47643Fw: [FAN-H] Rhapsody - hypertrophic cardiomyopathy, murmur, responsive to oxygen tx
- Apr 1, 2013I may have missed this, but I didn't see this posted to feline-heart. Gesine asked for info on anothe rlist, and this is a reply she got -- excellent information here for you, Jim. How is Rhapsody this morning?
----- Original Message -----
From: Mother Stephania
Sent: Monday, April 01, 2013 2:35 AM
Subject: Re: [FAN-H] Rhapsody - hypertrophic cardiomyopathy, murmur, responsive to oxygen tx
I'm not a vet and there are so many concurrent issues that my diagnosis
is: "Beats me!" I'm not even at the beginning of being able to know
what is going on here or what the best course of action is. But I have a
couple questions or possible comments.
If you think the primary problem is heart disease ... I would wonder if
it is because of the panting episodes, etc. But I believe that panting
and breathing difficulty caused by HCM is a result of congestive heart
failure. That generally takes the form of either pulmonary edema (fluid
in the lungs) or pleural effusion (fluid around the lungs). There is no
mention of the vets removing fluid. Did they do any x-rays to look for
fluid in or around the lungs ... or signs that it may be asthma related?
The other possibility in a lung related problem is heartworm disease
(HARD: "Heartworm Associated Respiratory Disease) which occurs not from
live heartworms but when the heartworms die, generally from 1-4 years
after initial infection (which makes it very difficult to diagnose).
IF the symptoms are from congestive heart failure (which would mean
fluid in/around the lungs), then giving a diuretic like lasix is
generally most helpful. IF this is not congestive heart failure ... then
there is no evidence that any heart medication will alter the course of
the disease (that comes from Dr Mark Kittleson after his many years of
working with and trying to treat HCM). So, Jim's money might be better
spent elsewhere. Dr Kittleson would only give a beta blocker (e.g.
Atenolol) if there is severe SAM (Systolic Anterior Motion of the Mitral
Valve) which would be indicated on the echocardiogram report.
If he had an echocardiogram done already ... the key to whether or not
this is congestive heart failure as a result of HCM is not the thickness
of the left ventricle ... but rather whether or not the left atrium is
enlarged (not thickened, but the chamber significantly enlarged). Dr
Kittleson makes the point that a prerequisite for congestive heart
failure is an enlarged left atrium. If it isn't enlarged, then there is
no congestive heart failure.
The grade of the heart murmur (which indicates its loudness) is not
necessarily an indication of the severity of HCM. One of the
characteristics of HCM is that it is a "dynamic" heart murmur ... which
means it gets louder during times of stress (when the heart is
beating/contracting harder, not necessarily faster). Cats that get very
scared or stressed at the vet's may have a loud murmur at an exam, but
when relaxed back home, the murmur may be much softer (lower grade), and
sometimes disappear all together.
Given the many concurrent problems, I have no idea what the diagnosis is
or how best to treat it or what tests to do next. He mentions a "known
history of liver and lung issues". Does that mean that other liver and
lung issues have been diagnosed? If so, what was the diagnosis? Since he
is concerned about the environment around his house, was the cat tested
for mold or fungal infection (which can also cause neurological signs)?
Perhaps that is what the vet wants to look for with the alveolar wash.
Well, I should keep my mouth shut when there is so much that I don't
know. I just wanted to make a couple comments related to possible
congestive heart failure. If there is no CHF, then heart meds are not a
priority if he is low on funds. Since he has another cat with liver and
lung issues with possible toxic exposure in his house ... that might be
the best route to pursue. But that is just an opinion of someone (me)
who has no veterinary training and only very minimal knowledge.
Sorry I can't be of more help. Let us know what happens.
Stephanie in Montreal
On 31/03/2013 7:47 PM, gesine_catnation wrote:
> Hi all,
> Below is a post from Jim, about his cat Rhapsody.
> I am taking the liberty of sending it to fanciershealth, to see if any of you have any thoughts --
> To me, this sounds like
> -- don't go to neurologist (doesn't sound neurological to me)
> -- try starting to treat hypertrophic cardiomyopathy with routine meds
> Finances are a serious issue.
