Progression of heart failure?

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elfin

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I'm sitting here looking at my boy, and it occurred to me that I don't really know what to expect in his future.

He has RCM with a 3rd degree AV block, not diagnosed until he was in heart failure. He's on lasix, vitamin K (for his anaemia) and steroids (for a tongue ulcer that just won't heal). His kidneys were okay a month ago when he had bloods done.

The last couple of days I've been having to give him half a lasix tablet instead of a quarter because of his breathing, but our vet just had me go to 3/4 for a couple of doses because he's still filling up with fluid. If that doesn't work I don't know what the next step will be.

He seems very tired but doesn't really sleep much - any sound or movement near him and he opens his eyes. He was eating vast amounts of food a few days ago but his appetite has dropped down to about what a cat would normally eat, maybe slightly less. Last night he had dinner in bed because even though he was hungry he wouldn't get up and go to the bowl.

The vet has suggested extra blood tests to find out why he's anaemic, but I question the value of doing it from his point of view. If we had found his anaemia earlier we might have been able to prevent his HF, but fixing his anaemia now isn't going to make him better. Even the full blood count the specialist recommended seems pointless if it's not going to lead to a cure. He growls at the vet now when she touches his arm because he's so sick of getting stuck with needles (though he forgives her straight away).

What's the usual progression of this sort of thing? Can I expect him to go up and down for a while, or is he likely to just get gradually worse? I worry about waiting too long before making a decision about euthanasia and having him suffer, especially when we're heading into the weekend and the after-hours vet is a half hour drive away instead of the 3 minutes to our usual vet.
 

stephenq

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I'm very sorry for what you;re going through. Restrictive CardioMyopathy is very rare in humans and I've never heard of it in cats.  In humans the prognosis is poor.

2 thoughts. 1) I think when you can no longer get fluid out of his lungs in a way that prevents distress in him then you are looking at euthanasia to end his suffering.

2) When my cat had HCM, a diffferent type of heart disease we had injectable Lasik standing by for emergencies in that it is fasting acting than a pill.  It is super easy to give, just a quick jab under the skin.  Your vet can show you how, plus there are youtube videos as well.  So I would discuss getting some injectable Lasik from your vet.

Lasik can also over time, put a cat into kidney failure so you have to watch for this, because if this happens its very serious because the standard treatment, sub Q fluids is not a good choice for a cat in heart failure as this can put them right back into heart failure.

If you can't balance him out soon with Lasik, then I think you have to consider the idea that his time is near.

A cat normally breathes 20-30 breaths per minute.  More than that, and upwards of 40 while at rest and you have a problem.  You should be timing his breathing rate at complete rest and discuss with your vet what rate needs intervention.
 
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elfin

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Thank you Stephen. Being told that he's not going to live long is not quite the same as having to watch him decline. Having read other threads here I know I'm far from the only to go through this, but that doesn't make it any easier.

He's a lot brighter this morning so the higher dose seems to have helped, for now. The vet didn't want him on that dose any longer than necessary, so he's back to half a tablet this morning and I'll watch him closely to see if he fills up again. I'll talk to the vet about injectable lasix, but I have to say that my initial response is it's a step too far and I would probably consider that to be a sign that it's time to let him go. 

I've been monitoring his breathing several times a day. At times it goes as high as 52 per minute when he's asleep. The extra fluid is really evident around his belly. Being a mostly hairless rex it's easy to see changes. Last night (when I posted) his belly was so big I couldn't pull his shirt over it.

He was lying on my chest last night and I could feel his heart beating. There's no pattern in his heartbeat at all, and at times it stops completely for a couple of seconds. It can't be a good feeling for him. It was making me nauseous just feeling it from the outside.

I totally agree with your first thought - how he was yesterday is just unacceptable, and if he reaches a point where he's always in that state then I'll have to make the decision. If he has a mix of good days and bad I don't know how I'll be able to judge. A heart attack at the end is probably too much to hope for.
 

mnm

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aww I'm so sorry. It's such a tough decision. Tomorrow will be 2 weeks that we put Minnie down with chylothorax... which she was diagnosed only 4 weeks prior. She had been drained 2X from fluid build up in the chest cavity and was ready for a 3rd time only a week after the last one... couldn't see putting her through it in hopes her leak would heal. Part of me thinks...it would have been so much more clear if she just layed around in agony and wasn't acting normal, but she pretty much carried on her routine.. slept a bit more..but even played with her hairband the day before. I didn't want her to get to the point where she suffered to try to get through it if that makes sense... as none of the "treatments" were a "for sure" mend.
 
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elfin

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MnM that's so recent for you, I'm sorry :(  I wouldn't have wanted to put my cat through another invasive procedure either. It's good that she wasn't suffering at the end and got to go peacefully.

After saying that my boy was looking a lot brighter I went back to the bedroom to find that he hadn't eaten his breakfast. He wouldn't eat it even when I took it to him in bed, just licked it then looked like he wanted to throw up. His breathing is laboured and from the way he's holding his ears I can see he's in considerable discomfort, possibly even pain. The lasix was in his food, so I've now thrown that out and given him the higher dose directly into his mouth.

If he doesn't improve shortly, well, this could be it.
 

mnm

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... I can only explain it as my sadness is lined in peace. I pray you feel that peace as well. I told hubby a couple days before..."she isn't Minnie anymore as I know Minnie". That's when I knew. I was far more a basketcase the prior few weeks during the diagnosis and drainings and pillings and worrying about every lil move she did or didn't make.... than the last week with her as I simply prayed and realeased it all...realized ...this isn't for me to carry all on my shoulders... it's a life thing that unfortunately happens, and I was filled with a deep peace after that even on "the day the vet came to the house". God bless you...(big hugs). This photo was when we were waiting for the vet to arrive...
 
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elfin

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We let him go this morning. He had a very brief period of feeling good after the lasix kicked in, but it didn't last and by the time I got him to the vet he was in distress again. The vet agreed that the time had come to say goodbye, so I wrapped him in a blanket and cuddled him through to the end. I've been crying on an off ever since but I know it was the right thing to do.
 

mnm

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oh i am so sorry.. I know your heartache....as I just went thru a lil crying session myself... still in disbelief Min is gone. Bedtime is the hardest as she kneaded on my neck every night... even her last night.

I am so glad you were with him but also know how difficult it must've been. May you find peace knowing it was most definitely the right thing to do to allow his sweet spirit to be freed from pain and suffering. I would love to hear more about his lil personality traits unique to him when you feel up to it. We never know just how long we will be entrusted to care for our pets but what we can control is the amount of love we have given to mold their lives into the bestest possible life they could ever desire. And to that we can say " we have succeeded". xo
 
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