The only situation we've had that was even vaguely similar was resolved with Atenolol, simply slowed down the heart. I'm sure Moe's situation is a thousand times more complicated.
I can only suggest you get a 2nd opinion. Maybe a different cardiologist will see something differently. And it never hurts to get a 2nd opinion.........
All paws crossed for Moe............
From: justmckee <justmckee@...
To: feline-heart <firstname.lastname@example.org
Sent: Tue, May 7, 2013 3:39 pm
Subject: [FH] Help! Atrial fibrillation info needed. This may be Moe's last stand.
My 9 year old cat Moe is in end stage HCM. We have successfully kept him clot free for a year and a half since his original diagnosis although he has heavy smoke on his echoes. We have had our fair share of challenges related to getting the right "cocktail" of meds in place as his condition has progressed. I can't count the number of echoes, x-rays, blood tests Moe has had to endure but he is honestly the best cat (easy to pill and give shots to, easy to syringe feed, etc.) We have had few additional problems (no asthma, kidney/renal failure) along this path. Moe's blood tests have been good to date with slightly elevated kidney values (bun) and slight variations in potassium due to his high doses of furosemide.
In April, Moe was diagnosed with atrial fibrillation and tachycardia-supraventricular. He had three very short episodes of syncope (related to a heart beat that rises from 180 to the high 300's - verified by EKG). We have been desperately trying to get this under control with medication. At the beginning of April, the cardiologist placed Moe on diltiazem (30 mg - 1/2 tablet 3 times per day). It stopped the fainting episodes but Moe still had intermittent breakthrough moments of racing heart beats (high 300's). I could tell when he was having the episodes because he would lick his lips (like he was going to vomit) and roll over on his side. He focuses inward and his heart beat races. During these episodes, his respiration rate stays under or close to 40. In addition, as soon as he was on diltiazem, Moe stopped eating and drinking and became lethargic. We put him on ondansetron and Pepcid because we thought if we could control the nausea, we could get him to eat on his own again. We had a few days of minor success and then the lip licking would start again and he vomited his food twice. So in we went again..... The cardiologist did not know whether the nausea was from kidney issues, the drugs, or a reaction to a rapidly beating heart.
He was placed on Sotalol (22 mg/ml - 0.5 ml twice daily) and in a recheck his blood pressure and heart rate were in acceptable ranges with mild fluid around the lungs (this had increased from previously) and his kidney blood work jumped a small amount. Since the EKG checks represents a "snapshot" in time, I wasn't sure that they caught Moe on a good moment because he still exhibited the lip licking behavior at home and laying on his side. I was sure he heart was racing. In we went again.....
The dose of Sotalol was reduced to a dose of 0.25 ml twice daily in the hopes we were over medicating with the drug creating the nausea and unwillingness to eat and drink the amounts he previously did prior to April. A second cardiologist had concerns that the blood work may be the cause of Moe's nausea which would be very difficult to manage giving the concurrent fluid around the lungs.
We have tried omeprazole, Pepcid AC, cerenia, and ondansatron and none of them seem to have helped much to induce his desire to eat on his own. When I syringe feed him, it appears to me to bring on an episode of racing heart although he is not stressed at the time it is done. I don't know whether the medication or the food creates excess acid in his stomach which in turn induces the racing heart. I have gone on the internet and read that there is a correlation between atrial fibrillation events and excess acid from people who have personally experienced and been treated for this.
We absolutely love this cat and we refuse to give up on him as long as I can keep his quality of life high and his perky little walk in place. He means the world to us and we owe this to him for more reasons than I can relate here. He was the happy little face that greeted us at the door and kept us going through years of caregiving for elderly parents with Alzheimers, cancer, etc.
However, Moe is not Moe these last few days although he periodically rallies throughout the day. I can tell the break through heart episodes are taking a toll and the cardiologists seem to have run out of ideas. I sat at home and bawled like a baby today at the thought of having to let him go but I think we may be there and will have to make this decision today. I have run out of options so am making one last call to the group to ANYONE who has had this issue (racing heart beat) and found a way to resolve it. We have had so much success in the past and I'm hoping one more miracle is around the corner.
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