Extremely elevated BNP - heart disease?

[RussellsMom]

We just got our 13-year old Russell's blood test results. The good news is kidney, liver, glucose, thyroid, etc., are all fantastic - like a healthy young cat.

The alarming news is his BNP - Cardiopet proBNP (Feline) - was extremely elevated. It's literally off the charts (there's a red arrow leading off the right side of the range chart): normal range is 0-100 pmol/L; Russell's is 1236.

He has no outward symptoms of heart disease or any other disease other than the occasional flare-up of an allergy to mosquito bites in the summer, which seems to bother us more than it bothers him. He's a healthy-seeming, happy, well-adjusted, sociable, bright-eyed, playful boy with very regular eating, drinking, and litter box habits.

I'm trying to stay calm - not my strong suit. Obviously he should see a cardiologist for an EKG or ultrasound. But please see my previous thread about his unbelievable stress level at the vet on Monday when he went to get the blood test. He had a full-blown panic attack there and has not been fully himself since. The last thing we want to do, at least at the moment, is add to his stress level.

Here's my hope, of course: that the test isn't always accurate and it was falsely elevated or that it was so elevated because of his extreme stress. (I ran that last one by the vet and she said it might raise the numbers a little but probably not that much. But who knows?)

Please, please - anyone with any experience of heart disease and/or such severely elevated BNP numbers, I'd love to hear any experiences and advice. Thanks

 

[FeebysOwner]

It can be hard to tell that a cat even has a heart condition until it progresses or is caught during a vet visit. The BNP is pretty sensitive in terms of accuracy with diagnosing a probable heart condition, so while some elevation could be attributed to stress, I can't imagine it would be as high as Russell's from just stress alone. Going to a cardiologist to have other heart related tests run is your best bet, especially given his age. All of his test results can and should be shared with the cardiologist.

As far as the stress, I will say the same thing I said in your previous thread. - There are many cats who are given gabapentin before a vet visit to help calm them and take the edge off the stress. This also can happen with cats who are not routinely taken to the vets for checkups, as they just don't have the opportunity to get used to the process. When you find a cardiologist to make an appt. tell them about his stress level and if they think gabapentin could be an option to help out or if it would impact the results of any tests. If gabapentin is not an option, ask what else would be.

Meanwhile, while you wait to hear from others, I did a search on BNP and found a couple of threads that you might be interested in. As you will see when reading them, the information can vary a lot so it is hard to compare two situations.
Cat Paralyzed-ish Back End? Vet appt scheduled. | TheCatSite
desperate for advice my beloved 8 yr old cat | Page 3 | TheCatSite

 

[RussellsMom]

Thanks so much, FeebysOwner - my threads are getting crossed now! I wrote in my other thread that Russi had a bad reaction to gabapentin in the past, but I just went through all his records and saw that the vet had administered a Torb injection at the same time - it was so long ago, I don't remember why, but from looking at the invoice it looks like it was just to sedate him for a blood draw. It could well have been the Torb that he reacted to.

 

[RussellsMom]

I read through the links above (and others). Obviously the best thing is to get a cardiologist appointment as soon as possible.

My fear is this. He was absolutely 100% fine, happy and healthy before we took him for the blood test on Monday. The stress and/or manhandling at the vet caused enough pain in his limbs for him to start immediately limping and avoiding jumping. Maybe the manhandling exacerbated existing mild arthritic pain or maybe the severe stress caused some sort of cardiac event, where any heart problem had been hidden before?

In any event, I'm terrified that the stress of another vet visit will make things worse for him.

At the moment he seems perfectly fine. His walking looks fine today - a vet wouldn't see any limping or anything. I'm even uncertain about what I'm seeing. I'd say the only difference from before the blood test fiasco at this moment is his reluctance to jump up. Eating, playing, interacting, posture, demeanor all seem as usual.

 

[FeebysOwner]

In any event, I'm terrified that the stress of another vet visit will make things worse for him.

I totally get that. Maybe a cardiologist will have some ideas how to help with that - they are dealing with patients with all kinds of heart conditions in cats young and old. Whatever is going on needs to be checked out so if it needs to be treated it is done sooner rather than later.

