Successful Heart Disease Treatment Surgery Performed for Dogs Outside of the US-Coming Soon to the US

A certain heart valve surgery on the mitral valve for dogs (no updates about cats yet but dogs do tend to have more heart surgeries than cats) is successfully performed in England and in Japan. Surgeries in the US have not been successful. But a hospital in Florida hopes to soon begin the surgery. I found out about it when my cats' cardio posted that a dog patient of hers, returned from overseas after a successful surgery and was continuing to do very well. 

"Friends I would like to thank everyone here for their vocal support of the University of Florida’s plans to bring Dr. Uechi and his team to the USA to perform this life saving open heart surgery, while also teaching our US veterinary surgeons how to perform the mitral valve repair (MVR) surgery, successfully..."

https://mightyheartsproject.org/travel-to-florida-uf?fbclid=IwAR07wKPey4-btklJ2qUYS58prcDhFoOZhhzU7Le7owadoPOu1YLI68qzVZo

Feline hyperaldosteronism-Adnrenal Cancer, Cause of CKD/Hypertension/Low Potassium

There has been a lot going on in our house of cats. In June and July, I think I've been to the vet-regular vet, cardio, vet for check-ups, vet for illness, vet for rechecks, shots, etc.-about 25 times. There are some serious issues to discuss and I'm still working on the information. But-all of the cats have seen the cardio except Roxanne (she goes in Dec.) and all are fine and no HCM.

The siblings went through a virus in late June through July with mild vomiting and diarrhea presenting in almost all four but not at the same time. At first, I thought nothing of it, that if one vomited, and another had diarrhea, that it's not unusual for those things to randomly appear by chance. As long as the cat that vomited didn't continue and didn't appear lethargic and continued to eat, I let it go. The diarrhea I treated as needed with either less fiber, more Forta Flora (probiotic) or rice water (great binding agent.)

But then early in July, Bette Davis vomited violently and then decided she was going to spend the day sleeping and not eating. I took her to the vet the next day (while hand feeding her liquids the day before to keep up hydration and nutrition.) She didn't have a fever and her blood work CBC/chem panel and PLI (pancreas test) was normal. But she did present with pain reflexes in the gastro/bladder/kidney area of the body upon exam. So, three days of Buprenex (pain reliever, swelling reducer) twice a day (about .3ml or so each-the vet sent home syringes of the med so I have forgotten the exact amount) did the trick. They also gave her sub-q fluids.

BUT-Baby has had signs of CKD-kidney disease-which I reported weeks ago. I did not review all that the vet hospital was testing. She has hypertension and is on a calcium blocker and her pressure went from 240 in May to 130 in June and now 124. She's responding very well. She's on a diet for low phos kidney food and her SDMA went from 21 to 20, while her BUN and creatinine remain normal.

BUT the vet suspected that she could have hypertension and low potassium NOT because of CKD (although the SDMA is supposed to indicate CKD) but due to hyperaldosteronism, a possible cancer of the adnrenal gland connected to the kidneys. I'm still reading up on it. But her blood test this week came in at 829-NORMAL is about 100-350. What's next? Not sure. She might need an MRI (the ultrasound in May didn't show a lot of change or masses) and further tests to try to pinpoint the cause which apparently is one form of cancer or another, or idiopathic masses or tumors that are caused by other issues.

Since May, I've been trying to learn all I can about CKD to help her. But now, if it's cancer, CKD is more like a secondary response to the cancer and not a primary issue that can be itself treated. Here's a link to a site about the issue. I'll write more soon.

"Screening for this disease should be performed in any cat presenting with hypokalemia or hypertension, as well as the subset of cats presenting with mild azotemia, if preliminary minimum database diagnostics fail to identify other underlying disease processes. Diagnostic tests should include a complete physical examination, complete blood count, serum chemistry profile, total T4 measurement, urinalysis, and blood pressure measurement."

https://veterinarymedicine.dvm360.com/feline-hyperaldosteronism-recognition-and-diagnosis?id&sk&date&pageID=5&fbclid=IwAR3o1gOhzRkIPM8GG-ArsBtCk4GMJfIZaXIy3HiS2UX90ZquZotkqpy6B9M

Kidney Disease-Even HCM Cats May Need Treatment

If your cat develops kidney disease-CKD-the cat needs a low protein, low phos diet. The article lists some of those brands. This may also apply to your HCM cat but in a different way. With heart disease, the kidney function declines. With diuretics, the kidneys take on the load of the work. Both issues create some decrease in function. At some point, your HCM cat may need a CK diet.

