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aortic aneurysm & meds change up

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  • acidsoda
    Hi all, I hope you and your kitties are all doing well. I m back looking for advice in regards to Ziggy s heart condition and meds change up. I m sorry if the
    Message 1 of 3 , Apr 22, 2014

      Hi all,


      I hope you and your kitties are all doing well. I'm back looking for advice in regards to Ziggy's heart condition and meds change up. I'm sorry if the post gets ultra long.

      We recently took Ziggy to the ER because he was breathing just a bit faster (24-28bpm) but appears to be unwell to one point he refused food. He never ever refuse food unless it's a dire situation. We gave him some lasix injection at home, took some x-ray at ER and the next day followed up with echo. His findings are as below:

      1. RCM stable. Used to be severe but now considered mild to moderate. No change in size for the past 2 years.
      2. Bloodwork mostly normal, one electrolyte is lower but expected to return to normal.
      3. No high blood pressure. No infection.
      4. Mild lower airway disease, which is his asthma.
      5. Dilated aorta. Remain the same as before.
      6. No fluid build up.
      7. *****Abnormal mass by his ascending aorta***** Seen in his echo 2 years ago, but just clearer now with the up to date echo machine.
      8. No change to the mass for the past years.

      Current treatment:
      1. enalapril 1 tab twice a day
      2. spironolactone half tab twice a day
      3. plavix quarter once a day
      4. lasix injection every 5th day
      5. supplement: cardiostrength, fish oil, CoQ10

      The cardiologist stated that Ziggy's case is very rare (said every doctor he's ever seen). His analysis is that although it does not look like how aneurysm usually looks, he's confident to say that it's one. He ruled out cancer and infection. Explained that it is most likely that Ziggy's aortic wall weakened and ruptured, blood rushed out into the space next to his aorta, forming a mass. The reason why Ziggy was feeling so unwell yesterday should mainly due to the excruciating chest pain caused by the mass, not asthma nor RCM. The vet said maybe it's scarring, maybe it's other things, we cannot tell for sure. 

      Has anyone had experience on this or heard of cases like this? Any thoughts?

      I know aneurysm is usually within the wall and not outside, and will increase the chance of blood clots, but Ziggy's outside his aorta?

      The cardiologist said since Ziggy's doing well with his meds in the past, he's reluctant to change the medication up. BUT, he is suggesting that we stop his spironolactone, lasix injection and plavix, because he thinks Ziggy doesn't need them. His explanation is that, since we are giving him lasix at such infrequent frequency, it is almost like not giving him anything. As for Plavix, the cardiologist is leaning toward not giving it to Ziggy because he is at low risk of blood clot and that it "may not" be helping with the aortic rupture/leakage of blood.  

      The cardiologist's current plan for Ziggy is to:
      1. Stop lasix, spiro and plavix now and recheck in 2 weeks to see how his heart does.
      2. Start beta-blocker after the recheck to help slow heart rate.

      His analysis is that heart condition doesn't usually get better such as in Ziggy's case, so it has to be something else bothering him that pushed him into heart failure. He diagnosed that the aneurysm is the main cause of most of what happened to Ziggy in the past and we should adjust our treatment plan to treat it.

      To be honest, I am kind of scared about changing up Ziggy's medication this much and I've said as much to the cardiologist. The only meds that I'm comfortable with stopping at this time is Spiro. The cardiologist understands but I know he feels strongly about his suggestion. He kept saying that he is reluctant to change Ziggy's meds but also made pretty drastic suggestion about it. I'm still trying to find out why we can't start beta blocker on top of what Ziggy has right now or give him pain killer(Buprenorphine) to help ease his discomfort..

      He said it's up to me whether I want to give him pain killer at this time...

      Any advice on the best way to change up meds?

      Thanks for reading,

      Zoe
    • ESID
      Zoe, I have too little experience with heart diseaes(s) but have always read that any change in heart meds should be done gradually. The resting breathing
      Message 2 of 3 , Apr 22, 2014
        Re: [FH] aortic aneurysm & meds change up Zoe, I have too little experience with heart diseaes(s) but have always read that any change in heart meds should be done gradually.  The resting breathing rate which you mentioned before is perfectly normal on this set of medications.
        I am all for less medications if possible.  Perhaps dropping the  lasix injections seems to make sense under the circumstances, but reducing the spironolactone likewise I would hesitate without running it by another cardiologist.

        I see a lot of enalapril prescribed here which is mostly cleared by the kidneys.  The diuretics are already hard on the kidneys and I wonder if you want to ask for Benazepril instead, the sister drug to Enalapril instead, as Benazepril is mostly cleared by the liver.

        With an aortic aneurism, it seems there is an added possibility of pooling blood and clotting so a anticlotter like Plavix makes sense, and I would hesitate to take him off it.  
        Yes, the more I think about it, I would run all of this by another cardiologist. Just a consultation should not set you back too much.

        My Boy has severe dilated cardiomyopathy ( DCM) and clotting is a big risk, turbulence , backflow, very low ability to contract the heartmuscle and he is getting Benazepril 1/2 tablet once a day.  How this dose relates to Enalapril, I don’t know, but looking both up it seems Enalapril doses per mg are lower than Benazepril doses. http://www.globalrph.com/ace.htm#Enalapril__%28Vasotec_%C2%AE%29
        So my Sammy is either on a very low dose or your Ziggy on a pretty high dose of these ACE inhibitors. Did he have high BP before being put on Enalapril??

