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Ariel - right heart failure/damaged tricuspid valve

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  • SThoyre
    Hi Everyone, Updating on Ariel, my CRF/pancreatitis girl who got the virulent calici virus abou 6 wks ago and had the mystery cardio-pulmonary events 2 wks
    Message 1 of 5 , Jul 2, 2007
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      Hi Everyone,
      Updating on Ariel, my CRF/pancreatitis girl who got the virulent calici virus abou 6 wks ago and had the mystery cardio-pulmonary events 2 wks ago. At the end of this very long post, I have listed some specific questions and certainly welcome any advice any of you have to offer. I am very uninformed about feline heart disease and hope to remedy that situation quickly. While Aus did have HCM, he had so many other issues that were more serious for him, that the HCM took a back seat for the most part.

      Last week, we took Ariel into her internal med vet for evaluation. (Well, actually, we took her to her reg vet first for chest films and xray then the next day to her IM vet.) She'd been on lasix at that point for 1 1/2 wks and she seemed to be improving. We felt she was strong enough to withstand a trip to the specialty hospital for diagnostics. Xrays showed fluid in her chest and abdomen. Initially, because of how the fluid was distributed, it wasn't clear whether it was from heart failure, or a tumor.

      After an echocardiogram and ultrasound, however, it was determined that she didn't have a mass in her belly or chest, but was in right heart failure due to a badly damaged tricuspid valve.

      She had massive amounts of fluid in her chest and belly. The vet drained 200 cc from her chest and 150 cc from her abdomen. (Fluid was clear.) During the procedure, her breathing became abnormal and she was put on O2. They did send her home with us, but it took her a VERY long time to recover from the sedation they gave her (Torbutrol/valium which is something she's gotten b4 and has never had problems recovering from). Her respirations were actually higher (mid 30s) for the 1st 24 hrs after the taps than before she went in (they were in the low 20s prior to the procedure). There was some concern that perhaps she'd had a complication from the taps, but she wasn't getting worse -- just slow to get better. And, given that she'd had to go to the vet 3 times in the previous 24 hrs, we didn't want to risk taking her back for further eval unless the trend was down.

      In comparing the echocardiogram done just 5 wks earlier by the cardiologist when she was initially hospitalized w/ the high fever, polyarthritis and pneumonia from the calici virus, it is clear that the tricuspid valve is radically different now than it was then. What we don't know is whether it was the 1 1/2 wks of high fever that did it, or if the calici virus itself attacked the valve. Indeed, I have read that some of the virulent strains of calici can attack the heart, and it seems in one way or the other, it did.

      We suspect she has had some level of tricuspid insufficiency for many years now, given how she would mysteriously retain abdominal fluids during acute illness and was unable to tolerate even moderate IV fluids without retaining fluids. However, the problem was so minor as to be missed on 3 separate echocardiograms, 1 of which was done by a cardiologist, 1 by a radiologist regarded as the best in the Bay Area, and the other done by our IM vet, who spent many years working in a cardiac consulting practice and who is regarded as the 2nd best at ultrasonography behind the radiologist. Our IM vet told us that this type of valvular disease apparently is unique in that it tends to cause fluid in the chest and abdomen, but not so much in the lungs. We do know that each time she's been acutely ill, she blows up like a balloon and previous to this, there had been no satisfactory explanation.

      He also said that this type of heart failure also tends to cause low blood pressure, which is exactly what I saw in the past month with her.

      Assuming the virus is done w/ the damage it was going to do, he said the prognosis for this type of heart disease isn't the worst and I hope that is true. He said cats tend to tolerate right-sided heart failure fairly well. She will be on diuretics from here on in, though, and we will have to really limit her fluids which will make managing her renal disease more difficult.

      We do plan to consult w/ the cardiologist next time he's in town, which prob won't be for another month. We have another cardiologist we used for our other kitty, Aus, but he is about 2 1/2 hr away, and Ariel doesn't do car rides as well as Aus did. Her breathing becomes very rapid, and given her condition, that doesn't seem to be the best idea for her if we can wait a month or so until the cardiologist is in.

      My questions:
      1.She is now on Lasix 6.25 mg BID (she is 5.5 kg -- 12#). Is this the best choice for her? She did not have (AFAIK) fluid in her lungs but pleural effusion and ascites.

