heart disease

Hello. I have a beautiful ragdoll kitten. He was diagnosed with a heart murmur at age 3 months. We chose to keep him. He was neutered yesterday and nearly died. The vet said he suspects cardiomyopathy. The breeder suggests that it might have been more about the anesthesia than the heart and suggests I do NOT waste my money seeing a cardiologist. Vet suggests cardiologist (lots of money, I'm sure).

Any advice?
Thank you so much.
Ellen

Hello,

I've moved your thread to our health forum where someone can answer your question for you.

I would strongly suggest taking your vet's advice and arranging a follow up with the cardiologist. Among other things, cats with cardiac problems can have serious issues with anesthesia.

George

How well do you trust your breeder? She probably made those comments because she doesn't want to investigate her cats for a potential link to cardiomyopathy....which would of course require her to cease breeding the suspect queen or sire or re-evaluate her line entirely.

You have two options: One is to get a second opinion from an equally qualified vet and opt for an ECG and heart workup to determine whether or not cardiomyopathy is a concern. The second option (which I strongly recommend) is a consult with a feline cardiologist who will start with an ECG and probably an ultrasound to confirm or grade the cardiomyopathy if it is present.

Your vet didn't recommend a cardiologist for monetary purposes, he wanted to refer you because he knows cardiomyopathy, when diagnosed early, can benefit from early treatment. He may also be inexperienced in diagnosing this particular condition, thereby referring you to a cardiologist who specializes in the condition and treatment.

As for the anesthesia, if the heart murmur was detected BEFORE anesthesia, your vet probably should have waited to perform the neuter. Some kittens with mild heart murmurs can actually eradicate the murmur as they grow and develop into maturity (about 1 year of age), while others may have a congenital condition that may exacerbate the murmur or develop a type of cardiomyopathy.

However, a vet who knows a heart murmur is present before anesthesia, usually will perform a quick ECG along with pre-surgical blood screening to determine anesthesia candidacy (or again, will wait for the kitten to mature to see if the murmur disappears). If this wasn't done, or you declined it, he probably felt the murmur was mild, in that, anesthesia would probably not present a fatal risk (dependant on the anesthesia type used). In any case, if he suspects a cardiomyopathy development, anesthesia might not have had anything to do with the event during the neuter. It depends on whether he knew about the murmur before or after the event, what kitten's vitals were prior to anesthesia, the results of the pre-surg bloodwork, and the vitals recorded during the actual event (you said "nearly died", but was this cardiac arrest or poor oxygen delivery during induction of gas anesthesia, or was it a result of arrest due to a combination pre-anesthetic injection?). All these things need to be taken into account when trying to place blame somewhere.

As for the breeder, she is required upon request, to check her records for any past history of her kittens developing congenital cardiomyopathy (your feline cardiologist can talk to you about this further, he may even talk to the breeder himself)...........................Traci

Thank you so much for your reply!!
Yes, the vet knew about the heart murmur. As a matter of fact, I asked them to double check the murmur. They asked if we wanted pre-surgical blood work. We asked why. They said just standard procedure - check for kidney issues. They said NOTHING about it being due to the murmur or we certainly would have said yes. We chose no on that one because it didn't seem necessary at that moment. they did not ask about an EKG. Is the vet liable under the circumstances? I ask about liability not because I have any interest in suing anyone - rather, just to save the HUGE fee they charged me to save the cat!!!

Also, as for the breeder, she will not help me with the cardiac fees. When I called her and told her about the murmur (a few days after purchasing Socki) she said she wanted him back and she'd give me some of my money back, but not all. I said no - and she said she'd give me 100 dollars if I gave her back the contract. I stupidly said okay.

Does the breeder have any responsibility to mitigate damages by helping pay costs?

I am going to take your advice and go the cardiologist. I have an appointment on Friday. I assume the cost of the meds (and I pray that I can buy meds vs. being told the cat has no chance) will be expense. SIGH!

