get a cat to inhale asthma med-med is sprayed into one end while the plastic mask end goes over her face and held for ten breaths.
In the ER with Myrna at 2 am. We've not been here this early since 2009. Breathing rate increased to about 12 around 8 pm and we gave extra lasix. Then she wouldn't urinate when she was due and then she laid under the bed about 10pm. When she came out to get a drink, she was still breathing fast and her next dose of lasix was due at 11pm. I decided to inject her with .3ml of lasix. Also gave .1ml buprenex pain med. Normally, in half an hour or less she'd use the box and in about an hour the breathing rate would decline and eventually would be normal. Tonight, she laid under the bed until after midnight when she came out to drink. She drank for an hour , never leaving the bowl, resting against the bowl, and pawing at the water. When I picked her up to try the litter box, she was wet. I assume she urinated at the bowl. By then it was 1:20 am and I gathered her up to go. Too many symptoms are similar to the heart attack in September. She'll be here next few hours and cardio will see her in am.
Update on Myrna: she's only breathing about 42 per minute-still high, should be about 32 or less; still on oxygen. Lungs are a tad clearer than xrays from Thursday's cardio checkup so it's not true CHF. BUT lower lung lobes are inflamed. They suspect she's asthmatic. Gave abutererol (an inhaler placed over the mouth and pressed and air forced into mouth) and her breathing rate was less forceful but still at 42 but lungs are less harsh sounding. Echo did NOT show a heart attack (there would be scar tissues and there are none, none as they saw in September after that heart attack.) They will try to take her off of oxygen about 1 p.m. to see how she does. They will decrease oxygen overtime to wean her. She did well not in oxygen when they did the echo. So, if all goes well, she'll be home later this evening. BUT she might also be on yet ANOTHER med, this time an inhaler, which will be fun to administer I'm sure. In discussing it with the vet as to when I should have taken her to the ER, she said since all seemed normal and I knew the protocol and followed it-more lasix, a lasix injection, wait for breathing to decrease-and she was eating and drinking, that it would be hard to say how much sooner she should have been to the ER. The only thing there they could do for her was give oxygen since we could have continued lasix injections as needed had it just been simple CHF. While a lack of response to the lasix indicated a need for the ER, it was realizing that she was urinating on herself while sitting for an hour drinking that prompted me to go right then. In truth, gut instinct said around 11 p.m that she wasn't well. Looking back, that was when I should have taken her even if two hours sooner wouldn't have made a difference in the outcome THIS time since it wasn't a heart attack. But what if it had been? Then she would have needed oxygen and ER care two hours sooner. Lesson learned-go on gut instinct. If the sick cat bothers you, leave right then, don't hesitate. By the way, a one hour drive to the vet ER is cut down to 30 minutes at 1:30 a.m.! But by the time I left the ER it was 3:30 a.m. and by the time I was back in bed, it was after 4 a.m. Leaving two hours sooner would have meant that I would have been back in bed two hours sooner. Keep that in mind the next time you hesitate at 11 p.m. to take the cat to the vet. Think-do I want to be up at 4 a.m. or 2 a.m.?????
She's home, she's well, we thank you for your prayers and kind words, and this is how you get a cat to inhale asthma med-med is sprayed into one end while the plastic mask end goes over her face and held for ten breaths.
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