HCM (Hypertrophic Cardiomyopathy) ....Questions

Has anyone had a cat with HCM (Hypertrophic Cardiomyopathy) that had NO congestive heart failure associated with it?

If so, what medication was your cat put on and/or how was she treated for the disease?
also, what symptoms did the cat have for you to take her to the vet to get diagnosed?

 

In 1990, when my Gwyn four months old, one of her earliest vets heard a heart murmur. In 2002, Gwyn had what we eventually decided was a stroke. (We consulted every specialist and ran every test suggested by the neurologist -- well, excluding the exploratory brain surgery -- but heart problems / blood clots were never suggested, so there was no heart-specific work-up at the time.) She had another presumed stroke in 2006; again we ran a whole bunch of tests, but again nothing heart-specific.

Labor Day weekend 2007, at age 17-1/2, Gwyn had a third stroke; this time the clot left her hind legs paralysed for two months (she did recover and ended up walking normally). During the battery of specialists / tests during this period, we finally saw a cardiologist, who ran an echocardiogram on my Gwyn (an ultrasound specifically aimed at the heart). Among various other other heart problems, Gwyn was diagnosed with moderate geriatric-onset hypertrophic cardiomyopathy.

The cardiologist we saw was board-certified and, from our research, was one of the best in the area. He's also inclined to be conservative with medications. He said that we could start Gwyn on heart medications (atenolol or diltiazem), but his inclination was that we should wait on that. Since he was the best we could find in the area, we agreed to hold off on those meds, although we did start treating Gwyn for hypertension. Currently, she's on a daily dose of norvasc, and she gets 1/4 of a baby aspirin twice a week.

Gwyn has never had congestive heart failure. As with many older cats, Gwyn does have lower kidney function and, like many kidney-impaired cats on this board, she gets subcutaneous fluids. However, because of Gwyn's heart conditions, we are very conservative in the amount and frequency of the fluids that we give. We also try to avoid excessive amounts of salt in her diet. That was two and a half years ago; in just under a month, Gwyn will turn 20 years old.


As for your cat: there are different types of HCM -- I seem to recall the cardiologist saying there were three main types? -- and there are different severities. You'll probably get folks with different types and different severities, and I'm sure there are differences in how each one is treated.

Before you make any decisions on Ginger's future, I'd suggest seeing a cardiologist, preferably a board-certified one. They'll probably run some tests, and will hopefully be able to give you a more knowledgable diagnosis and treatment plan than your regular vet. Which isn't to diss your normal vet, I'm just saying that there's a difference between someone who treats a range of problems in a variety of animals and someone who's only job is to look at hearts.

If you do see a cardiologist, make sure to get a copy of the report for you to keep yourself, so that you can refer to it as needed and can provide copies of it to any other vets you may see in the future. For example, given all of Gwyn's heart problems, she's at a high risk for complications if she ever has to undergo general anesthesia; the cardiology report gives an entire list of things to do before, during and after the anesthesia to keep those risks to an absolute minimum. It also discusses drug possibilities, diet, activity, subcutaneous fluids, etc.

 

When Merlyn was diagnosed with HCM he already had pulmonary edema.. basically if theres fluid build up, thats technically when its CHF..so any heart condition can lead to CHF. That doesnt mean you dont want to treat it if there is no fluid build up. I believe it depends on wether heart rate is elevated, or Blood pressure, and also what architecture is going on. Merlyn already had severely enlarged left atrium when diagnosed, but no heart murmur. He was put on Diltiazem, and Lasix, benazapril, and later an aspirin regimen.

You may want to PM Jess and Earl, she works for a veterinary cardiologist.

Some links for you:

http://maxshouse.com/Cardiology/myocard ... he_cat.htm
http://www.2ndchance.info/heart.htm
http://home.online.no/~colmar/hcm_eng.html
http://www.vin.com/proceedings/Proceedi ... 2&PID=2991

 

Maggie didn't have congestive failure at dx. She was on ditalizam and a baby asprin 2 times a week. But she did have congestive failure at the end.

