Atenolol

If your cat was not yet diagnosed but is suspected of having HCM (Hypertrophic Cardiomyopathy) without Congestive Heart Failure signs, and the vet prescribed Atenolol (beta blocker).............would you give it to your cat?

 

Was blood pressure taken? If so, was it high?

 

No...I would want a cardiologist, after an echo and ECG, to tell me that. My civie is going in today for a bp check........has been on Norvasc for a week....wants to see if bp has gone down or if we NEED to add Atenolol.

 

No her BP was not checked. They are going from an x ray that showed her heart being of abnormal shape of a "heart" as in valentines day shaped heart. The x-ray showed no fluid around the heart or lungs.
He listened to her heart and lungs and they sounded fine.

I am not very confident in this vet. First diagnosed with diabetes, now they say she's not diabetic.
AFTER having me administer insulin.
1 shot and she stopped eating and drinking totally and just laid around, so I did not give anymore shots.
Then was at the vets for 2 days being tube fed and re-hyrated and trying to find another diagnosis.

At first they had me give her 1/4 of a 25 mg tablet 2x a day.
Then because she seemed so sleepy, they had me cut it down to 1x a day.
after about 4 days on 1x a day, I just now took her off of them totally.
She seems to be acting more alert and eating a little now.

I have been referred to a cardiologist and intern specialist and will go as soon as I can get the money.

 

I personally was on atenolol. From my perspective it made me very tired. I could barely move. It's a drug used to lower the heart rate.

According to Plumb's Veterinary Drug Handbook the primary adverse effect is lethary, hypotension, or diarrhea. And if discontinuing, recommend withdrawing gradually. It's uses/indications are: Atenolol may be useful in the treatment of supraventricular tachyarrhythmias, premature ventricular contractions (PVC's, VPC's), systemic hypertension and in treating cats with hypertrophic cardiomyopathy. Atenolol may prolong the hypoglycemic effects of insulin therapy. Exacerbation of symptoms has been reported following abrupt cessation of beta-blockers in humans. It is recommended to withdraw therapy gradually in patients who have been receiving the drug chronically.

You haven't been giving the drug over a long period of time (chronically) so I doubt that any ill effects will be produced if you stop the drug cold turkey.

Hope you can get to a cardiologist for an ultrasound.

Dale

 

Pearl is on enalipril and lasix for mitral regurgitation. I hope Jess can chime in here. I *think* it is also supposed to slow the heart to make it work easier? She has been on it for as long as she has been diabetic (all was diagnosed at same time. We don't have a cardiologist but they had a cardio ultrasound guy come in.) I do not find it bothers her at all. I would sure want *some* kind of real cardio rx over just a vet if at all possible.

 

Hope, one of my diabetics, was dx'd almost 3 years ago by a cardiologist with Restictive Cardiomyopathy. She is on Enalapril plus other heart meds. B.K. has a slight heart murmur but otherwise heart is okay but she has hypertension, blood pressure is elevated. She went in today for another bp check after being on Norvasc for a week. It came down some but not enough so now she is also going to be taking Atenolol. Different heart drugs for different heart problems and/or blood pressure. A cardiologist is definitely needed to find out what, if anything, is wrong with her heart.

 

Hi Ginger's mom

As Dale mentioned, atenolol is used to lower the heart rate and for irregular heart beats. Its use in cats with HCM should be restricted to those cats who have a certain subtype of HCM ... these cats can get winded when their hearts beat too fast and atenolol can keep them from having near-fainting episodes or what's called "exercise intolerance". These are the cats that pant after playing with another cat or chasing a laser. Anyway the type of HCM should be diagnosed by the cardiologist after the echocardiogram. Its use for HCM in general doesn't make too much sense so I'm not sure why some vets throw atenolol at every symptom-less cat they suspect of having HCM.

The short answer to your question is: I think you did the right thing. You started it, your cat became very sluggish and since there is not a clear medical need for it, you stopped it. That is what I would have done personally.

 

Hi Karen

Wow I didn't remember that Pearl was a heart kitty. DId I know that? Did we talk about it? I don't remember her being in heart failure ... Anyway you just said enalapril and Lasix ... is she on atenolol too? Other than an arrhythmia, I don't know why a cat with MR would be on atenolol. Do you know why Pearl has MR? Does she have a congenital defect? (Did I ask enough questions? ;-) )

 

Thanks everyone.
Since she was on the 1/4 of a pill twice a day for 4 days and and then once a day for another 4 days, I think it was ok to take her off of them. the 1/4 piece is so tiny there would be no way to cut it into a smaller amount to wean her off any other way.

I will be calling for an appointment with a cardiologist tomorrow.

 

She was diagnosed around the same time as her asthma. The day after actually. She was looking at the xrays the ER vet had taken and seen the donuts on the lungs, but my vet kept saying she thought the heart was enlarged. They happened to be having the ultrasound cardio guy from another clinic that travels around to other vets was in that afternoon to check on another heart kitty and so he did Pearl too and said it was mitral regurgitation. Yeah. It was a fun two days. I don't know if we ever talked about it. She just takes enalipril and tab lasix. I don't know if it helps but it doesn't hurt I don't think.

 

Whoa ... she went on Lasix and enalapril because someone said she had mitral regurgitation? Does she have a heart murmur? Was there any fluid in the chest (heart failure)? And then they gave her steroids? These are not benign drugs, I am stunned that they would be prescribed for supposed MR without evidence of congestive heart failure. I hope I've misunderstood something here.