      2. Her respirations were better yesterday morning (normal) but then, after drinking about 30 mLs of chicken broth, they picked up again to the mid-upper 20s and have not come back down. She has not gained any weight in the past 24 hrs and her urine output is normal. (She's actually dropped 6 more ounces since her taps last Thurs -- and yes, she is getting plenty of food.) Her BP was also nicely back to her normal level yesterday morning, but is now dropped back again somewhat which makes me concerned she is again in CHF. Could 30 mLs of broth trigger CHF? She has certainly drank that much at one time plenty of times before.

      Currently, she is resting comfortably, grooming a bit during the day, has a decent appetite (knock wood!!). She is not as active as she should be but improved since the taps. Resp are 25/min where her normal is 20. HR 185 (was 200-210 prior to the taps) where previous normal was 160-180. I listed her meds below.

      Thanks to all of you for the help. And extra thanks to any who have read all the way through this epic post!!

      Stacey

      Ariel's current meds:
      - lasix 6.25 mg BID
      - prednisolone SID (5 mg/2.5 mg alternating) -- going to 5 mg EOD this week; the pred was given b/c of the acute pancreatitis attack she had in April
      - sucralfate 1/4 tab TID (for possible GI bleed)
      - Zantac 9 mg BID
      - chlorpheniramine 1 mg BID (for long-standing inhalant allergies)
      - Lactated Ringers 30-40 mLs BID (though we haven't given those to her since her taps b/c her respirations were elevated; we are monitoring her closely for dehydration)
      - potassium 2-3 mEq/day
      - iron supplement & B complex (she became anemic from the calici virus)
      - taurine 500 mg
      - Cosequin 2 capsules/day
      - Lactulose as needed for constipation



      [Non-text portions of this message have been removed]
    • Penny Branham
      Stacey, There s no post like an epic post!! Sometimes necessary, as in your case, to give all the details that might be influencing Ariel s illness. There are
      Message 2 of 5 , Jul 2, 2007
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        Stacey,

        There's no post like an epic post!! Sometimes necessary, as in your case, to give all the details that might be influencing Ariel's illness.

        There are others here who know more than I who will respond, but I have to ask - chicken broth can be loaded with salt. How much was in the broth she consumed? Salt makes many retain fluids, as you probably well know. i

        Best of luck to you both. God bless and Hugs.

        Penny & Angel Snowball

        SThoyre <sthoyre@...> wrote:
        Hi Everyone,
        Updating on Ariel, my CRF/pancreatitis girl who got the virulent calici virus abou 6 wks ago and had the mystery cardio-pulmonary events 2 wks ago. At the end of this very long post, I have listed some specific questions and certainly welcome any advice any of you have to offer. I am very uninformed about feline heart disease and hope to remedy that situation quickly. While Aus did have HCM, he had so many other issues that were more serious for him, that the HCM took a back seat for the most part.

        Last week, we took Ariel into her internal med vet for evaluation. (Well, actually, we took her to her reg vet first for chest films and xray then the next day to her IM vet.) She'd been on lasix at that point for 1 1/2 wks and she seemed to be improving. We felt she was strong enough to withstand a trip to the specialty hospital for diagnostics. Xrays showed fluid in her chest and abdomen. Initially, because of how the fluid was distributed, it wasn't clear whether it was from heart failure, or a tumor.

        After an echocardiogram and ultrasound, however, it was determined that she didn't have a mass in her belly or chest, but was in right heart failure due to a badly damaged tricuspid valve.

        She had massive amounts of fluid in her chest and belly. The vet drained 200 cc from her chest and 150 cc from her abdomen. (Fluid was clear.) During the procedure, her breathing became abnormal and she was put on O2. They did send her home with us, but it took her a VERY long time to recover from the sedation they gave her (Torbutrol/valium which is something she's gotten b4 and has never had problems recovering from). Her respirations were actually higher (mid 30s) for the 1st 24 hrs after the taps than before she went in (they were in the low 20s prior to the procedure). There was some concern that perhaps she'd had a complication from the taps, but she wasn't getting worse -- just slow to get better. And, given that she'd had to go to the vet 3 times in the previous 24 hrs, we didn't want to risk taking her back for further eval unless the trend was down.

        In comparing the echocardiogram done just 5 wks earlier by the cardiologist when she was initially hospitalized w/ the high fever, polyarthritis and pneumonia from the calici virus, it is clear that the tricuspid valve is radically different now than it was then. What we don't know is whether it was the 1 1/2 wks of high fever that did it, or if the calici virus itself attacked the valve. Indeed, I have read that some of the virulent strains of calici can attack the heart, and it seems in one way or the other, it did.

