HCM diagnosis in my 4.5 year old cat.

lilin

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Hi guys. Update from this thread about finding a heart murmur in Pia at a routine exam: http://www.thecatsite.com/t/321299/heart-murmur-im-worried-advice

So I got her the heart scan, and it's hypertrophic cardiomyopathy (HCM). I'm freaked out. From the research I'm doing, treatment options seem so limited, and the progression of the disease so unpredictable.

She's started Atenolol, which seems to be pretty much all there is until they get to congestive heart failure, at some relatively unpredictable point in the future. They said the thickening of the heart is fairly early stage. Her heart rate was fast and there's the murmur obviously, but otherwise it's still functioning relatively well.

I don't know what to expect. The vet was encouraging that she could live to 12 or 13, but all the reading I've done makes the disease sound so random. He said to possibly do blood panels every 3 to 6 months, but didn't recommend doing regular scans.

Does anyone have any help or experience with diagnosis in a younger cat?
 
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catpack

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I'm sorry to hear about the diagnosis! However, your vet is correct that Pia likely will live a happy long life.

We currently have 4 cats in the rescue with HCM. Two are at such early stages that medication was not currently recommended. The other two are on meds. One is on Atenolol, the other is on Diltiazem.

The one on Diltiazem was diagnosed two years ago (at 3) and everything is stable with his heart/unchanged since diagnosis.

The one on Atenolol is recently diagnosed. She will have a follow-up scan at the 3 month mark.

We typically do echoes every 6 months for the first 1 1/2 years, then, if all is stable, may switch to once a year.

What blood test is your vet recommending? A ProBNP? If so, are they doing the SNAP test (done in house using something that looks like a cat combo test or dog Heartworm test), or are they sending out blood work to a lab for testing?

Honestly, I have been told (by both regular vet and 2 vet cardiologists) that the echo is preferred as you can get measurements and compare to previous scans.

The ProBNP detects a protein released by the heart muscle when it breaks down, which can be a good test to do during routine blood work, before a murmur is ever detected. But, I am told that the ProBNP doesn't give the full picture.
 
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lilin

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I'm sorry to hear about the diagnosis! However, your vet is correct that Pia likely will live a happy long life.

We currently have 4 cats in the rescue with HCM. Two are at such early stages that medication was not currently recommended. The other two are on meds. One is on Atenolol, the other is on Diltiazem.

The one on Diltiazem was diagnosed two years ago (at 3) and everything is stable with his heart/unchanged since diagnosis.

The one on Atenolol is recently diagnosed. She will have a follow-up scan at the 3 month mark.

We typically do echoes every 6 months for the first 1 1/2 years, then, if all is stable, may switch to once a year.

What blood test is your vet recommending? A ProBNP? If so, are they doing the SNAP test (done in house using something that looks like a cat combo test or dog Heartworm test), or are they sending out blood work to a lab for testing?

Honestly, I have been told (by both regular vet and 2 vet cardiologists) that the echo is preferred as you can get measurements and compare to previous scans.

The ProBNP detects a protein released by the heart muscle when it breaks down, which can be a good test to do during routine blood work, before a murmur is ever detected. But, I am told that the ProBNP doesn't give the full picture.
Thank you! I guess it's just scary, reading that there are some cats who just drop dead at 5, and then others who die at 17 of something totally unrelated to their heart. It makes me feel like I don't know what tomorrow will be like, if that makes sense? However, she doesn't have the obstructive type of HCM. So hopefully that makes her day-to-day status a little more stable?

The blood test will be the ProBNP SNAP test. They do home visit, which I'm going to take advantage of. I want to keep her stress as low as possible now that I know her ticker is compromised.

I didn't get a blood test so far. I went straight to the heart scan, as the heart murmur was pretty loud and I wanted to just know exactly what it was. So, I will have the blood test in 3 months so that I have a baseline for where she is once she's firmly on medication, and then I can kind of compare from there on.

Thanks for the recommendation about the scan. Perhaps I'll do the blood test every three months for the next year, and the scan every 6, so I can see how reflective they are of each other? I'll see if I can find more info on it.

Pia seems pretty lethargic after her first dose of Atenolol. Not sure if it's the drug or the trauma of the scan -- she is very scaredy! But I don't think she's allergic. She's just a very small cat, so maybe this dose is a little heavy? I'll watch her for the next couple days.
 
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catpack

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It certainly is scary. And, I'm still learning about HCM myself.

I will mention that we have lost 2 cats suddenly as a result of heart problems. HOWEVER, neither of these cats had a prior diagnosis (because...no murmur was ever heard) and, therefore, we're not on any medication, etc...

One cat passed away within about an hr post neuter surgery. Necropsy confirmed occult heart disease (his likely caused by a systemic case of Calicivirus.)

