How are heart problems diagnosed?

My almost 14 year old cat is having some issues and although my vet doesn't think they're heart related, others I've described his situation to continue to suggest that it is and I can't stop worrying about what I should do and how to prioritize his care. I'm on a limited budget but that said I do have a vet fund in the hundreds of dollars. But that's what I've got for the next year.

Sonny started having hacking/coughing incidents in April and in November was finally diagnosed with asthma when his coughing attacks happened more often and someone suggested it might be asthma rather than him trying to extract a hairball (which is what I thought it was). He was given prednisolone which right away seemed to put a stop to the episodes. He didn't have a single on from November until the middle of last month. Even after the dose was lowered from 5 mg 2X a day to 5mg 1X/day.

Anyway, after he began having attacks again I did more research on feline asthma and realized the harmful potential of prednisolone and that inhalers were the treatment of choice for asthma in cats. I got the inhalers and Aerokat and began his treatments, keeping him on the prednisolone for 2 weeks while the Flovent builds up in his system.

He had his first Flovent treatment Tuesday night. Wednesday night, he had a somewhat different type of coughing fit that sounded more "congested" than his asthma attacks, but I did assume it was a mild asthma attack so I gave him a dose of albuterol. His breathing for 15 minute was very loud and there was definitely some phlegm built up. Then it subsided and he was fine. This happened again the next day (yesterday), and this time I didn't administer albuterol and once again his breathing was bad for about 15 minutes.

I returned to the vet today and she listened to his heart and lungs. Someone had said it sounded like fluid was building in his lungs but she said his lungs are clear. I asked about whether it could be a heart issue and she said feline heart problems rarely present this way. Yet I continue to be told it could be a heart issue and that the prednisolone could aggravate it and I just don't know what to do at this point.

I could have the vet run all the tests (which my understanding are expensive) to diagnose a possible heart problem she doesn't think he has, for my own peace of mind, but then if it isn't his heart and IS asthma, my vet fund is nearly depleted by then and I woudln't be able to afford his asthma treatment. I've done research on heart issues in cats and I can't find anything necessarily helpful.

Sonny is not very active and hasn't been.... for quite a few years. He's always been that lazy cat content to lie in the sun, since he was a few years old (he was a MANIAC kitten). He eats and eats and eats (in fact he's overweight which I'm trying to deal with), drinks and drinks and drinks just fine, doesn't have any problem getting around, jumping, etc. He is deaf but I doubt that's a symptom of a heart issue.

I'm just confused about how people come to even have their pets diagnosed with a heart issue... a sudden crisis?? 

He's been on prednisolone for four months. i have a hard time believing that just now it would start aggravating an existing heart problem when two days before his phlegmy coughing started is when he went on the Flovent... I don't know, I'm just soooooo overwhelmed and exhausted right now. I felt almost at peace with the asthma stuff when I found out about the inhalers but now to have people say his heart could be going... I can't get a peaceful night of rest without wondering what else is wrong with him. And whether I should have all those tests run or not when the vet said she doesn't hear any murmur and doesn't see heart problems presenting this way. Is peace of mind worth depleting my vet fund that I need to pay for the condition he HAS been diagnosed with? I guess the obvious answer is no but I still can't sleep at night without worrying if I don't do the tests and it is his heart that he'll die and it'll be my fault.

Hi, I'm so sorry your kitty is not well. Are you able to count his breaths per 15 seconds? When I found my cat breathing a little too rapidly, I brought her in. She was diagnosed with cardiomyopathy....(an enlarged heart with thickening of the walls, thereby creating fluid to build up around the lungs and then into the lungs making it difficult to breathe. (I think that's how it happens)). The Dr. asked if she was coughing.....she was not.  Maybe that's how they determine what route to take with tests....I don't really know.

X-Rays are taken which will show the heart and the thickening. It will also show the fluid.   An echo-cardiogram is also taken showing the actual heart muscle in action.

I monitor my baby black Dot's breathing and if it is greater than 10 per 15 sec. or 40 + per minute, I know she is struggling and in need of oxygen. She has coughed, but not often. Maybe 5 times since she was diagnosed in Oct.

 There are two kinds of heart disease, I believe one is treatable. Unfortunately, the one that I am currently treating is terminal. I just take it day by day, love her and give her the medication required to help eliminate fluid build up, and other medications that help 'behind the scenes' to help her heart not work so hard, and blood thinner to prevent clots.  It is expensive.

I'm hoping your kitty feels better soon. And please know, if the outcome is poor, it will not be your fault. I can tell by your post, the level of your concern and love for your cat is genuine. We take are pets to the Dr. when they are in need and depend on their expertise. What else can we do?

