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Re: [FH] Update on Tavy's cardio appointment

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  • lclarizia@aol.com
    Hi Jenifer, Here s a *really* long answer! ... Diuretics are generally ineffective at clearing pleural effusion -- they work much better on pulmonary edema, as
    Message 1 of 3 , Mar 1 8:56 PM
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      Hi Jenifer,

      Here's a *really* long answer!


      > I took Tavy in today for an appointment with the cardiologist. She was
      > diagnosed in 12/04 and went into heart failure 2 weeks ago. He did a follow
      > up ultrasound (her last one was on 12/20/04) to see the status of her heart
      > given that she is in heart failure. He said that she has a moderate amount
      > of pleural effusion that doesn't seem to be decreasing with the conservative
      > dose of lasix she is on right now (6.25 twice daily).
      >

      Diuretics are generally ineffective at clearing pleural effusion -- they work
      much better on pulmonary edema, as the lungs have plenty of blood vessels
      ready and waiting to reabsorb fluid and carry it to the kidneys. Not so with the
      pleural cavity, which depends on the lymphatic system to drain it. From
      personal experience -- you have to practically dehydrate the cat to get the fluid
      out, which of course is dangerous and not something I wouldn't have done had
      the situation not been desperate.

      > 1) He said that she looks atypical in that she had mild HCM 2 months ago,
      > so he was very surprised that she was in heart failure at all. He said
      > based on her measurements from December, he did not expect her to go into
      > heart failure this quickly. He did say her heart has worsened a bit, with
      > her atrium going from about a 15mm to 17mm. He still said with the
      > progression, he would classify her as moderate, and it would still be
      > surprising to see her in heart failure at this stage. He said regardless of
      > the heart failure, this is a fast progression for such a short period of
      > time, and this does not speak well to her prognosis.
      >

      What were her other measurements, did he say? As to the CHF with moderate
      disease -- it does depend on the cat and the specific disease progression. CHF
      isn't limited to certain chamber measurements, rather, its occurance depends
      on how well the heart pumps blood. HCM does result in enlargement, but aside
      from gross physical changes, there are significant cellular changes. For
      instance, the myocytes (contractile units of the heart) are normally arranged in a
      neat, parallel arrangement -- this is so they can contract in unison. In HCM
      (and DCM, and RCM) something called "myocitic derangment" occurs -- they're no
      longer neat and parallel, and contraction is compromised. Also, scar tissue
      and fibrotic tissue begin to occur in the heart as well. So, it's possible to
      have a cat with "moderate" disease by one metric (chamber size) yet be in CHF
      due to cellular changes (which you can only see under a microscope).

      As far as her prognosis goes -- I don't want to give you false hope. HCM is
      ultimately a losing battle, but there is no way to predict what will happen.
      So, you can't live by her prognosis and you cannot lose hope entirely. She
      will always have heart disease, but there are things you can do to help her.

      > 2) She has more fluid in her left lung than her right lung, which he
      > doesn't usually see with heart failure. He said this leads him to think
      > that it is possible she has something else going on other than heart failure
      > (e.g., she could have cancer or a lymphatic illness causing the fluid). To
      > check this, he took a sample of the fluid in her lungs (Tavy's first chest
      > tap, poor thing). He took out 20 ccs and since she was distressed, he
      > stopped there. He did it for a sample, not for therapeutic reasons. He
      > could tell by appearance it's not the lymphatic problem. I'll wait for the
      > lab results to see if she has cancer or if this is just heart failure
      > presenting atypically.
      >

      Ick, chest tap! I know what that's like ... I hope *you* are okay after it,
      as well as Miss Tavy!

      As for the fluid in the lung -- did you mean in, or around? Due to the cat's
      anatomy, pleural effusion tends to present in both lungs as opposed to
      discretely around one, like you'd see in a human. If he meant *in* the lung, then
      yes, that's odd because left-sided heart failure should result in more fluid in
      the right lung.

      > 3) Until the lab results on the fluid come back, he is treating her as if
      > this is heart failure (since that is the most likely issue). He said her
      > doseage of lasix (6.25mg bid) was conservative and he upped it to 12.5 bid
      > and added 2.5 mg enalapril per day. He said if this is heart failure, this
      > should wipe it out given that she doesn't have a huge amount of fluid. He
      > said to go back to my vet for a recheck xray in 7-10 days (unless we get
      > some news from the fluid sample first).

      The combination should help a great deal -- her dose is basically what Baby
      Boy's getting, except he's got spiro and an extra enalapril in there.

      >
      > 4) I asked about clot risk, and he said she's not at a huge risk because her
      > atrium isn't huge and he didn't see smoke on the ultrasound. I asked about
      > aspirin. He said there's not much evidence it helps but it probably won't
      > hurt (though he said if I start it to watch her). He said he usually uses
      > injectible heparin in lieu of aspirin, but since she isn't a huge risk, he
      > would say to perhaps hold off on that. I'm trying to figure out whether to
      > start aspirin... what do you guys think?
      >

      That she has no clots or smoke is excellent -- and what I think is this: Any
      cat with a compromised heart is, by definition, at some risk for clots. I
      don't like the idea of aspirin myself, due to its toxicity, but there are other
      options besides heparin and aspirin -- for instance, vitamin E has
      anticoagulant properties. It's also an anti-oxidant, and taken in reasonable doses,
      there's no risk of toxicity (cats have a higher tolerance for fat-soluble vitamins
      than we do, since they're carnivores).