The second cat passed away at home. Was seemingly fine and then suddenly gone. No necropsy was done; but, I'm fairly certain of diagnosis. She was just 3. One of this cat's litter mates does have a diagnosis of HCM and recently turned 4, is on medication (I believe he is taking Diltiazem) and is doing excellent.

So, I think getting a proper diagnosis and being on medication helps prolong life.

As a precaution, our rescue has begun running a ProBNP with full CBC/Chem prior to a cat being altered. (This test is literally $1 dollar more than just the CBC/Chem we run, so we figure why not?)

I've also decided to have this test done on my personal cats just to know if there is a potential issue that needs to be checked out.
 

ginny

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It certainly is scary. And, I'm still learning about HCM myself.

I will mention that we have lost 2 cats suddenly as a result of heart problems. HOWEVER, neither of these cats had a prior diagnosis (because...no murmur was ever heard) and, therefore, we're not on any medication, etc...

One cat passed away within about an hr post neuter surgery. Necropsy confirmed occult heart disease (his likely caused by a systemic case of Calicivirus.)

The second cat passed away at home. Was seemingly fine and then suddenly gone. No necropsy was done; but, I'm fairly certain of diagnosis. She was just 3. One of this cat's litter mates does have a diagnosis of HCM and recently turned 4, is on medication (I believe he is taking Diltiazem) and is doing excellent.

So, I think getting a proper diagnosis and being on medication helps prolong life.

As a precaution, our rescue has begun running a ProBNP with full CBC/Chem prior to a cat being altered. (This test is literally $1 dollar more than just the CBC/Chem we run, so we figure why not?)

I've also decided to have this test done on my personal cats just to know if there is a potential issue that needs to be checked out.
That's really good to know about the cost of the BNP!  
 

catpack

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Yes, I believe the test is about $130(?) give or take about $5.

The test includes a full CBC/Chem, ProBNP, Heartworm antigen test, as well as the new SDMA test which shows a loss of kidney function at 30% (if you don't know, this is HUGE! as I believe most tests pickup on a loss of 50-65%).

Well worth the $$ in my opinion, especially when you're about to put an animal under sedation.
 
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lilin

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It certainly is scary. And, I'm still learning about HCM myself.

I will mention that we have lost 2 cats suddenly as a result of heart problems. HOWEVER, neither of these cats had a prior diagnosis (because...no murmur was ever heard) and, therefore, we're not on any medication, etc...

One cat passed away within about an hr post neuter surgery. Necropsy confirmed occult heart disease (his likely caused by a systemic case of Calicivirus.)

The second cat passed away at home. Was seemingly fine and then suddenly gone. No necropsy was done; but, I'm fairly certain of diagnosis. She was just 3. One of this cat's litter mates does have a diagnosis of HCM and recently turned 4, is on medication (I believe he is taking Diltiazem) and is doing excellent.

So, I think getting a proper diagnosis and being on medication helps prolong life.

As a precaution, our rescue has begun running a ProBNP with full CBC/Chem prior to a cat being altered. (This test is literally $1 dollar more than just the CBC/Chem we run, so we figure why not?)

I've also decided to have this test done on my personal cats just to know if there is a potential issue that needs to be checked out.
You know, I'm sort of glad she had a murmur! It seems like the majority of the "they just died out of nowhere one day" stories I've read are either HCM with obstruction, or cats who had no murmur and therefore no obvious symptoms upon routine exam until they were already in heart failure. That murmur might have saved Pia's life!

I was just so unprepared to get that news at a routine exam for such a young cat. Looking around and seeing how common HCM is, I wonder why I didn't know anything about it when I've had cats my entire life. I'm gonna drive myself crazy researching this.

P.S. I've read thyroid disorders can mimic HCM. Is it worth testing her thyroid on the off chance despite lack of symptoms? Ugh, I just want my kitty to be well...
 
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lilin

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So Pia has been taken off her meds.

She seemed really sedated and kind of fearful of everything. I called the vet and they said it might be tanking her BP and to take her off them for a few days, then bring her into the vet so they can administer them and track her BP.

*sigh* I need this to work. There's not that many meds for HCM...

I hate this. I'm sad. Ugh.
 
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catpack

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What dose of Atenolol was she on? How much does she weigh?

Diltiazem may be an option for her. It is given twice a day (every 12 hrs) as opposed to Atenolol, which is once per day.
 
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lilin

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What dose of Atenolol was she on? How much does she weigh?

Diltiazem may be an option for her. It is given twice a day (every 12 hrs) as opposed to Atenolol, which is once per day.
She was actually on Atenolol twice a day, 6.25mg per dose (25mg tablets cut in quarters). She weighs about 8.5 pounds (not thin, just a little kitty).

