Hypertrophic Cardiomyopathy - General Questions

We are heartbroken. Recently our 10 year cat named Toby was diagnosed with Hypertrophic Cardiomyopathy after he failed to eat one morning and our mobile vet came to check on him where it was discovered he had fluid build-up around the lungs and also detection of a murmur which had not been picked up in previous routine checkups. Referral to cardiologist confirmed Hypertrophic Cardiomyopathy after echocardiogram. 

1. With regard to EXERCISE RESTRICTION we have a question. We presently have the litter box in the basement and we are wondering if we should bring it upstairs to avoid unnecessary trips up and down the stairs. But then we thought, this might be good exercise. So does anyone have any thoughts on this?

2. With regard to STRESS... I have read countless stories about excess stress and even some stories where cats have died on trips to or from the vets for regular checkups. Our Toby hates leaving the house and it clearly stresses him out. Getting him to take all his new pills for his newly diagnosed HCM also stresses him out. 

Any tips on getting his meds down? Can pills be ground up and mixed with food or fish paste or something? Or should pills not be ground up?

He is on 6.25mg Furosemide (Lasix),  1.25mg Benazepril,  and 75mg Clopidogrel (Plavix).

3. What is normal breaths per minute for a cat with this issue?  What breath rate would be cause for alarm and time to bring to emergency vet?

4. Our Toby has NOT been placed on Atenolol. I have read countless stories where this drug is part of the medication regimen. I will be asking the cardiologist but was wondering if anyone had an opinion as to what this drug is specifically for and why Toby might not have been prescribed it.  

5. With regard to BLOOD CLOTS and Plavix (some people use aspirin instead)... our cardiologist said it appears there was a blood clot formation in the left atrial chamber that showed up on the echocardiogram at several angles so she believed it to be real.  

This is probably a stupid question but does Plavix break up that existing clot in the left atrial chamber?

Notes: It was noted that Toby has "trivial to mild mitral valve regurgitation at this time." And the murmur was described as "faint".  However when we first knew something was wrong he obviously was having congestive heart failure with fluid around the lungs. The cardiologist later described the state of the disease as "moderate". 

Now for the really tough questions:

6. What is the most common way for a cat with HCM to pass on when the time comes:

   A. sudden death event

  B. congestive heart failure (fluid around lungs), panting, coughing, tongue out, elbows out, lack of oxygen 

  C. blood clot (such as a painful saddle thrombus with paralyzed limbs) 

  D. something else

We are terrified that B or C could happen and last quite a while and God forbid we're not around to rush him to the emergency vet. We're scared to even leave the house now.  We have a lot of paranoia and anxiety right now because of what we don't know. We do realize that B or C, even if we make it to the emergency vet in time would likely result in a humane euthanasia event. We are mentally preparing ourselves for that now.

7. Beside HCM, Toby is otherwise healthy. Given the facts that Toby is 10 years old, has recently had a mild congestive heart failure event (refusing to eat due to fluid build-up around lungs), has responded well to meds so far and is mostly back to normal, and cardiologist has described Toby as having "moderate" HCM, a faint murmur, and possible blood clot formation in the left heart atria...  what is your best guess on:

  A. Best case scenario life expectancy

  B. Worst case scenario life expectancy

  C. Average case scenario life expectancy

Any help would be greatly appreciated from anyone who has gone through this now or has in the past and has lost a loved one. If you have any additional tips please share if you can.

I believe atenolol is for blood pressure. Did they say he had high blood pressure? I'm assuming they checked it already (it's not part of a regular exam though so if you're not sure, you'd probably want to get it checked).

Regarding pilling, if you can get him to take pills in pill pockets, wraps, pastes, etc, that would help CONSIDERABLY. There's a myriad of things out there. We have a thread specifically regarding pilling cats out there, I'll try to find it. If none of those work, my suggestion is to buy a pill popper (a good one), gel caps, and then put his meds in the gel caps and pill them all in one shot. It is not the least stressful way to do it, but it is probably the fastest. There is also crushing up pills, but some pills are very bitter and would not be suitable to do that with. Hopefully some others here can speak to the pills you are dealing with.

I don't know a whole lot about HCM unfortunately, but there are quite a few folks that do, and hopefully they will see this soon. I'm so sorry your are going through this with your boy, it's obvious how much you love him. Sending lots of vibes your way

LoveOurCat said:

 
Any help would be greatly appreciated from anyone who has gone through this now or has in the past and has lost a loved one. If you have any additional tips please share if you can.

Click to expand...

