Re: following my prev post, im confused about numbers...
- First, you need both but you need to have the echo done for sure. Second, the cardiologist should do the echo. Experience shows that vets do not really understand echos and only the cardiologist vet will understand what they are seeing and what it really means. The xrays will show you if there's congestion in the lungs. They can hear congestion but the xrays will show how little or how much is there. Xrays also will show if the heart is enlarged. There's a way of determining size based on how many ribs it takes up on the xray. But the echo determines the condition of the heart and the cause of the illness.
Often cats' heart rates will race if they are stressed just as their glucose can be abnormally high when they are at the vet and when blood work is done. Normal is what you will see at rest at home. If the cat's heart races for a sustained period of time at home, then the cat would need to see the vet immediately. So, if the vet said the heart rate was 240, that is way too high and the cat would be in distress and would need immediate treatment. If that didn't happen at the vet, then the 240 is wrong or was regarding something else.
As for enalapril, as an ACE inhibitor, it basically keeps blood veins opened and free from restrictions and can lead to low blood pressure-which is fine for a diseased heart if not too low. Normally, if there was a sudden blood loss or heart attack, the blood would be cut off to the other parts of the body and would flow from the heart to the brain and kidneys. But the blood running through this narrow channel would increase blood pressure and make the heart pump the blood faster due to the shorter circulation route. The ACE inhibitor keeps all veins opened which results in low blood pressure and the heart not pumping faster than a weakened heart should pump. It's also given to diabetic patients to prevent diabetic renal failure but can cause problems with the kidneys. Here's a quote from the Wikipedia page about ACE inhibitors:
"Renal impairment is a significant adverse effect of all ACE inhibitors, but the reason is still unknown...Renal blood flow may be affected by angiotensin II because it vasoconstricts the efferent arterioles of the glomeruli of the kidney, thereby increasing glomerular filtration rate (GFR). Hence, by reducing angiotensin II levels, ACE inhibitors may reduce GFR, a marker of renal function. To be specific, they can induce or exacerbate renal impairment in patients with renal artery stenosis. This is especially a problem if the patient is concomitantly taking an NSAID and a diuretic. When the three drugs are taken together, there is a very high risk of developing renal failure."
HCM cats have constant blood work to make sure that, if they are on a diuretic and Enalapril, that kidney issues do not develop or are caught early. It's possible he does need to stop Enalapril or change the dose. It depends on the rest of his renal blood chemistry values and how the kidneys are functioning. But if the vet said to stop Enalapril because of what he was seeing on the heart echo, I'd get a second opinion and explanation from the cardiologist. The cardiologist will suggest meds based on what he sees in the echo.
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