 

Thanks for the responses.
my cat is almost 10 years old and last friday I took her to the vet because she was pretty lathargic and drinking tons of water.
They ran blood work and everything was normal except for her Blood Glucose level. It was 460.
So they prescribed 2 units of insulin 2 x a day.
We gave her the first shot on Saturday morning after she ate.
She didnt eat again for over 32 hours. (I did not continue with the insulin)
I took her to the vets and for 2 days they tube fed her and re-hydrated her fluids.
They ran the blood tests again, and everything was normal.
Blood Glucose was 75-80 for the 2 days she was at the vets.

They suspect either pancreatitis or hepatitis because of the crazy saturday BG level of 460.
So they took x-rays.
They found no tumors or anything, but did not like the way her heart looked.
They feel she possibly has HCM, but there is no fluid buildup around her heart or lungs.
Her heart and lungs sound normal. There is no murmor.
They said she might have 1 yr to live, if she has it.

They prescribed and antibiotic incase of infection and atenolol for her heart.
They said she is not diabetic now, they do not know why her BG is normal again.
They are not sure if she has an infection, or if its pancreatis or hepititis since all the blood work looked fine.

None of it makes sense.

 

Hi Gingers mommy

Most cats with HCM have no symptoms -- not even a heart murmur. Usually the finding is incidental or (unfortunately) only occurs after the cat is in congestive heart failure, as in Lisa's cat's case. Medication doesn't help prevent the disease, reverse the disease, or prevent the disease from progressing. Cats with a subtype of HCM can benefit from beta-blockers (atenolol) in some cases, but those are less common.

There are two other major culprits for "pseudo" HCM -- hypertension and hyperthyroidism. Has your cat's BP and T4 been tested recently?

I would urge you to see a cardiologist for a workup. There are board-certified cardiologists in Akron, Cinncinnati, Cleveland, and Columbus, Ohio. If you are closer to another state's border you can check out acvim.org for other cardiologists in your area.

Also as I mentioned before, I don't think we have enough information to give your cat a prognosis. Ginger needs an echocardiogram (and a BP and T4, if she hasn't had them already) to determine if she has HCM and if so, how much it might impact her life.

 

I know she needs to see a cardiologist, but there is a money issue right now.
I just spent $600 at the vet only to find out maybe they think she has HCM among other things maybe she has.
I do have the name of a cardiologist in the Cleveland area.

We also want to wait and see if the antibiotics clear up her other symptoms.
I contacted the Specialists and was told the cost would be around $2000 to get a diagnosis of all her issues.
I am not working, my husband is retired, so its a big issue.
And for the HCM, when they confirm it, will they just say to keep her on the beta blocker the regular vet prescribed?

 

I definitely get the money issue but 2000 seems pretty steep to me. San Francisco is pretty expensive but in 2006, even with Merlyn at the ER the whole night (700) and at reg vet all day and overnight (565) and taking him in a few days later for the traveling radiologist for u/s (400) and then in 2008, at the internal med specialist for another u/s (500) I would think that you would only need more bloodwork if they didnt do a T4 as Jess said, and if they already did Xrays, then they dont need repeating. You can ask if you can bring them to the specialist. The main thing you need now is a cardiac ultrasound. If they are quoting 2000 dollars they may be thinking they have to redo X rays and bloodwork etc.

I also wanted to say that Merlyns diagnosis was accidental. We went to the ER for obstipation -he couldnt poo and was straining and bleeding from his butt. They did an xray before cleaning him out and found the enlarged heart and wouldnt clean him out. They just made him comfy til our reg vet could see him and do the clean out.

And...I also wanted to say that his diagnosis was in November of 06, and he also had moderate kidney disease that I was giving subqs for as well, and he passed away April 29th last year. He lived for two and half years post diagnosis and that was with CHF and kidney disease. So for them to say she would only live for a year is a very negative, discouraging thing to say. ECID! Every cat is different.