 

Umm ok. I guess yes? I was under the impression this was a standard treatment. The steroids really were imperative for the cough. But of course they caused the diabetes (or precipitated it) and we went on flovent. If I taper off the flovent, she coughs. So I'm confident the asthma is a good diagnosis. I'm pretty sure the MR is too. Do you not treat MR at your clinic that way? I guess I don't know what to say. The nearest cardiologist clinic is four hours away. I truly can't get there with her. She's been on the enalipril and lasix four years now. I guess I am totally freaked out now.

 

I wanted to add the heart did appear enlarged on the xray. It has not been as large in subsequent ones a year or more after starting this. We haven't done one in some time now.

 

Enalapril and Lasix are drugs for congestive heart failure. They are not curative for any type of heart disease, and they have no use but to control congestive heart failure. I'm sure that Pearl is asthmatic -- she's symptomatic and responsive to treatment. My comment about the steroids is because steroids can induce heart failure in cats with heart disease so to simultaneously treat CHF and give steroids is a head-scratcher. Maybe they weren't sure if it was asthma or CHF and decided to do both treatments at once? I dunno. What are her doses for enalapril and lasix?

MR is not treated. There is no treatment for it. In humans, depending on the cause of the MR, they will often do a valve replacement surgery. Does Pearl have a heart murmur? MR is easily audible if it is significant. MR is a description, BTW, not a diagnosis. MR in cats is usually congenital, caused by either the valve not being shaped properly or the valve not opening fully. These defects cause a small amount of blood to "regurgitate" back into the chamber it's coming from. Very elderly cats often get "stiff" valves that will cause a small amount of MR, usually too little to be heard with a stethoscope.

I checked, and the closest cardiologists to you are in Ames, IA and Columbia MO which are not close to Lincoln. It's not clear what's wrong with Pearl's heart, if anything, but since there is no way to find out and the meds aren't causing her to be dehydrated or have kidney issues, I wouldn't stop them at the moment. Is there a specialty hospital within driving distance? An internist or radiologist there might have the experience to evaluate her.

I assume since this was four years ago that the xrays were probably not digital?

I'm sorry, I didn't mean to freak you out. I was just gobsmacked that she'd get put on CHF drugs for MR. Anyway I suspect she is on very low doses and there's no apparent harm done right now ... I do think it warrants investigating in the long-term though. She's handling them well but they are not benign drugs.

 

1/2 a tab enalipril, which are 2.5 mg so 1.25 mg enalipril. 1/4 tab lasix which is the12.5 mg so 3ish mg. Boy, now I don't know what to do. Seriously I don't know how to investigate further without going to a specialist and since she throws up and poops just driving 10 minutes to the vet, there is no way I am driving 5 hours with her somewhere. I don't know what to do. The reason she went to ER was the coughing wheezing bonanza she had. She's *always* coughed, but I thought it was hairballs. I took her and the x-rays in to our regular vet the next day and on the xray, my vet noticed the enlarged heart. The ultrasound was done that afternoon. Apparently this vet goes around with the ultrasound machine in this area of the state. My understanding was that it was specifically someone versed in reading cardio trouble.

*sigh* I just don't know. I hate to think I have been giving her something for years she doesn't need. Some days I'm just done. I give her the heart meds, her flovent, test, insulin, allergy meds (which don't help the itches she has developed but it really does help the sneezy runnies). I attempt to get cosequin in her for her leg but that usually goes by the wayside. I feel like I am *constantly * medicating her. I only want her to feel better and sometimes I wonder what I am doing. I guess I'm just disheartened right now. I seriously trust my vets, the only all feline vets in town, above other vets here. I don't know. Just no idea what to do.

 

Oh I certainly didn't mean to inspire a crisis of confidence here. If I were you, I would just call the vet and ask her. I think it's important to know if your cat was diagnosed with CHF before, for starters. Maybe they did think she had CHF and asthma? It's an important part of her history. And if she was never diagnosed with CHF, it's reasonable to ask about the Lasix and enalapril. You can say that you feel like she's on a lot of meds and you've gone over them and wonder why she is on heart failure drugs? Your vet should be able to explain. It's possible that the ultrasonographer convinced her to use them for some reason, who knows?

Just in case you do talk to her and it comes up, enalapril is correctly used to either try to delay the onset of CHF (in animals that are "on the brink") or used in animals with CHF to interfere with the angiotensin system (something that activates in heart failure but can add to the problem). Its ability to delay CHF isn't 100% proven but it is a reasonable enough use. Lasix is a diuretic used solely to clear the pulmonary edema (water in the lungs) that results from congestive heart failure.

Pearl's dose of enalapril is low to normal (depending on her exact weight) and her lasix dose is on the low side, FWIW.

You didnt' tell me if she has a heart murmur?

Anyway I don't think this means that the vet needs to be chucked, but I do think she should be able to discuss her decision with you. As I frequently say around here, I haven't met your kitty and don't know the whole clinical picture so this could all make sense, given the right circumstances.

PS You totally jinxed me, you know ;-) Dillon just gave this little cough and he hadn't coughed once since moving to the new apartment! All I had to do was read the words "flovent" and "asthma" and off he goes!

 

Sorry about this jinx! Well, I'll ask, but it was three years ago. Seriously, all we went on, I believe, was the x-ray and ultrasound. Would there be any reason for the enlarged heart due to the asthma? No, I don't believe we ever heard a murmur but I can't say for certain. Whenever we have gone in since, it seems like her heart and lungs sound good.