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16702Re: [FH] great news about Spazz

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  • Susan
    Jun 4, 2004
      --- Linda Fischbach <fischbl@...> wrote:
      > Susan, thanks for this info. Mittens was diagnosed
      > with mild HCM in Dec
      > 2001, and prescribed atenolol. His heart improved
      > in the next 4 months,
      > then stayed constant until Jan 2004 when he had
      > fluids in his chest, and the
      > cardiologist (a different one since our regular
      > cardiologist wasn't there)
      > said his heart had deterioated significantly.
      > Enalapril (an Ace
      > Inhibitor) and Lasix were added to his meds. At
      > his recheck in April (I
      > was expecting the worse) we were pleased to hear the
      > cardiologist keep
      > saying "looking good" as he did the ultrasound.
      > Mittens' heart is back to
      > where it was a year ago; the cardiologist has no
      > idea what caused the
      > problem in January. But maybe the added meds did
      > the trick.
      > Linda


      While it is certainly only anecdotal evidence it is
      heartening. I think when Dr. Atkins and others such as
      Bonagura are expressing skepticism at Dr. Rush's
      report is because until a cat has reached a point
      where the Renin Angiotensis system (RAS) is activated
      the rationale for the ACE-inhibitor is not there. I
      think Dr. Atkins does not believe that an
      ACE-inhibitor can prevent renodeling and hypertrophy
      before the point when the RAS gets activated. In other
      words they do not think an ACE-inhibitor is indicated
      for asymptomatic patients.

      The way I understand RAS, is that if the kidneys
      "think" the body is losing pressure because they think
      the body is bleeding even though the loss of pressure
      is due to heart disease and not bleeding, it initiates
      the RAS so that the body has a better chance of
      surviving the bleeding. This is good if you are
      bleeding, very bad if you are not and the RAS
      activation is bad for the heart if it chronic as it is
      in CHF.

      The other thing that goes on in CHF that is bad for
      the heart is the Sympathetic Nervous System (SNS) AKA
      "flight or fight" gets activated. This is good if a
      predator is chasing you, bad for the heart if it is
      chronic as it is in CHF.

      If anyone is interested in reading up on the
      ACE-inhibitor trial, it was called SOLVD (Studies Of
      Left Ventricular Dysfunction)

      Early Treatment with Enalapril Prevents Heart Failure
      and Myocardial Infarction and Improves Long-term
      Survival in Patients with Asymptomatic LVD: XSOLVD



      > ----- Original Message -----
      > From: "Susan" <somnamblst@...>
      > To: "Morticia" <morticiaw666@...>;
      > <feline-heart@yahoogroups.com>
      > Sent: Friday, June 04, 2004 9:38 AM
      > Subject: Re: [FH] great news about Spazz
      > > Great news Morticia,
      > >
      > > Can you tell us if Spazz is on an ACE-inhibitor?
      > If so
      > > is he also on lasix?
      > >
      > > The reason I ask is because there is one
      > cardiologist
      > > (Rush) who has reported improvement he has
      > attributed
      > > to an ACE-inhibitor.
      > >
      > > "A recent report by Rush, et al. demonstrated a
      > > reduction in wall thickness with the
      > administration of
      > > enalapril to cats with HCM. This suggests a
      > potential
      > > role for ACE-inhibitors in the treatment of HCM.
      > > These drugs are generally safe and do play a role
      > in
      > > cases which are refractory or in which pleural
      > > effusion is present. In asymptomatic patients,
      > it is
      > > logical that the renin-angiotensin-aldosterone
      > system
      > > is not pathologically activated, and hence
      > > ACE-inhibitors would not be useful. The study
      > > referred to argues that they may play a role,
      > however.
      > > Further studies are being planned."
      > >
      > > Susan

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