Maybe a vet could consult directly with a cardiologist to see if re-running the BNP a few weeks down the road could reap different results? I doubt that, but it couldn't hurt to ask. Maybe if you share Russell's records with your previous vet, they would be willing to help with this for now? If even remotely possible that re-running this test, blood could be drawn at home with a mobile vet or a vet tech? Ultimately, he is going to have to go somewhere for more testing - if for no other reason than to rule out a heart issue.

I don't envy you being caught between a rock and a hard place, but it seems like that happens so many times when health issues crop up. Going through something similar with my 19+ yo cat, but with a whole different set of issues.

 

[RussellsMom]

I was just writing this message when I saw your post, FeebysOwner - thank you! It's so hard to think clearly at the moment. I'll post anyway:

I guess what I'm trying to weigh up is the benefit of additional testing (hopefully finding out what exactly the problem is and hopefully finding some way to treat it) versus the potential cost to his health and well-being (via stress levels) through additional testing.

Russell has such a great life and is so happy and well-seeming. My husband and I are at home all day every day and he's the center of our lives - we give him all-day, every-day attention, affection, and enrichment. He's protected and doted on - everything here is designed and arranged for his safety, happiness, and comfort.

I feel like I disrupted that by taking him in for this blood test.

On the other hand, if he has a heart condition (off the charts BNP indicates that, right? Though I'm trying to find every which way to deny it) and we can treat it...

On the other hand, he shows no symptoms of heart disease - no breathing issues, no lethargy, no eating problems...

On the other hand, people have posted such tragic stories about finding out their cats had heart disease too late...

 

[fionasmom]

I know that you have limitations with what might be possible. Rikki who is almost 3 had a BNP of 109 a few months ago. His vet saw it as a huge caution, but his internist put it down to stress and did not feel that she heard anything suspicious upon examination. However, I don't know that I would take 1236 in the same way. The ProBNP is accurate to 85%.

My HCM boy, Jamie, had no symptoms and was diagnosed by accident when the vet was looking for an answer to his kidney problems. Six years later there are still no visible symptoms.

 

[RussellsMom]

Thanks, fionasmom - we certainly are heartened by his lack of symptoms (such a happy boy!), but also disheartened by sudden heart failure stories. What a terrible situation.

I've spent the whole day reading about heart disease. I haven't found any mention of BNP values even close to that high. I don't know what to think about that (testing error is my hope). I'm also wondering about heartworm. Russell has mosquito bite hypersensitivity and we try very hard to prevent him from being bitten by mosquitos in the summer, but they do get in the house. He's never been on heartworm preventive. I guess the only way to know is to have the echocardiogram. I think we have to do this one way or the other. We just need to figure out the least stressful way to do it.

 

[mrsgreenjeens]

I would say if nothing else, this is definitely going to require another Vet visit. Since that is required, might as well be to a cardiologist. It IS possible something went wrong with the test, but just in case that isn't the issue, a cardiologist would be required anyway, so why not skip the re-test and just go first.

I did find things about that test that could go wrong, and here is the FAQ that might explain, things like someone not adding the exact amount of drops of (blood) sample and conjugate (whatever that is ), or that the results must be read within 10 minutes , or the kit components needs to be stored at a certain temperature, but then brought to room temp for 30mins before using, etc. So...if some of these protocols were NOT taken, this could explain things.

I have a silly question for you...WHY was this test run in the first place. It is not typically part of the normal blood work. One has to ask for it to be done (as far as I know). My boys get blood work done every 6 months ever since they turned 8 because they are seniors, and they have never had that test done!

And, lastly for now, I'm so sorry the blood work didn't come back perfect. I'm kind of surprised other items weren't out of whack due to his stress level, but this is a shocker. Vibes that it is an error.

Just read your last post. I would discuss with the cardiologist the best way to handle his stress for his visit to them

 

[RussellsMom]

Thanks, mrsgreenjeans - I especially love hearing that the test administration could be in error!

We didn't ask for the test to be done, but I assume it was done as part of the senior wellness panel we asked for. He hadn't had a blood test for 5 years. He also has a very low grade heart murmur, which might be why the vet added it. We only found out they were doing this test when we got the invoice and asked what the BNP add-on was for.