 

Grace isn't my kitty, but I do help her mom with her ... She was diagnosed with HCM quite recently, and no heart failure. She is on Fortekor and baby ASA (1/4 pill twice weekly) -- and is doing VERY well!

By the way, and this is a tad late since you've already had all the tests- but your Ginger is a prime example of why diabetes should *never* be diagnosed on the basis of a single blood glucose reading! Many things, including stress, can cause isolated episodes of elevated BGs, and without further investiagtion, starting the cat on insulin (especially a high dose like 2u) can be disastrous. I am hoping your vet learned from this, and will now order a fructosamine (gives the average BG for past 2 weeks) before putting another suspected diabetic cat on insulin! Confirm the diagnosis, and then treat!

By the way, Grace's cardiologist said that there was a good chance that because she is young (10) and this was caught early, that it may not progress and may even reverse!

Best of luck.

 

As soon as I can, I will be figuring out my Income Tax Return so I know how much, if any, refund we will get this year.
The vet already said I would need to bring the x-rays with me to the cardiologist appointment and she would fax the
results of all the different blood work she did.

My biggest concern right now is that she is eating very little and is suspected of also having Pancreitis or Hepatitis instead of diabetes.
Her possible HCM was found by accident too, when checking for tumors, etc regarding the pancreas and liver.

I was told the diagnosis to find out that....... is what is the bulk of the expense.
The ultrasound and exam for the heart would be $400-500.

I am hoping once she is done with the antibiotic she is on, she will act more normal and eat better.

I do not think she had a T4 test since the regular blood work did not indicate anything abnormal regarding her thyroid.
confused_cat

 

I agree with you. Is she eating anything at all? If she will not eat she *will* develop hepatic lipidosis. A vet can put in a temporary feeding tube (slip it down the nose) so she can get water and some nutrition. If she is truly not eating at all, don't hesitate to do this. She is going to become very dehydrated, feel worse, and is less likely to eat because she feels so crappy. So many cats get through a diabetic crisis, or severe pancreatitis, etc. only to be stricken with hepatic lipidosis. The survival rate can be poor in some cases so you always want to be ahead of the curve here.

You should see a pretty rapid response to the antibiotic. Not necessarily dramatic, but rapid -- there should be some change. It's always possible (unfortunately!) that the antibiotic could also make her feel poorly, so if she isn't looking better please call your vet in the morning. Anti-nausea drugs (Cerenia, dolasetron) can work wonders for cats too, so it's another thing to try. It can be difficult to tell if cats are nauseous -- they can avoid food for many different reasons -- so anti-nausea meds should always be considered.

THe T4 test is the only test that would show abnormal thyroid function -- a cat can be desperately hyperthyroid and have good general bloodwork results. Your cat doesn't sound classically hyperthryoid, BTW, I'm just mentioning it because it can cause heart changes of the same type that were seen in the x-ray and the cardiologist is going to recommend the test (and it will be cheaper to do it at your vet).

Hope this helps. Please do keep us posted.
Jess

 

She was at the vet 2 days with a feeding tube and water re-hydration Monday and Tuesday.

Wednesday she was eating very little, but just the dry food and very little water, so I fed her and gave her water with a syringe a couple of times.
Today, I bought the Grain free Evo dry, so she would at least get less carbs than what I had here if she will only eat the dry.
She likes it and ate pretty good. My other 2 cats also like it, maybe too much lol.

The vet called today and I mentioned it was hard to tell if she was lathargic still or just drowsy from the beta blocker meds.
So she said to just give one dosage a day instead of two.

Ginger seems to be feeling a little better this evening and has come several times to eat and drink water.

 

Any type of stress can cause a rise in the bg. Sammy's bg's went sky high when he had cancer. Not trying to imply it's cancer, just pointing out that other body stresses can cause it. Granted, that's pretty high for a non-diabetic cat, but it's possible. But they seem to be concentrating around certain things because of that one reading. I wouldn't start counting too much on that infection thing. Perhaps, but it almost seems like you want so much for it to just be an infection that you're ignoring other possibilities that need checked out. And some infections need certain types of antibiotics.