        Sammy gets 1/4 tablet Plavix like most heart kitties once a day and 1 tablet furosemide twice a day , Aspirin 1/4 table twice a week. Plus 1.5 tablets of Pimobendan/Vetmedin twice per day. I read in the meantime that Benazepril (Enalapril likewise) are impacted in effectiveness by Aspirin. It seems common to give them simultaneously to many kitty patients, which does not mean that vets are aware of this interaction.  I separate the Benazepril by 12 hours from the aspirin dose for this reason even though this was not specified.

        I hope that you get reliable advice from your vet.

        Erika

        on 4/22/14 15:20 , r17re@... at r17re@... wrote:




        Hi all,


        I hope you and your kitties are all doing well. I'm back looking for advice in regards to Ziggy's heart condition and meds change up. I'm sorry if the post gets ultra long.

        We recently took Ziggy to the ER because he was breathing just a bit faster (24-28bpm) but appears to be unwell to one point he refused food. He never ever refuse food unless it's a dire situation. We gave him some lasix injection at home, took some x-ray at ER and the next day followed up with echo. His findings are as below:

        1. RCM stable. Used to be severe but now considered mild to moderate. No change in size for the past 2 years.
        2. Bloodwork mostly normal, one electrolyte is lower but expected to return to normal.
        3. No high blood pressure. No infection.
        4. Mild lower airway disease, which is his asthma.
        5. Dilated aorta. Remain the same as before.
        6. No fluid build up.
        7. *****Abnormal mass by his ascending aorta***** Seen in his echo 2 years ago, but just clearer now with the up to date echo machine.
        8. No change to the mass for the past years.

        Current treatment:
        1. enalapril 1 tab twice a day
        2. spironolactone half tab twice a day
        3. plavix quarter once a day
        4. lasix injection every 5th day
        5. supplement: cardiostrength, fish oil, CoQ10

        The cardiologist stated that Ziggy's case is very rare (said every doctor he's ever seen). His analysis is that although it does not look like how aneurysm usually looks, he's confident to say that it's one. He ruled out cancer and infection. Explained that it is most likely that Ziggy's aortic wall weakened and ruptured, blood rushed out into the space next to his aorta, forming a mass. The reason why Ziggy was feeling so unwell yesterday should mainly due to the excruciating chest pain caused by the mass, not asthma nor RCM. The vet said maybe it's scarring, maybe it's other things, we cannot tell for sure.

        Has anyone had experience on this or heard of cases like this? Any thoughts?

        I know aneurysm is usually within the wall and not outside, and will increase the chance of blood clots, but Ziggy's outside his aorta?

        The cardiologist said since Ziggy's doing well with his meds in the past, he's reluctant to change the medication up. BUT, he is suggesting that we stop his spironolactone, lasix injection and plavix, because he thinks Ziggy doesn't need them. His explanation is that, since we are giving him lasix at such infrequent frequency, it is almost like not giving him anything. As for Plavix, the cardiologist is leaning toward not giving it to Ziggy because he is at low risk of blood clot and that it "may not" be helping with the aortic rupture/leakage of blood.  

        The cardiologist's current plan for Ziggy is to:
        1. Stop lasix, spiro and plavix now and recheck in 2 weeks to see how his heart does.
        2. Start beta-blocker after the recheck to help slow heart rate.

        His analysis is that heart condition doesn't usually get better such as in Ziggy's case, so it has to be something else bothering him that pushed him into heart failure. He diagnosed that the aneurysm is the main cause of most of what happened to Ziggy in the past and we should adjust our treatment plan to treat it.

        To be honest, I am kind of scared about changing up Ziggy's medication this much and I've said as much to the cardiologist. The only meds that I'm comfortable with stopping at this time is Spiro. The cardiologist understands but I know he feels strongly about his suggestion. He kept saying that he is reluctant to change Ziggy's meds but also made pretty drastic suggestion about it. I'm still trying to find out why we can't start beta blocker on top of what Ziggy has right now or give him pain killer(Buprenorphine) to help ease his discomfort..

        He said it's up to me whether I want to give him pain killer at this time...

        Any advice on the best way to change up meds?

        Thanks for reading,
        Zoe




      • acidsoda
        Hi Erika, Thanks for the information. I ll definitely speak to the cardiologist about Benazepril. Ziggy had borderline high BP when we transferred him to the
        Message 3 of 3 , Apr 25, 2014
          Hi Erika,

          Thanks for the information. I'll definitely speak to the cardiologist about Benazepril. Ziggy had borderline high BP when we transferred him to the cardiologist who saved his life. She advised the treatment plan of lasix injection and enalapril twice a day because Ziggy was doing quite badly then and he wasn't responding to oral lasix. The recheck we just had showed that his BP is within normal limits. 

          We want to get advice from another cardiologist, but the cardiologist we used to see and trusted very much moved away and I don't have her personal email address. This is a new cardiologist we are seeing from the same hospital. I'm a little lost who to find at the moment. If anyone also in NYC has recommendation?

          We are keeping the medication as is for now and not changing anything until Ziggy's fully recovered.

          I am still observing Ziggy and trying to tell what's going on in the last few days. He's slowly getting better, usually energetic, bright eyes, and even running around a bit early in the morning for maybe an hour or two, then he kind of just goes back to being a little tired. It seems like he is being gentle with his chest. He doesn't like to lie on his side stretched out, and he will prop his head up with his arms when he is lying down. But he doesn't mind curling into a ball in his hideout. His nose is still very stuffy, I'll be steaming him later on in the day to help with that.

          Anymore advice from the board is appreciated.

          Best,
          Zoe

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