CHEERS and THANKS for your first and any subsequent answers!
CHEERS!
Ellen

Ellen, I should ammend that the pre-surgical blood screen doesn't detect heart disfunction...what it does is detect abnormalities with the liver and kidneys in order to determine candidacy for anesthesia. It also checks platelets as a method of determining clotting factors, and total protein. Every vet has a different pre-surg screen which should ALWAYS include BUN, ALT, Total Protein and PCV (packed cell volume), although some vets include one or more enzymes (organ function) in the pre-surg screen.

The ECG is commonly declined by clients for young pets simply because heart disease is uncommon in YOUNG pets (except for congenital...some forms of heart disease are aquired, not congenital). A full examination is done prior to any anesthetic procedure anyway, and if a heart murmur, gallop or unusual rythm is detected at that point, then the vet and client decide how to proceed from there concerning anesthesia. If the murmur were only mild, again, most pets do fairly well with anesthesia, but others, if the murmur is strong or other developments are detected, then surgery should not be performed until further diagnostics are done to ensure optimal health and heart function.

Don't jump the gun on heart medications just yet, you have yet to determine IF a cardiomyopathy is a concern. Some mild forms of heart disease may not require medications until later on, your cardiologist will be thorough and will take the time to explain to you what to expect.

See your PM for more information, and at this point, don't give the breeder your copy of the contract just yet,....hold on to it until after you've had a chance to talk with a cardiologist......................Traci

Traci - you're so wonderful. Unfortunately, I gave the breeder her contract - signed null and void - 6 months ago. She pressured me into that and sent me 100 dollars for the contract. She told me that she would take the kitten back, but only give me part of the money back. But we wanted the kitten. So I stupidly took the 100 dollars. I guess she's off the hook, huh? But I'd like to "threaten" her with contacting whoever you contact to let them know about the cat. Why? Mostly to save other kittens. But selfishly, maybe she would give me money towards the cardiologist bill (not more than she made on this cat, which was 400 dollars after returning 100). But the most important thing is the cat, Socki.

WHen I pick up the cat from the vet, should I ask them about the anesthesia? Should I ask for part of the bill to be waived or is that unreasonable? Again, the money is NOT the big deal for me at this point (though money is always a good thing to have rather than spend

I WISH we had had that bloodwork, but I had no idea it might have detected an issue that could have prevented this!!!
Cheers,
Ellen

Unfortunately, without a copy of the contract, you don't know if there were any stipulations (or fine print). As per PM, talk with your cardiologist who can possibly help you further....if congenital cardiomyopathy is determined by the cardiologist, then the breeder should, by all means, act responsibly and review past and current records on her kittens, as well as work toward eradicating this 'defect' from her breeding. (I'm not a breeder, so I would be hard pressed to say how that's going to go...also, remember there is a difference between congenital and aquired, your cardiologist is the only one who can make that determination. If it turns out to be aquired, the breeder would probably not be accountable, although cardiomyopathies are rare in young cats)

Yes, ask about the anesthesia used (injectable vs ISO, or what combination injectable was used - typically, males are neutered with a combo injectable anesthetic, while females are spayed with either a combo/ISO or ISO alone, but every vet chooses what he/she is most comfortable with per procedure). Also ask about details about your kitten's "crash", the length of time CPR was administered, and ask for details, don't settle for a brief comment. I would also request a photo-copied record of that day's events recorded in kitten's health chart.