The food is a real concern. As Jess said, she could be on the path to hepatic lipidosis due to the lack of eating, so you need to get that under control. (And stop worrying so much about debating on food. Do that after she's feeling better.) It's better that she eat on her own, so whatever she'll eat, yes including EVO dry. If she'll eat canned, great. See if she'll eat some meat baby food (no onion). That doesn't contain nutrients that she needs so that can't be her only diet, but it can get some calories in her if she'll eat a little of it on her own. If you need to, syringe feed her. That's stressful so it's not the best option - you'd much rather have her eat on her own. But she needs to be eating, so do it if you have to. You need to get on top of this so it doesn't get worse and turn into an even bigger problem. It's kind of a bad cycle -- not eating cause she doesn't feel well, then getting sicker from not eating, making her want to eat even less, etc. And not all cats will eat if they "get hungry enough." (I took care of a friend's cat with fatty liver, who got sick because he didn't like a different food she bought, and simply refused to eat. He wasn't originally sick, just made himself sick.)

Seems like your vet is just guessing from an xray. Though being that weird shape probably does mean something. But different meds are appropriate for different things. I have no idea whether the beta blockers could be harming her if he's wrong.

As for those costs... hmm. I'm in Ohio and it's the not most expensive place in the world. If someone from California is saying $2000 seems steep, then I've got to believe that's even more steep for Ohio. For instance, basic blood work is about $50. I see where that's up over $100 other places in the country. The ultrasound I had done (specialist in from Indiana) was about $300-350. I see huge differences in costs like that a lot. So I would expect some place in California to be way higher than here. I don't know exactly where you're at, but if you're near me I might be able to steer you in a better direction. (If you don't want to say where you are, you can PM me.)

 

I am in Ohio between Cleveland and Akron.
I was referred to a Speciality Clinic.
I asked what the prices would be, and I was told about $1500-$2000 to diagnose.
I wanted to wait until the antibotic precription was done before I made an appointment, just incase.
I am taking her off the beta blocker until I get a diagnosis.
I have tested her BG at home, and each time it was 75-90, but she is not eating normally yet.
Any day I do not feel she eats enough, I syringe feed her several times a day.
I do understand how serious this is.
Thank you for your reply

 

Oh btw.
Basic blood work was $150

 

That's pretty expensive for basic blood work, unless it included a T4 or something expensive like that. I don't know costs up in that particular area very well, but I know both MI and PA are around the same as here. For a specialist you don't always have a lot of choice, but cost may come into play for your regular vet as well if costs are an issue. You might want to shop around. (I can get blood work done on me for that kind of amount, and human stuff is always more expensive.)

I saw in your other post that she was sometimes eating a decent amount on her own, so I'd consider that blood glucose is that way cause it's normal, and not because she isn't eating. For a diabetic, even when they aren't eating enough, we generally still have to give insulin, maybe just a reduced dose. So my (unprofessional) conclusion is that she's not diabetic.

 

Maggie's dx was first made by my vet hearing a "gallop rhythm" when she listened to her heart. I was sent for an echo and they did the blood pressure and thyroid test. I didn't see a specialist, though the echo was read by a specialist via the internet somewhere else, NJ I think. I live in the Toledo area, and the echo cost $500. I don't remember the cost of the office visit and T4. So $2000 seems high to me.

BTW, there are 3 Ohioans on this thread. Strange, isn't it?

 

She also needs a seperate echo of her pancreas and liver and whatever other tests they would need to do to get a diagnosis of what is wrong with her in additon to the echo of the heart.
That is why the cost is so much higher.

 

I took Ginger to the specialty clinic for an ultrasound and tests to see if she has HCM, pancreatitis or hepititis.
She does not have HCM.
She does not have diabetes.
All her blood work and urine tests looked really good.
The GI Panel results are not in yet.

 

GI Test results are in.
EVERYTHING is NORMAL.

 

That's great!