        We suspect she has had some level of tricuspid insufficiency for many years now, given how she would mysteriously retain abdominal fluids during acute illness and was unable to tolerate even moderate IV fluids without retaining fluids. However, the problem was so minor as to be missed on 3 separate echocardiograms, 1 of which was done by a cardiologist, 1 by a radiologist regarded as the best in the Bay Area, and the other done by our IM vet, who spent many years working in a cardiac consulting practice and who is regarded as the 2nd best at ultrasonography behind the radiologist. Our IM vet told us that this type of valvular disease apparently is unique in that it tends to cause fluid in the chest and abdomen, but not so much in the lungs. We do know that each time she's been acutely ill, she blows up like a balloon and previous to this, there had been no satisfactory explanation.

        He also said that this type of heart failure also tends to cause low blood pressure, which is exactly what I saw in the past month with her.

        Assuming the virus is done w/ the damage it was going to do, he said the prognosis for this type of heart disease isn't the worst and I hope that is true. He said cats tend to tolerate right-sided heart failure fairly well. She will be on diuretics from here on in, though, and we will have to really limit her fluids which will make managing her renal disease more difficult.

        We do plan to consult w/ the cardiologist next time he's in town, which prob won't be for another month. We have another cardiologist we used for our other kitty, Aus, but he is about 2 1/2 hr away, and Ariel doesn't do car rides as well as Aus did. Her breathing becomes very rapid, and given her condition, that doesn't seem to be the best idea for her if we can wait a month or so until the cardiologist is in.

        My questions:
        1.She is now on Lasix 6.25 mg BID (she is 5.5 kg -- 12#). Is this the best choice for her? She did not have (AFAIK) fluid in her lungs but pleural effusion and ascites.

        2. Her respirations were better yesterday morning (normal) but then, after drinking about 30 mLs of chicken broth, they picked up again to the mid-upper 20s and have not come back down. She has not gained any weight in the past 24 hrs and her urine output is normal. (She's actually dropped 6 more ounces since her taps last Thurs -- and yes, she is getting plenty of food.) Her BP was also nicely back to her normal level yesterday morning, but is now dropped back again somewhat which makes me concerned she is again in CHF. Could 30 mLs of broth trigger CHF? She has certainly drank that much at one time plenty of times before.

        Currently, she is resting comfortably, grooming a bit during the day, has a decent appetite (knock wood!!). She is not as active as she should be but improved since the taps. Resp are 25/min where her normal is 20. HR 185 (was 200-210 prior to the taps) where previous normal was 160-180. I listed her meds below.

        Thanks to all of you for the help. And extra thanks to any who have read all the way through this epic post!!

        Stacey

        Ariel's current meds:
        - lasix 6.25 mg BID
        - prednisolone SID (5 mg/2.5 mg alternating) -- going to 5 mg EOD this week; the pred was given b/c of the acute pancreatitis attack she had in April
        - sucralfate 1/4 tab TID (for possible GI bleed)
        - Zantac 9 mg BID
        - chlorpheniramine 1 mg BID (for long-standing inhalant allergies)
        - Lactated Ringers 30-40 mLs BID (though we haven't given those to her since her taps b/c her respirations were elevated; we are monitoring her closely for dehydration)
        - potassium 2-3 mEq/day
        - iron supplement & B complex (she became anemic from the calici virus)
        - taurine 500 mg
        - Cosequin 2 capsules/day
        - Lactulose as needed for constipation


        [Non-text portions of this message have been removed]






        ---------------------------------
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        [Non-text portions of this message have been removed]
      • SThoyre
        Penny, Zero salt in the chicken broth -- I made it myself. Just water (filtered) and organic chicken parts (that were just chicken -- not injected/infused w/
        Message 3 of 5 , Jul 2, 2007
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          Penny,
          Zero salt in the chicken broth -- I made it myself. Just water (filtered) and organic chicken parts (that were just chicken -- not injected/infused w/ any add'l flavorings or salt which I guess they sometimes do these days).

          But that's a really good thing to mention just in case I'd given her purchased stuff.

          And thx for not minding my loooooooong post ;-)

          Stacey

          Penny Branham <pennybranham@...> wrote:
          <snip>I have to ask - chicken broth can be loaded with salt. How much was in the broth she consumed? Salt makes many retain fluids, as you probably well know.
          <snip>



          .