 

[RussellsMom]

fionasmom, if you're still reading: You mentioned that Jamie still has no symptoms 6 years after diagnosis with HCM. Has he been on any medications or other treatment for HCM all these years? I have read a lot of material today that indicates that many (most?) cats with subclinical HCM do not ever show symptoms, which is great.

If anyone else reading has a cat diagnosed with heart disease and could post what treatments, if any, they use, I'd really appreciate hearing about your experiences.

 

[fionasmom]

Jamie was placed on Plavix and atenolol by the regular vet who ordered the ultrasound of his heart and by the doctor who performed the ultrasound.

They encouraged me to take him to a cardiologist, who took him off of both medications because she said his case was very early. In her opinion, atenolol does not do anything for cats with this condition, but I do want to restate that it is the opinion of only one veterinary cardiologist.

He has never been put back on any of the medications and has been successfully maintained. He has never had the blood test done because we know the condition he has so I can’t give you any comparison with what he is reading would be, since everyone considers it to be superfluous in his case

Rikki is a young cat who had a urinary issue several months ago, which turned into an emergency. I took him to another vet I use who is known for operating out of an abundance of caution, and she ran the test. I did not ask her to do it, but she was so successful with treating my dog that she also knows that she has carte blanche from me to do whatever she thinks is necessary.

Otherwise, I don’t know how commonly or routinely the blood test is run.

 

[RussellsMom]

We called the best-rated cardiology group in our area to make an appointment and they told us the next available appointment was in December!! I spent the next few minutes crying more than I though was possible and beginning to hatch plans for flying somewhere else in the world to get Russell seen, when they called back a few minutes later and said a space had opened up this Tuesday.

My husband did the phone calling (he's a much better ambassador than I am where vets are concerned), and he said that the person doing the appointments told him she'd seen numbers much higher than Russell's that turned out not to be heart disease. I don't know if that was just irresponsible but well-meaning reassurance, but it's given my fear a tiny break.

Also, at this practice pet parents are actually asked to be in the room during the ultrasound, which I like.

Please keep your fingers crossed for Russell. And thanks, all, for your continued advice and support - it helps me so much.

 

[FeebysOwner]

This is really all good news! Most of these places don't offer information like they shared with you unless there are things to back up what they said, more often than not they just don't say anything, so just keep that in mind.

You (and your husband) and Russell have my never-ending support with this journey to help Russell.

 

[mrsgreenjeens]

That you were able to secure an earlier appointment is FANTASTIC . Usually the wait is months, but December...wow! So I'm thinking luck is with you on this one. Did they say you should try to give him anything prior to the visit?

How is he doing today? Getting better still? I'm just wondering if he's still not quite himself because he may still hurt a little bit in his back legs, but not enough to actually show it in his movement. You know cats, they are reluctant to show pain.

Hang in there...Tuesday is right around the corner. We'll be here waiting to see what the appointment reveals. Hopefully nothing but good news

 

[RussellsMom]

fionasmom, Thanks so much for the details about your boys. After I wrote to ask you, I found and was reading Barbara/Jenga's thread where you also shared your experiences, so thank you for explaining again! My husband and I are so heartened by both your boys' experiences.

FeebysOwner, You're right - she probably wouldn't have said anything if that wasn't true, so that does make me feel a lot better.

mrsgreenjeans, They asked us not to give him anything before the appointment. They did say that if he just can't get calm enough to get good ultrasound images during the appointment, they could give him gabapentin then. (Though doesn't it take some time to take effect?). Also, you may be right about him not seeming quite himself because of lingering leg pain from the bad vet visit. His movement is better today but not great. He's jumped up to sofa height a few times today. He's bunny-kicked me a few times (not as vigorously as usual), so I assume his back legs can't be too sore. I feel like he has a slight limp, though I'm not sure if that's just my tear-stained eyes! And his fur is sitting awkwardly all over his back - he has a mohawk-like ridge of fur standing up all along his spine, unlike his usual very soft, smooth marshmallow fur. He's also unusually quiet - not completely silent, but not nearly as talkative as usual. These are small things, admittedly, but... I can't tell if it's a "Moms just know" thing or a "Moms can't see clearly because they're oversensitive" thing.

