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Re: [FH] update on Chessie's cardio appmt

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  • lclarizia@aol.com
    In a message dated 1/26/2005 8:13:54 PM Eastern Standard Time, reneelva@earthlink.net writes: Hi Renee, ... It is unusual in cats, and the slight enlargement
    Message 1 of 1 , Jan 30, 2005
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      In a message dated 1/26/2005 8:13:54 PM Eastern Standard Time,
      reneelva@... writes:

      Hi Renee,

      > I wanted to update you on Chessie's cardiologist appmt today. We
      > discovered it was not hypertrophic cardiomyopathy (which is what the
      > preliminary ultrasound at my regular vets seemed to indicate).
      > Instead, it seems that she has tricuspid valve problems. The cardio
      > doc said that her ventricles were fine, the left atrium was
      > minimally enlarged but not significantly, but the right atrium was
      > significantly enlarged. She has a grade 2 murmur which he says is
      > from the valve disease (rules out the anemia factor). He said
      > tricuspid valve disease was pretty unusual in cats, more often it is
      > seen in dogs (can be linked to heartworms, but he did not see any).

      It is unusual in cats, and the slight enlargement of the left atrium makes me
      wonder if something else isn't in play. The reflux from the right ventricle
      to the right atrium because of the diseased valve should not, I *think* (must
      read up on this) by itself result in enlargment of the left atrium.

      > So, that makes treatment options more challenging to tailor since
      > there wasn't a good feline template from which to work. He said
      > about the only cardiac med he would consider would be enalapril (ACE
      > inhibitor), but he was on the fence about whether that was a good
      > idea given the kidney issues and the the fact that the enalapril was
      > really better suited for left-side failure as it functions to reduce
      > afterload (as right side doesn't see as much of since its path is
      > only to the lungs). He also said the enalapril can selectively drop
      > the pressure in the kidneys, despite systemic blood pressures
      > remaining within normal ranges (and there really isn't any good way
      > to measure intrakidney pressure, would only know there is a problem
      > based on kidney values skyrocketing). This would of course drive
      > the kidneys down very quickly. After mulling it over a little
      > further we agreed that, for now, it might be best to see how she
      > gets along on the Lasix and that if she begins to fill up again we
      > could always add the enalapril then and perhaps even some
      > spironolactone. She does have some pericardial effusion as well
      > (which my regular vet suspected), and he did see a little fluid
      > around her lungs (remaining from before) but not that much.
      >

      He's right about the left vs right sided failure, but one of enalarpil's
      actions, as you mentioned, is to drop blood pressure. In cats, unlike humans,
      both left and right sided failure can result in pleural effusion to some degree
      (again, I think -- will double check). There's a lot of hand-wringing about
      the effect on the kidneys, much of it justified in a theoretical sense, but you
      have to weigh potential problems against potential benefits. Enalapril also
      prevents a destructive neurohormonal cascade which occurs when lasix is
      administered and a cat is in heart failure, which can improve the overall health of
      the animal. Baby Boy gets lasix, spironolactone, and enalapril and thus far,
      his kidneys are holding up. We're about to venture into the wonderful world of
      dandelion as well.

      > new worry today is that, when I went to retrieve her from her
      > little den, I discovered that she had completely soaked her bedding
      > with urine and was still laying in it. She has never done this
      > before and I am hoping it was perhaps due to being a little more
      > relaxed from the Feliway spray and Rescue Remedy that I gave her
      > before bedtime to reduce her obsessive/compulsive grooming, and NOT
      > her showing signs of losing her bladder control. That would really
      > break my heart, especially if we are able to improve her anemia and
      > fluid situation only to have that indignity surface. As with all
      > her other issues, I will have to watch this situation closely.....

      I think that's probably behavioral, rather than directly med-related. She
      was probably distressed and all, and Rescue Remedy really does calm them down
      ... how is she doing now?

      Lisa


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