Depending on what you are told when you pick your kitten up from the clinic, will depend on how you wish to proceed. If you are not satisfied with the answers to your questions, or if you have a gut-instinct something is not being revealed to you, and they refuse to give you a copy of her record, then I would suggest getting a second opinion from another vet, and having that vet review those records. But, at this point, since your primary vet is suspecting a cardiomyopathy concern, your first concern should be to get an appointment set up with the cardiologist and worry about your primary vet later. (do try to get a copy of kitten's records first, regardless of the conversation you have with your vet)

Keep in mind I'm not trying to persuade you to take action (legal) with your primary vet at this point, because he has yet to converse with you about the incident in detail...you and he should be the only ones privy to that conversation should a legal issue arise later on. This also applies to any monetary damages you try to recover. Depending on that conversation with you will depend on your approach to ask about reducing the fees. If your vet truly feels it was an isolated incident, he will have no true obligation to reduce the fees for an emergency resuscitation, but this is where a copy of kitten's medical chart will be in your favor (so you can review for yourself the comments and notes recorded during and after the incident)...........................Traci

HI Traci,
We just brought Socki home.He did not have cardiac arrest. He became "cyanotic and developed pulmonary edema." The anesthesia was reveresed and 4mg/kg lasix was given and oxygen therapy was given for 24 hours. He covered quickly. He had domitor/detamine combination for anethesia."

How does that sound? Our appointment for the cardiologist is Friday. My husband doesn't want to do it. TOUGH. He says the cat isn't worth the money. YOu know what else he said? He said he'd only spend about 20,000 to save the life of one of our KIDS (human kids) because more than that would affect the lives of the other kids. MEN!!!!!!!!
Cheers,
Ellen

Well that would be somewhat of a better outcome from anesthesia than cardiac arrest, althought it still isn't a favorable thing to expect during a procedure. Dormitor and Antisedan are used consecutively...dormitor is the induction agent, antisedan is to reverse the anesthesia. I hate ketamine, while it is a good anesthetic for short procedures, recovery time can be slow and prolonged.

I would still continue with the plan for cardiology workup. In light of your new post, it could have been a reaction to anesthesia, however, cardiomyopathy still is looming over you, and you want to get that diagnosed effectively...or ruled out effectively.

As for your husband, sure hope you guys have insurance!!................Traci

Traci - Yes, we have insurance! I don't think my husband is going to enjoy my company for a few days!

Interesting that you said it may have been a reaction to medication - that was exactly what the breeder said. The vet INSISTS that's totally impossible. Well, I will go to the cardiologist and invest the money to be sure! Tonight Socki is home and happy (albeit quieter than usual) and sleeping with my son.

I'll keep you posted!!!
Cheers!
Ellen

Well my initial response was not in favor of your breeder's comments, mainly because of the cardiomyopathy concern. It's important to note that an anesthetic reaction can occur to any anesthetic, and any pet could be susceptible at any time. We don't know why this occurs to some pets, we don't know why cardiac arrest occurs sometimes in a perfectly healthy patient. The same can and does occur in humans as well. Anesthesia has it's risks indeed, but without anesthesia, we don't want to think of the alternative.

I'm not fond of some breeders (this is not a stab to the legitimate, hard-working ones, and those truly dedicated to their breed), because many of them fail to act responsibly, many of them are not into it for bettering the breed, and many of them will jump at any opportunity to dispell a veterinarian's comment or diagnosis because they don't want to believe a cat in their line may be producing defective offspring. If she is truly responsible, she would want to work with you and the vet, would want to get an update from you at every opportunity, and would want to know if there is a problem with her genetics.

Ultimately, the only one who knows what occured was your vet and the tech(s) assisting during the neuter. Again, we work very hard to prevent these things from occuring, but it is not an exact science....and believe me, when a reaction or arrest occurs, the vets and techs are every bit as concerned as you. You may never know for certain if this was an anesthetic reaction, but if it was, at least Socki was fortunate, recovered and did not suffer any permanent damage. One concern you want to keep in the back of your mind, is why your vet didn't wait a bit to perform the neuter when he knew it was present. Again, he may have felt it was not a risk, I can't claim to know what he was thinking, or his personal assessment of Socki's health prior to the anesthesia. But, if you have bad feelings about this, don't hesitate to search for a new vet altogether, and in the future, you can always opt for a pre-surgical blood screen prior to any anesthetic procedure, no matter if it is elective vs non-elective surgery (my cats never undergo any surgical procedure without a pre-surg blood screen). The ECG probably would not be necessary as a precursor to anesthesia for young healthy pets, but any pet with a compromised lung/heart/respiratory tract problem would benefit from an ECG prior to anesthesia..........................Traci

