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Re: [FH] ACE Inhibitors for Tabby Jean?

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  • Susan
    ... By not worked do you mean that beta-blockade has not slowed her heart rate or have not addressed the PVCs? from VetGo cardiology concepts: Consequences of
    Message 1 of 2 , Aug 1, 2004
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      --- sandworm90292 <erosla77@...> wrote:

      > Here's the update, fellow fur luvers!
      >
      > TJ, as you know, was diagnosed with some form of
      > cardiomyopathy about 3 months ago.
      >
      > She has an enlarged left ventricle, a gallop
      > rhythm, irregular EKG with premature
      > ventricular contractions. Has moderate lesions on
      > her aortic valve that is causing
      > moderate blood flow reguritation. Is
      > asymptomatic-runs around like a maniac with her
      > sister, Tazzleberry Marie.
      >
      > Atenolol and another beta-blocker have not worked.

      By not worked do you mean that beta-blockade has not
      slowed her heart rate or have not addressed the PVCs?

      from VetGo cardiology concepts:

      Consequences of PVCs:
      Several isolated premature beats are of no hemodynamic
      significance.
      However, when enough of these beats are present, a
      marked reduction in cardiac output may result (due to
      a loss of atrial induced ventricular filling and high
      heart rate).

      Treatment:
      Several isolated beats do not warrant therapy.
      However, such individuals should be frequently
      monitored for exacerbation of their rhythm
      disturbance. In addition, attention should be directed
      toward identification and management of the underlying
      disorder.
      Criteria for therapy include:
      if the animal is symptomatic with this disorder
      if paroxysms of sustained tachycardia develop such as
      a burst lasting greater than 60 sec.
      Drugs commonly used include:
      digoxin
      beta blocker therapy: propranolol metoprolol
      atenolol
      calcium channel blocker therapy: diltiazem
      Dosages:

      Digoxin:
      cat: 1/4 of 0.125 mg (PO) q 48h - SID
      Propranolol:
      cat: 0.21-1.0 mg/kg BID-TID (PO); 0.04 mg/kg (IV)
      slowly
      Metoprolol:
      cat: 2-15 mg TID (PO)
      Atenolol:
      cat: 5-12.5 mg SID (PO)
      Diltiazem:
      cat:
      cardizem: 1-2 mg/kg TID (PO)
      cardizem CD: 10 mg/kg SID (PO)
      Comment: Although propranolol is the best known beta
      blocker in veterinary medicine, it has drawbacks in
      its combined beta 1 and beta 2 blocking activity. We
      should attempt to use beta-1 selective beta blocker
      such as metoprolol and atenolol. As well the Ca
      channel blockers, such as diltiazem, may be
      particularly useful in these disorders.

      >
      > Doctor B is discussing ACE Inhibitors; I showed
      > her Susan's post on the subject. Tabby is
      > stable; her recent sonogram is identical to the
      > first one from 3 months ago.

      I cannot remember if Tabby Jean is on lasix. The vast
      majority of cats on Lasix are also on an ACE-I because
      the activation of the renin angiotensin system has the
      effect of causing further remodeling of the left
      ventricle. If TJ is not on lasix then she is not
      considered to be in CHF and certainly no treatment is
      an option. Was a calcium channel blocker tried and was
      a CCB plus BB tried? I know I have seen references to
      that combo for refractory tachycardia (fast heart
      rate)
      >
      > I don't know if the ACE Inhibitors are worth the
      > risk of damage to TJ's kidneys.

      Is TJ CRF and how old is she?

      Susan

      =====
      Rudy: Male DSH brown tabby, feral mom, diagnosed 09-2002 at 19 months of age with idiopathic HCM: grade 2 murmur, hyperkinetic heart, borderline normal thickening, considered asymptomatic, 12.5 mg Atenolol 1x day, 1/2 baby aspirin 2x week administered via pilling



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