          [Non-text portions of this message have been removed]
        • Sue at MAGDRL
          Stacey, There have been many posts here that are much longer. Providing lots of information makes it easier to reply. I see that the salt issue was already
          Message 4 of 5 , Jul 3, 2007
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            Stacey,

            There have been many posts here that are much longer. Providing lots of
            information makes it easier to reply.

            I see that the salt issue was already discussed. Steroids often cause
            weight gain and I'm not sure if it's true weight or involves some fluid
            retention. That may be something to look into. From what I've hear, I
            think that prednisolone is less problematic than prednisone. It is possible
            that drinking all that fluid caused the CHF but it would probably be because
            she can't process fluid rather than that it's chicken broth.

            If she has fluid in the chest, she may benefit from spironolactone. That is
            a diuretic that seems to work best on fluid in the chest rather than in the
            lungs. I gave my Pepper both "spiro" and lasix together to control her
            fluid since she had it both in her lungs and chest. If Ariel has fluid in
            her lungs, you should continue with the lasix.

            I never had to deal with CRF so I'll leave that to people who have.


            Sue & Angel Pepper



            ----- Original Message -----
            From: "SThoyre" <sthoyre@...>
            To: "Feline Heart Group" <feline-heart@yahoogroups.com>
            Sent: Monday, July 02, 2007 1:31 PM
            Subject: [FH] Ariel - right heart failure/damaged tricuspid valve