Traci,
I have learned so much from you. The tech during Socki's surgery was a student. I'm sure he learned a lot, too! The vet who performed the surgery was very shaken up. She talked a lot about how that gave her hives and how she had only experienced a problem once before. I don't question her ability - what I question is why the practice (it's a big practice) didn't use the most experienced vet and an experienced tech considering Socki's condition. But I'm letting go of blame towards the vet - it won't help Socki. I honestly feel as though, despite possible poor judgement, they really cared and did their best. The breeder is a different story, as she may affect other kittens in the future.
Cheers,
Ellen

Hi Traci,
Socki has microvalve prolapsed - no cardiomyopathy. The cardiologist feels as though the murmur should have been enough to have the vet at least offer an alternative to the anesthesia they used. Apparently there's a way to use just gas, but it's more expensive so most vets don't offer it unless there's a cat with a murmur.

The cardiologist said Socki's heart rate is nice and low right now, so he doesn't need medication. Isn't this great news? What do you know about microvalve prolapsed in a cat?

Cheers!
Ellen

hello my cat also has a heart murmur she is about 14 years old and she was diagnosed with this about 3 years ago. we take her to get an ultrasound every 3 months about and the vet put her on 2 meds. she is perfectly healthy besides this and has no reactions to the meds. i dont know the names of them but i can find them out for you if you would like.

That would be great. I don't know if I'd go every 3 months for an ultrasound. doesn't that cost you 175 a pop? Is it necessary?
CHEERS!
Ellen

Ellen, are you sure your cardiologist didn't say mitral valve, rather than micro valve (I've never heard of the condition termed like that)

If mitral valve, it depends on several factors, mainly blood flow (or obstructed flow, or a leak in the valve) and heart size. Since Socki is only 6 months of age (right?), this still may eradicate on it's own, but I would follow up as your cardiologist advises, to at least re-grade the murmur and/or check the heart size. I'm assuming he graded this as 1 (grades are between 1 and 6, with 1 usually meaning least severe and usually considered an 'innocent' or 'functional' murmur that doesn't necessarily mean it is related to cardiac disease)

In the meantime, monitor Socki for any of the following symtoms, in which you would want to re-evaluate Socki immediately: poor exercise intolerance, coughing, vomiting, open-mouthed breathing or labored breathing, increased heart rate, weakness and lethargy (especially after exercise or play). Not to scare you, as your cardiologist probably has already instructed you on what to watch for and advised a followup in the next few months.................Traci

i will get the names of the meds for you and let you know tomorrow! its not every 3 months it is 6 months sorry about that! but it is worth it to keep sam healthy..now she has hyperthyroidism which we are trying to take care of, but good luck and i will let you know about those names!

Yes, mitral valve. You're more up on it, thus you spell better, Traci!!! THe cardiologist seemed to think everything else looked normal. And yes, Socki is 6 months old. It is a level one murmur, so he'll probably be okay, huh? Traci, thanks for everything!!!!! You've been my lifeline.

akh! Thanks for getting me the names!!
CHEERS!
Ellen

Heh, my spelling tends to go wayside on occasion!

As long as there are no abnormal size to the heart, any leaking causing blood flow obstruction, then it may not develop into anything more serious. But, your vet/cardiologist want to re-evaluate Socki more frequently (especially during his growth and development period) just to ensure that this is an innocent murmur only and not something that is going to progress. It is nearly impossible to predict how a murmur might progress into something more serious, for this reason, it's best to get frequent evaluations and of course, to notify your vet at once should any of the symptoms I mentioned above should ever occur. Stay in good contact with your vet, he needs to know from you how Socki is doing and/or if he ever develops any signs that might indicate another checkup in the near future.................Traci