Hi a lot of your questions can be addressed by your vet. Generally under 30 breaths per minute is good, make sure the Toby is at complete rest or asleep when you measure.  I can't tell you the most likly cause of death but i would suspect it is CHF, and that is how my cat died of it.  For emergencies, i would ask my vet to give me injectable Lasix so that if his breath rate goes badly, you can inject him before you get to an emergency vet or regular vet.  It's super easy to give sub Q right into the skin, your vet can show you how.

Lasix can lead to kidney failure in cats, but its about the only thing to keep the CHF at bay so there really isn't any choice in treatment, but you should be watching him closely and getting regular blood work done.  If he goes into kidney failure, the normal treatment (sub Q fluids) isn't an option for CHF cats as it would go to the lungs, so you would have to do a mainline IV catheter drip in the hospital to get him out of it.  The Kidney/CHF issue can become a loop.

I wish you and Toby all the best.

Stephen

Hi LoveOurCat and welcome to the forum !

Forums like this are a good starting point for many people.....but, when it comes to dealing with serious health conditions, the very best sources of information and support are sure to be the specialized online communities that deal with each type of disease/chronic condition.

For the last 16 years there has been an active online community of people with HCM kitties.....that's where I'd be posing my questions.

Now, most of these groups were started in earlier internet days before forums like this came along, and they used email as their 'operating platform'. The majority, including the HCM group, continue like this today. I'd suggest that you get yourself a new separate email addy to use exclusively for the group as that will help better manage the info flow.

The group can be found right here: Support Group for Feline Hearts

And, hopefully you'll not be a stranger here......where we'd love to see some pics of Mr. Toby !

Thank you everyone for your responses and helpful info.

It has been a very stressful day.  Toby took a marked turn for the worse today.

Thankfully we have been watching him essentially non-stop and he had an episode where he started to pant very heavily and couldn't find a comfortable position.  He would shift and hold his paws out every few seconds.  His breaths per minute were quite high and just when I went up to wake my spouse that I thought we had to rush Toby to the emergency vet we came downstairs and found him doing mouth open breathing and immediately knew we had to go.

We rushed him over to the e-vet. They placed him in an oxygen chamber and gave him IV Lasix and took x-rays. X-rays showed very little fluid if any at all. Toby didn't eat well today either and he threw up bile a few times.  However, after an hour at the e-vet we came home and Toby was literally 90% of his normal self.  He even ate a bit of his food, quite a bit actually.

Then, one hour later, he was right back to mouth-open breathing and even partially collapsed. He went from near normal to full mouth-open breathing in like 5 minutes. We immediately rushed him back to the e-vet. He is again in an oxygen chamber and appears to be stabilized again.

We are now worried that we are out of options.  If there is no fluid and even if there was, he was just given a dose of Lasix to clear it a couple hours ago so there shouldn't be any at all. We actually thought that the first e-visit did the trick specifically because of the Lasix. Now we are really worried because why can't he breath?  The e-vet doc doesn't have much to give us yet and will be doing an EKG once he is stabilized for a while.  

Is there hope for Toby? Or is this probably the end?

LoveOurCat said:

 
Thank you everyone for your responses and helpful info.

Is there hope for Toby? Or is this probably the end?

Click to expand...

I'm so sorry and we are all hoping the best for you and Toby.

Thanks StephenQ.

We took your advice and was in the process of trying to ensure the balance between treating the heart condition and keeping his kidneys going strong. It was on our long list of questions for the vets that we never even really got to due to the emergency issue.

I just hope he didn't suffer too much. We hated leaving him there. At least we got to spend some quality time with him before he took a turn for the worse last evening. That also makes it harder to understand since he was fine one minute and then in complete respiratory distress again just a short time later.

An enormous weight of worry and stress has been lifted from us but that has been replaced with sadness.  Time will help heal and we will always love and miss our little guy.

LoveOurCat said:

 
Thanks StephenQ.

We took your advice and was in the process of trying to ensure the balance between treating the heart condition and keeping his kidneys going strong. It was on our long list of questions for the vets that we never even really got to due to the emergency issue.

I just hope he didn't suffer too much. We hated leaving him there. At least we got to spend some quality time with him before he took a turn for the worse last evening. That also makes it harder to understand since he was fine one minute and then in complete respiratory distress again just a short time later.

An enormous weight of worry and stress has been lifted from us but that has been replaced with sadness.  Time will help heal and we will always love and miss our little guy.

Click to expand...

I'm so sorry for your loss.  Mercifully it didn't go on too long, and you can take comfort from that and eventually celebrate all your great memories of him.

Stephen