            > Hi Everyone,
            > Updating on Ariel, my CRF/pancreatitis girl who got the virulent calici
            virus abou 6 wks ago and had the mystery cardio-pulmonary events 2 wks ago.
            At the end of this very long post, I have listed some specific questions and
            certainly welcome any advice any of you have to offer. I am very uninformed
            about feline heart disease and hope to remedy that situation quickly. While
            Aus did have HCM, he had so many other issues that were more serious for
            him, that the HCM took a back seat for the most part.
            >
            > Last week, we took Ariel into her internal med vet for evaluation.
            (Well, actually, we took her to her reg vet first for chest films and xray
            then the next day to her IM vet.) She'd been on lasix at that point for 1
            1/2 wks and she seemed to be improving. We felt she was strong enough to
            withstand a trip to the specialty hospital for diagnostics. Xrays showed
            fluid in her chest and abdomen. Initially, because of how the fluid was
            distributed, it wasn't clear whether it was from heart failure, or a tumor.
            >
            > After an echocardiogram and ultrasound, however, it was determined that
            she didn't have a mass in her belly or chest, but was in right heart failure
            due to a badly damaged tricuspid valve.
            >
            > She had massive amounts of fluid in her chest and belly. The vet
            drained 200 cc from her chest and 150 cc from her abdomen. (Fluid was
            clear.) During the procedure, her breathing became abnormal and she was put
            on O2. They did send her home with us, but it took her a VERY long time to
            recover from the sedation they gave her (Torbutrol/valium which is something
            she's gotten b4 and has never had problems recovering from). Her
            respirations were actually higher (mid 30s) for the 1st 24 hrs after the
            taps than before she went in (they were in the low 20s prior to the
            procedure). There was some concern that perhaps she'd had a complication
            from the taps, but she wasn't getting worse -- just slow to get better.
            And, given that she'd had to go to the vet 3 times in the previous 24 hrs,
            we didn't want to risk taking her back for further eval unless the trend was
            down.
            >
            > In comparing the echocardiogram done just 5 wks earlier by the
            cardiologist when she was initially hospitalized w/ the high fever,
            polyarthritis and pneumonia from the calici virus, it is clear that the
            tricuspid valve is radically different now than it was then. What we don't
            know is whether it was the 1 1/2 wks of high fever that did it, or if the
            calici virus itself attacked the valve. Indeed, I have read that some of
            the virulent strains of calici can attack the heart, and it seems in one way
            or the other, it did.
            >
            > We suspect she has had some level of tricuspid insufficiency for many
            years now, given how she would mysteriously retain abdominal fluids during
            acute illness and was unable to tolerate even moderate IV fluids without
            retaining fluids. However, the problem was so minor as to be missed on 3
            separate echocardiograms, 1 of which was done by a cardiologist, 1 by a
            radiologist regarded as the best in the Bay Area, and the other done by our
            IM vet, who spent many years working in a cardiac consulting practice and
            who is regarded as the 2nd best at ultrasonography behind the radiologist.
            Our IM vet told us that this type of valvular disease apparently is unique
            in that it tends to cause fluid in the chest and abdomen, but not so much in
            the lungs. We do know that each time she's been acutely ill, she blows up
            like a balloon and previous to this, there had been no satisfactory
            explanation.
            >
            > He also said that this type of heart failure also tends to cause low
            blood pressure, which is exactly what I saw in the past month with her.
            >
            > Assuming the virus is done w/ the damage it was going to do, he said the
            prognosis for this type of heart disease isn't the worst and I hope that is
            true. He said cats tend to tolerate right-sided heart failure fairly well.
            She will be on diuretics from here on in, though, and we will have to really
            limit her fluids which will make managing her renal disease more difficult.
            >
            > We do plan to consult w/ the cardiologist next time he's in town, which
            prob won't be for another month. We have another cardiologist we used for
            our other kitty, Aus, but he is about 2 1/2 hr away, and Ariel doesn't do
            car rides as well as Aus did. Her breathing becomes very rapid, and given
            her condition, that doesn't seem to be the best idea for her if we can wait
            a month or so until the cardiologist is in.
            >
            > My questions:
            > 1.She is now on Lasix 6.25 mg BID (she is 5.5 kg -- 12#). Is this the
            best choice for her? She did not have (AFAIK) fluid in her lungs but
            pleural effusion and ascites.
            >
            > 2. Her respirations were better yesterday morning (normal) but then,
            after drinking about 30 mLs of chicken broth, they picked up again to the
            mid-upper 20s and have not come back down. She has not gained any weight in
            the past 24 hrs and her urine output is normal. (She's actually dropped 6
            more ounces since her taps last Thurs -- and yes, she is getting plenty of
            food.) Her BP was also nicely back to her normal level yesterday morning,
            but is now dropped back again somewhat which makes me concerned she is again
            in CHF. Could 30 mLs of broth trigger CHF? She has certainly drank that
            much at one time plenty of times before.
            >
            > Currently, she is resting comfortably, grooming a bit during the day,
            has a decent appetite (knock wood!!). She is not as active as she should be
            but improved since the taps. Resp are 25/min where her normal is 20. HR
            185 (was 200-210 prior to the taps) where previous normal was 160-180. I
            listed her meds below.
            >
            > Thanks to all of you for the help. And extra thanks to any who have
            read all the way through this epic post!!
            >
            > Stacey
            >
            > Ariel's current meds:
            > - lasix 6.25 mg BID
            > - prednisolone SID (5 mg/2.5 mg alternating) -- going to 5 mg EOD this
            week; the pred was given b/c of the acute pancreatitis attack she had in
            April
            > - sucralfate 1/4 tab TID (for possible GI bleed)
            > - Zantac 9 mg BID
            > - chlorpheniramine 1 mg BID (for long-standing inhalant allergies)
            > - Lactated Ringers 30-40 mLs BID (though we haven't given those to her
            since her taps b/c her respirations were elevated; we are monitoring her
            closely for dehydration)
            > - potassium 2-3 mEq/day
            > - iron supplement & B complex (she became anemic from the calici virus)
            > - taurine 500 mg
            > - Cosequin 2 capsules/day
            > - Lactulose as needed for constipation
            >
          • SThoyre
            Thank you, Sue. I plan to ask our internist about whether spiro might be better for her -- or perhaps used in conjunction w/ the lasix at her re-check in 2
            Message 5 of 5 , Jul 3, 2007
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              Thank you, Sue. I plan to ask our internist about whether spiro might be better for her -- or perhaps used in conjunction w/ the lasix at her re-check in 2 wks. She definitely had lots of fluid in her chest (200 mls) and abdomen (150 mls). I do not think she had fluid in her lungs, but I will double check. I suspect they will be repeating a chest film when she goes in for her re-check. The IM vet said she didn't, but her breath sounds were slightly harsh -- I guess that could still be from the pneumonia from the calici, but I am wondering about whether she had/has fluid in her lungs, too.

              Stacey

              Sue at MAGDRL <susan@...> wrote:
              <snip>
              If she has fluid in the chest, she may benefit from spironolactone. That is
              a diuretic that seems to work best on fluid in the chest rather than in the
              lungs. I gave my Pepper both "spiro" and lasix together to control her
              fluid since she had it both in her lungs and chest. If Ariel has fluid in
              her lungs, you should continue with the lasix.
              <snip>



              .





              [Non-text portions of this message have been removed]
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