Cat heart

Question
QUESTION: No murmur or irregular sounds at exam this week.  X-ray shows enlarged right side taken in sept because I told vet he was coughing and had taken him in for worms.  That vet told me thickening of heart just to keep it in back of my mind. Two visits before that ran every blood test in book for constant diarrhea.  When i told vet about mouth hanging open after exercise, she told me she didn't hear anything and could just be him.   At this last visit this vet looked at X-rays and said pulmonary blockage but no murmur or irregular sounds.  No coughing but definitely has mouth open a lot and is less active.   I've had him since May and he is just over 1 year.  Rescue.    I just want to know what s best to do now.  Three vets three different diagnoses.  1000$ gone . He is an indoor cat and a total cuddle bunny!   I'm very frustrated and don't know what's best to now.  This last visit really left me in shock!

ANSWER: Hi Marisa,

I'm so sorry to hear you're going through this. The poor little guy! Did he have a heart worm test run? If not, I would urge this. Heart worms rarely make it to the heart in cats. They usually cause problems in the lungs. But just in case...it's an inexpensive test (around $50 in most vet offices, in combination with the leukemia and AIDS test), and then you can rule it out. If it comes back positive, it's possible that he's dealing with a lot of inflammation due to a heart worm or two. Usually, you need to wait out the heart worm infection and hope the cat pulls through. Infections usually last around 3 years.

Unfortunately, if you want to get to the bottom of his problem, you're probably going to need a referral to a veterinary cardiologist OR at least an internal specialist with specialized diagnostics. An x-ray is 2-dimensional, and many things are obscured. Even the best vets are only taking a shot in the dark when trying to diagnose heart problems with an x-ray. He will need to have an echocardiogram to determine the problem for certain. Once more information is obtained from the echo, a treatment plan might be able to be implemented, depending on the diagnosis.

If it IS a blockage, sometimes the best thing to do is to leave it in place. If you start him on a blood thinner and the clot breaks free, it can move to a more critical location and cause a worsening of symptoms and even death. If the clot is inside the heart, it is relatively harmless so long as it stays put.

However, I do think that as a cardiac patient, he could receive some kind of treatment. Because your cat's heart is enlarged, I would imagine he is suffering from Hypertrophic Cardiomyopathy (HCM), the most common type of heart disease in young cats. Even if a blood thinner isn't appropriate, a beta blocker might be beneficial to reduce the work load on his heart.

If you don't wish to pursue a diagnosis, I can understand that. A specialist and all the tests would likely run you another thousand dollars. And very sadly, the long-term outlook for cats with cardiac conditions is not bright. I have had a couple of cats with HCM, and their survival time, from diagnosis, was only 3 months and 9 months, with treatment. Unfortunately, their cases were not out of the ordinary.

Cardiac problems are an all around sad situation. I wish you weren't having to face this decision. Knowing what I know about the symptoms of heart disease, the indications of heart disease on an x-ray and how well cats fare, even with treatment, I would personally lean toward just making him comfortable. But only you can make the best choice for your situation and your cat.

Best of luck,
Jessica

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QUESTION: The doctor who did the X-ray said she did it to rule out worms in lungs and heart  so we saw none just the enlarged heart.   So at this point is echo worth the trauma he will suffer from being there alone and the process?  He slept all day after his last visit and wouldn't. Eat after his shots and exam last week?  Thanks for your help.  I'm crying .

Answer
I really don't know that I would put him through the stress and risks of an echo. Most of the time, at least light anesthesia is going to be required for an echocardiogram, and while a cardiologist and going to have advanced equipment to monitor his heart function, anesthesia is very risky in a cardiac patient. There is a significant risk of losing him trying to get a diagnosis. You can always go for a consultation, and that may be a good idea. A specialist would certainly be able to give you more solid answers than I can about the process and the risks. There may be a cardiologist out there who has the expertise to diagnose him pretty accurately without an echo, or to do an echo without needing to anesthetize him, but I brought my cats to one of the leading vet hospitals in the country, and I was required to sign a waiver stating that I understood the high risk of losing the kitties just during diagnosis. I'm so sorry that you and he are in such a tough spot. There is really nothing good about a diagnosis of cardiac disease of any kind.