      > 5) I asked about COq10, and he said he doesn't use it, but it probably
      > wouldn't hurt anything. He said I could use it if I wanted.
      >

      I really, really suggest you do. There is a lot of human literature
      regarding it's efficacy in helping ameliorate CHF symptoms. There's evidence that
      when combined with L-carnitine, it's even more effective. It has really, really,
      really helped my highly-refractory-CHF Baby Boy.




      > So, my questions for you:
      > -Any ideas about whether it makes sense to start the aspirin? He left it up
      > to me. Have your cats had side effects from aspirin?

      Since she has no indication that she has clots, you have some time to
      research what you'd like to do. I'd say though that you should definitely consider
      some action to prevent clots. Baby Boy started on aspirin, was getting
      fragmin, but began to have injection-site reactions to it. Now, he's on vitamine E
      and nattokinase. There were no clots or smoke on his ultrasound either, but
      that doesn't mean it couldn't ever happen. He never had side effects that I
      could see from the aspirin, though.

      > -Have any of your cats progressed this quickly on followup ultrasounds?
      >
      Yes, but Baby Boy has DCM and not HCM -- my vet only has a small, protable
      ultrasound, used for obstetrics mainly, so I'm not surprised he couldn't get
      accurate measurements. Still, you can see on his x-rays how enlarged his heart
      became over a period of just a few months.

      > Do you know about indications for atenolol dose? I've noticed some of your
      > cats on are higher doseages than mine (tavy is on 6.25 twice/day). Any
      > ideas based on what your cardios have said about this?
      >

      I don't know -- he's not on atenolol. Hopefully, someone else can give you
      an answer here.

      > Have your cats had more fluid in one lung than another?

      He had more *edema* in his right lung than the left, when he was first
      diagnosed. The effusion was everywhere, as expected (see above).

      > -What doseages of q10 are your cats on? Where do you buy this?
      >
      Baby Boy's on a megadose -- he gets 100 mg 2x per day, but since he spits
      some out, it's probably more like 60 mg 2x a day. I usually get Nature Made, and
      buy it at any drug store. It's a gelcap -- coenzyme q10 is fat-soluble, so
      to be absorbed it needs to either be suspended in oil (as in the gelcaps) or
      taken with food.

      > Any other thoughts on this update?
      >

      See above! :)

      Lisa



      [Non-text portions of this message have been removed]
    • Lise Cummings
      Sorry that Tavy had to have her chest tapped. About the Atenolol, all I know is that when Tigger was downgraded from HCM to Restrictive Cardiomyopathy, they
      Message 2 of 3 , Mar 2 6:44 AM
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        Sorry that Tavy had to have her chest tapped. About
        the Atenolol, all I know is that when Tigger was
        downgraded from HCM to Restrictive Cardiomyopathy,
        they actually cut his Atenolol in half, to 3mg/day.
        Unfortunately, I can't remember exactly what the
        explanation was for this. Regarding the aspirin,
        Tigger was on it for some time (1 baby aspirin every 3
        days), but it seemed to mess up his stomach, so you
        might watch out for stomach issues if she goes on
        aspirin.

        Lise
        --- MS <ms3213@...> wrote:
        > So, my questions for you:
        > -Any ideas about whether it makes sense to start the
        > aspirin? He left it up
        > to me. Have your cats had side effects from
        > aspirin?
        > -Do you know about indications for atenolol dose?
        > I've noticed some of your
        > cats on are higher doseages than mine (tavy is on
        > 6.25 twice/day). Any
        > ideas based on what your cardios have said about
        > this?





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      • Susan
        ... Jenifer, Atenolol is really good at lowering a too fast heart rate (tachycardia) It is used in human heart failure in addition to lasix and enalapril but
        Message 3 of 3 , Mar 2 6:49 AM
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          --- MS <ms3213@...> wrote:
          >
          > 6) I asked what the indications for increasing
          > atenolol would be. I don't
          > remember everything about his answer, but I think he
          > said he doesn't usually
          > adjust that often.

          Jenifer,

          Atenolol is really good at lowering a too fast heart
          rate (tachycardia) It is used in human heart failure
          in addition to lasix and enalapril but it is started
          at a very tiny dose and titrated up. People report
          feeling worse on atenolol before eventually feeling
          better. Keep in mind people typically suffer from
          systolic rather than diastolic disfunction and
          beta-blockers are people meds that can only be cut
          into halves or quarters.
          >

          > -Do you know about indications for atenolol dose?
          > I've noticed some of your
          > cats on are higher doseages than mine (tavy is on
          > 6.25 twice/day).

          My cat is on 12 mg. probably based on his hyperkinetic
          heart before atenolol. He is 8 lbs.

          Since Tavy is a girl and older has hyperT absolutely
          been ruled out? My mom's neighbors cat was referred to
          Rudy's internist recently. He was initially diagnosed
          with mild HCM and put on atenolol, but eventually
          because the internist said you could not rule out
          hyperT based only on a negative lab work result,
          somehow discovered nodes on the thyroid and was
          referred to a surgeon for removal. I have not spoken
          to the owner since the initial HCM diagnosis, but I am
          thinking the thyroid node removal may resolve the HCM
          as the HCM may be secondary to the thyroid problem.

          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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