I noticed the change in her within an hour of the very first dose yesterday morning. I actually gave her less than the full quarter tablet last night, thinking maybe I'd ramp her on. She seemed a bit more normal this morning. She at least got out of her basket and came to the kitchen for food. But as soon as I gave her the full quarter tablet this morning, she was back to seeming really miserable.

I wish they could talk!

P.S. Her breathing still seems fast to me, despite that she basically won't move from her basket. She has always had slightly fast breathing -- I always wondered about that, actually, but of course it's hard for vets to tell with a shy cat whether it's just them being anxious about being at the vet.

But for something that slows the heart rate, it seems like it shouldn't be fast.
 
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catpack

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Hmm...all of our cadiologists have said Atenolol is only given once per day (at the 6.25 mg dose). Would be curious to hear where you vet gets their dosing from (not saying your vet is wrong, honestly just curious as this is diff info than what I have been given.)
 

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It seems like the Atenolol is what's making her miserable.  Hopefully she'll become used to it after a time.  Poor kitty!
 
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lilin

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Hmm...all of our cadiologists have said Atenolol is only given once per day (at the 6.25 mg dose). Would be curious to hear where you vet gets their dosing from (not saying your vet is wrong, honestly just curious as this is diff info than what I have been given.)
My location is incorrect -- I've since immigrated to the UK, so the protocol might be different here. Or perhaps it's higher dose due to where her progression is at?

Either way, it seems like even a single dose knocks her down for most of the day. She seems pretty uncomfortable even now and her last dose was now almost 12 hours ago.
 

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Ok, location could very well be the reason for the difference in dosing.

You are correct that Pia just seems very sensitive to the med. Hopefully you can either find a dosing that works for her, or a different medication that does.

Will be waiting to hear what you find out at the vet!
 
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lilin

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It seems like the Atenolol is what's making her miserable.  Hopefully she'll become used to it after a time.  Poor kitty!
Ok, location could very well be the reason for the difference in dosing.

You are correct that Pia just seems very sensitive to the med. Hopefully you can either find a dosing that works for her, or a different medication that does.

Will be waiting to hear what you find out at the vet!
Thanks, guys. This sucks so hard... Night in with kitty cuddles I think.
 
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lilin

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Hi guys. So I have an update and some questions.

Took a while to get Pia in for the monitored medication -- their detailed BP machine broke down. But they fixed it, we got her in, and this is what happened...

Her BP before the dose of Atenolol was actually perfect. Just a tiny hair below the average -- which is just what we wanna see in a cat whose heart needs to be takin' it easy.

After taking Atenolol, her BP was "borderline." Not alarming, but lower than they'd strictly like.

What they told me was basically this.

If the change in BP is distressing her, there isn't a ton of point to the medication, because right now, her unmedicated BP is good. And since the only point of the Atenolol is to lower the work load on her heart, it isn't particularly necessary if her heart isn't actually working too hard right now.

I asked about Diltiazem, and they said they wouldn't use it in a cat who is this early-stage. Usually Diltiazem is the medication they start after it's developed beyond what Atenolol can handle.

So, basically, they're telling me that whether to give her the Atenolol is just down to what makes me feel better, and what Pia is comfortable with. It might not be doing her any good at this stage.

I know it's good that her heart function is still strong enough that the need for medication is basically negligible, but it also makes me feel like I'm not doing anything -- just waiting for her to decline. I hate feeling like I'm not doing anything.

Does this sort of match up with what you guys have been told about early-stage HCM kitties in terms of meds? I just hate the idea of there being nothing I can do to slow it down right now.
 
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catpack

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Yes, we have a cat in the rescue with very early stage HCM and it was decided medication was not needed at this point. So, she goes in for yearly echoes and we basically watch and wait. She was diagnosed 2 years ago this fall and is still doing well.
 

caligirl1939

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Hello everyone!
I am new to the cat site.
I have a beautiful kitty named Tarzan who was diagnosed with HCM at 6 months in December . His heart murmur is large. It is very unusual for a kitten of his age to be this advanced. Obviously it has been very stressful. He just had a check up today and the great news is that his x-rays and heart have not changed a bit! I just thought I would tell everyone what medication he is on. He takes one half atenolol 2x a day and 1/4 plaxil once a day.
I live in San Francisco and we have very good and specialists here. I love his cardiologist.
They seem to believe the plaxil is very important with HCM to help prevent blood clots. He eased into his atenolol dosage over the course of a month.
For the person who talked about their cat being groggy. Tarzan was a bit loopy the first week on atonolol. Now that he is used to it he is fine.
Good luck to everyone!
 
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