 

[RussellsMom]

New question: We're taking Russell in to the cardiologist for an echocardiogram on Tuesday morning. If he does have heart disease (and possibly even severe heart disease given the BNP?), and given his off-the-charts massive panic attack at the vet on Monday (was 100% happy, healthy little dude going in; came out panting severely, expressing anal glands, bright red toes and ears, limping on all 4 legs, and still, 5 days later, with depressed affect), we're scared of putting him through further stress. There's a good chance he'll be massively stressed when he sees the carrier, in the 40-50 minute car ride, and at the cardiologist, even though we'll be with him during the ultrasound. We're not supposed to give him any calming/sedating drugs before the ultrasound. Any tips for stress reduction?

We bought a new carrier (arriving today) since he expressed his anal glands in the old carrier and I figured no amount of cleaning would get the scent out at least for his sensitive nose, and he might associate the old carrier with his terror on Monday. It's been a bit too small for him for a while anyway. As usual, I'll kit out the carrier with plush blankets and we'll wear our fleeces and then put them in the carrier before heading out.

I'm very reluctant to try Feliway because of some bad experiences I've read about.

Thank you!

 

[mrsgreenjeens]

f. I can't tell if it's a "Moms just know" thing or a "Moms can't see clearly because they're oversensitive" thing.

I think it's a "Moms just know" thing.

AS for getting him to the Vet, I would suggest putting the new carrier out as soon as it arrives. Leave the door open so he can go in and out at will. I do this for my guys and often I will find them inside the carrier sleeping! To them, it's like a nice cozy cave. Once you have him in the car, you can cover up the carrier with a towel or blanket or something so it's even cozier (sp?) and maybe just leave the front area uncovered so he can see you, depending on how you place the carrier in the car. I always put the carrier in the backseat, strapped in with a seatbelt, but I can turn around at stoplights and look inside to check in them. Play soft music all the way there. There is actually music for cats that perhaps you can download and play in the car for that long ride. It's supposedly very calming for them. I suspect with such a long ride,he will curl up and sleep, but you never know. (We moved across states with three cats and they were all three in one large dog crate for the entire trip. They only made a fuss for about the first 10 minutes and then settled right in)

Oh! As to the ultrasound and possible sedation, one of mine is scheduled for an ultrasound in May,and the Vet said to withhold food after midnight just in case they need to sedate him for it. Did they mention that to you? But in any case, I think you are correct in that it would take Gabapentin a few hours to take effect. I'm guessing they don't want you to give him any type of chemical sedation until they exam him to try to figure out if it's safe to do. You could try calling to see if it's ok to give him Rescue Remedy for Pets, or any type of "natural" calming aid. I know you're against Feliway, but their spray is supposedly good to use on their carrier and cushions to help calm them.

 

[RussellsMom]

Just to add: Russell is a very doted-on, cossetted, totally treasured Mama's and Papa's boy - generally very well adjusted, affectionate, and sociable with everyone - except vets and other cats. He's probably about 13 - we adopted him when he was probably about 9 months old. He'd been severely injured before we adopted him, and we suspect he was feral or a stray. He's never quite lost a touch of "feral": in play, he's quite an aggressive biter and scratcher. We happily sacrifice our arms, legs, and furniture to his happiness, but the feral really comes out at the vet.

 

[FeebysOwner]

You told the cardiology office about his last vet visit and asked if there was anything that you could be allowed to give him and they said no? If not, call them. Also. you can ask about Bach Rescue Remedy (drops can be rubbed into the ear) for calming. If not that either, then I don't have any suggestions above what mrsgreenjeens has already mentioned.
Bach RESCUE Remedy Pet | Natural Stress Relief | Non Drowsy (nelsons.com)

Not all cats have a bad reaction to Feliway, some have no reaction, and others do fine with it. There is really no product out there that hasn't had a cat have a bad reaction to. Same can be said for Rescue Remedy as well, I presume. It is hard to do with short notice appts. but it is usually beneficial to test any ot them out ahead of time to see if they are worth bothering with.