With warm regards,

sonnyvincent I'm so sorry to hear about your cat. Firstly, cardiomyopothy in cats doesn't generally present with coughing...the coughing is related to the set of dog symptoms. We don't go in for so many tests in the UK. My cat and dog were diagnosed based on breathing difficulties (cat) / coughing ending with a retch (dog) and obvious heart murmur. Heart murmer has to be present to diagnose cardiomyopothy. Fluid on the lungs is present at initial diagnosis as the has to have been some form of respiratory distress to require a trip to the vet...unless it's really severe a heart murmer can't be detected without a stethoscope.

The battery of testing that can be done is simply to confirm diagnosis and assess how far the disease has progressed. To the best of my knowledge, the tests don't affect the treatment plan. Treatment is all about managing symptoms and giving quality of life. I think in the UK the feeling is that any tests that are invasive or require sedation should only be done if absolutely necessary. This is even more the case when things like breathing problems are involved as sedation (I think) will be a bigger risk than usual.

So...ask if a murmur is present before going ahead with expensive tests. Hope some of that helps you.

blackmagik I'm so sorry to hear that Dot has this dreadful disease. I wish you many more good days with her.

My understanding of cardiomyopothy is thar there is one type in cats and two types in dogs. None are curable, only manageable. If you're very lucky and catch it early (ie have all the tests done at first presentation of a murmur...especially if it wasn't there from birth) you can halt progression for a while. That's the real point of all the testing. (Worth pointing out that the majority of heart murmurs are *not* cardiomyopothy...cardiomyopothy = heart murmur but heart murmur doesn't = cardiomyopothy)

To both of you...I wish you luck and strength and many many happy days with your cats. My heart goes out to you both.

Hi Columbine

I'm interested about this as I've been told by our own vet and a vet that posts on another forum that meds are not given if the cat is not symptomatic (even if they have HCM) and if a murmur is detected then it's OK to monitor (as you say, breathing, etc) as opposed to going in for scans. But then I also read things that say it's better to get an early diagnosis and treatment started as soon as possible to help halt progression, but if the cat is not symptomatic, how can treatment begin?

Confusing.

It is confusing I agree. I think the problem is that, unlike people, cats have to be sedated to do the tests. I imagine that any decent vet wouldn't want to sedate unless absolutely necessary as sedation can cause it's own problems (my greyhound comes out with colitis every time he's put under )

I'd think that tests would be done if there was a family history of the disease but maybe not otherwise? It really is a case of textbook scenarios vs real life!

Good luck with your boy. I really hope you get some answers soon. Trust your instincts, and trust yourself.

The people who are telling you it might be a heart problem aren't vets, are they? Do they have experience with heart problems in cats and have they also had the opportunity to observe or examine your cat personally? If not, it's best to accept your vet's diagnosis (i.e., lack of it), rather than become upset due to internet "diagnoses".

Our last cat died of hypertrophic cardiomyopathy (HCM) just short of his 14th birthday. It was diagnosed in the course of a senior blood panel while he was still asymptomatic. He never had a heart murmur (many don't), even when the disease was in its advanced stages. He never coughed, although he did wheeze when he started to go into congestive heart failure (which happened a couple of times). The test that determined he had HCM was called the Cardiopet ProBNP, and you can read about it and HCM here Jamie also had echocardiograms and X-rays as the disease advanced, but its progress was mainly tracked using the ProBNP test.

Like jcat's Jamie, my mother's cat had was diagnosed with HCM. She did have a heart murmur prior to diagnosis. She went into congestive heart failure one night and was brought to an emergency vet where x-rays shows lots of fluid in her lungs. She later had an echocardiogram with confirmed the diagnosis.

Do you trust your vet? If you do, go with their diagnosis. If you are unsure, it may be worth it for your peace of mind to get a second opinion.

:anon: jcat I got my wires crossed. Cali's only diagnosis was CHF...and he'd had a heart murmur all his life. I've been reading up about dogs so much recently that I must've confused the two species! I have to admit that I've not come across HCM. Sorry for the misinformation :anon:

Columbine said:

:anon: jcat I got my wires crossed. Cali's only diagnosis was CHF...and he'd had a heart murmur all his life. I've been reading up about dogs so much recently that I must've confused the two species! I have to admit that I've not come across HCM. Sorry for the misinformation :anon:

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Columbine A lot of cats with HCM do have heart murmurs. It would be easier if they all did - the disease is so insidious that a lot of people are completely unaware that their cat has a heart problem till it's too late.

My cat was diagnosed firstly by a murmur upon his exam, then an xray of his chest and it was noticable that his heart was enlarged and not a normal shape.  We then had a specialist do an ultrasound (echocardiogram) of his heart.  He was diagnosed with Hypertrophic Cardiomyopathy about a year ago.  He has a history of Feline Asthma as well.