> Heart meds are typically not too expensive.
> Jim goes to the wall for his cats, and has kept some very sick cats going with good quality of life, through some very bad stuff.
> I'm bcc-ing this post to the Orphan Kittens group (which I first joined
> because of Cricket, April 2010-April 2011), Feline Heart (which I joined
> because of Clipsy, June 2001-July 2011), and Feline Asthma (which I joined
> because of Buttercup, March 2000-February 2012). I have blood work and
> ultrasound reports which I'm not up to posting tonight but will try to
> organize for later posts. I have an echocardiogram report with all the
> numbers in a PDF file and would like to know if the Feline Heart group
> accepts attachments or has a file folder where I can upload that for review.
> Short version: Rhapsody is a one and a half year old neutered male cat,
> born a third-generation stray to a momcat who was described as "skin and
> bones," rescued at approximately four weeks old at which time he weighed 18
> ounces. He's now a tiny adult weighing just over five pounds. He has a
> known history of liver and lung issues, has recently had one course of
> Clavamox and then another course of azithromycin with WBC going up the down
> then up again, plus is on cyclosporine eye drops which don't seem to be
> helping as he's still squinting all the time and having a dry rust-colored
> crust around his eyes, and was just diagnosed on March 18 with a grade 4
> heart murmur and hypertrophic cardiomyopathy. There's also speculation
> about possible neurological concerns, and I also suspect there's something
> toxic in my house (which is old, dusty, drafty, damp, and I'm sure moldy).
> That's a lot of complications to untangle.
> Rhapsody has had two episodes in the past week and a half, and an earlier
> episode last year, of emergency hospital visits with weakness/ataxia, pale
> gums, and low body temperature (about 98F). The episode last night also
> included some open-mouth breathing. Additionally he had a brief (like about
> 5 seconds) incident of open-mouth panting last week in between his two most
> recent ER visits. In both of his recent ER visits, March 18 and March 29,
> he was placed in an incubator with oxygen while diagnostics were done. In
> both cases no other treatment was given, but after a few hours on oxygen he
> returned to his usual condition (which is not exactly the picture of
> glowing feline health, but at least he's alert, responsive, affectionate,
> purry, and has a normal temperature, pink gums, and a good appetite).
> Blood work from last night's ER visit isn't back yet. They could have run
> it in-house but it would have cost a lot more and the vet knew my financial
> situation is pretty dire. When he saw that Rhapsody was improving on his
> own with the oxygen, he decided to send the blood work out instead. They
> did do in-house RBC, hematocrit, and PCV, which the vet said were "good"
> (sounded surprised when he said it) but I don't have a copy of the actual
> Pending results of the rest of last night's blood work, the ER vet
> recommended another one-week course of azithromycin, following up with an
> internist for an alveolar wash to see what's down deep in his lungs, and
> following up with a neurologist in case these episodes could be related to
> something neurological rather than heart- or lung-related.
> As mentioned above, my financial situation is dire (especially now that
> I've got a second cat with lung issues and a liver biopsy report suggesting
> possible chronic toxic exposure, and I'm afraid to keep my animals or
> myself living in that house). I don't know how I can manage to do *any* of
> the recommended diagnostics, much less *all* of them. Assuming I manage to
> do any of it, I need to prioritize what to do first.
> Question: What would cause episodes like this--extreme weakness, inability
> to walk or even stand up, low temperature, pale gums, sometimes open-mouth
> breathing, overall condition so bad that veterinarians have initially been
> quite pessimistic about his chances of immediate survival--that resolve on
> their own after a few hours on oxygen? Is this more likely to be something
> related to his heart condition, to possible asthma, to liver disease, or to
> a neurological condition as yet undiagnosed?
> Another question: If all he needs to survive these episodes is oxygen,
> where can I get the equipment to do that at home? My Care Credit card won't
> cover another ER visit. If he had another episode right now, I don't know
> what I would be able to do for him.
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