Both CKD and HCM cats need more potassium supplementation (Renal K, Nature Made, Sundown, etc.) as well as COQ10, vitamin E, vitamin C (made for felines), and iron (use human iron cut into halves or quarters.)

https://www.medicanimal.com/The-truth-about-renal-diets-for-cats/a/ART111494?fbclid=IwAR2TmszV--YG90Pa1AIGHKuJcUbFi3Vhs7dqegpsd-CcGlv3WJYfNKiDDyw

Oxygen Therapy-When in CHF and at the Vet-How to Restore Oxygen Levels and Why

When your cat is in CHF-congestive heart failure-or has any other illness or issue, the cat likely will need oxygen therapy. When in CHF, oxygen and injected lasix at the vet/vet ER works fast to restore the cat. HCM depletes oxygen over time especially with CHF (read previous posts for explanations.) A body depleted of oxygen isn't just weak but isn't functioning well at all. Read this link for more information on the necessity of oxygen therapy.

https://bluepearlvet.com/library-articles/cardiology/oxygen-delivery-methods/

Lethargy Causes and Solutions

Let's review possible causes of lethargy, when it is common and when it is not common and the cat should see the vet.

Lethargy can be due to the difficulty of HCM-difficulty getting oxygen to the body from the lungs into the blood stream when the heart cannot pump enough blood due to swelling and heart failure.

Lethargy is also due to a lack of electrolytes-a lack of potassium, sodium, glucose, magnesium, potassium, calcium, phosphate, chloride, and bicarb-caused by the necessary use of diuretics which, when pulling fluid from the body, takes the electrolytes with the fluid. Low electrolytes leads to low heart rate, low blood pressure, a lack of what makes the heart beat and the kidneys work, etc. This makes one feel weak and faint. A cat owner can supplement electrolytes by giving the cat a potassium supplement (Renal K powder or gel, or human potassium pills such as Nature Made or Sundown), or some mashed banana or sweet potato-or baby food banana or sweet potato-and by giving sweetened condensed milk or corn syrup 1/8 tsp cut with 2 oz of water, added to food or fed by mouth a couple times a day. Sodium should not be given unless a cat has been vomiting or had diarrhea a few times a day for more than two days.

Lethargy is due to dehydration, caused by the necessity of diuretics. Dehydration lowers the heart rate and blood pressure, making one feel weak and faint. A cat owner can give water by mouth using a 3ml syringe (gently give 9mls or more this way), by adding it to wet food, and by providing many bowls of fresh water to encourage intake of fluid.

Lethargy can be caused by the use of medications for heart disease. These meds lower the heart rate and blood pressure in order to help the heart and may make one feel weak and faint. The cat may need time to get used to the meds but a cat owner can discuss the possibility of adjusting meds with the vet.

Lethargy can be caused by any number of issues or complications of heart disease, especially CHF-congestive heart failure-or the buildup of fluid in or around the lungs, making breathing difficult and painful.

Lethargy can be caused by any procedure or vet visit that has worn the cat out. The cat may take a day or two to recover but should be eating enough and using the litter box.

Lethargy can be caused by a lack of intake of food-a lack of nutrients and electrolytes found in foods. If a cat is not eating enough, hand feeding may be necessary. Hills AD is a good choice. It's high in calories and blends well with little water, and can easily be syringed up into a 3ml syringe and fed by mouth to the cat. Stimulants can also be used. Cyproheptadine, an antihistamine, increases appetite but does not wind up a cat. 1/4 tab once a day may be enough to help the cat eat enough. Mirtazapine is another stimulant which I use when the cat is terribly ill and cypro is not strong enough to spur eating. 1/4 of a tab once or twice a day may be needed. Further hand feeding may be necessary if the cat is very run down. Try using baby sweet potato for potassium, corn syrup in water for glucose, protein from tuna juice or homemade beef/chicken broth (plain-no salt or spices) or peanut butter are good protein choices. These should be fed a few times a day, giving the cat about 9-15mls at each feeding.

Whenever your HCM cat is lethargic, note it in your notebook; track what the cat eats, if the cat is moving about; track when the cat had meds and if you hand fed. Then if the cat is not improved after a day, take the cat to the vet and review your notes with the vet. Have the cat examined and blood work drawn to test for electrolyte levels, dehydration, kidney and liver values, and overall health.

Fluid In the Cat's Heart-Pericardial Effusion

What about fluid in the heart? That is known as pericardial effusion, caused by pericarditis, which is an inflammation of the pericardium, a double-layered membrane sac that surrounds the heart. This is NOT the same as CHF but it can lead to CHF. Pericardial effusion affects the right side of the heart more, compressing and restricting, and damaging the heart. The lower heart rate means the heart cannot be strong enough to pump fluid in and out, leading to the fluid backing into the lungs causing CHF. Fluid retention throughout the body typically follows ascites, swelling of the limbs, and weakness or collapse. While PE is possible, it is not always present or the cause of CHF in a typical pet.

Symptoms include those for any HCM issue or other disease:

Lethargy
Vomiting
Anorexia
Pale gums
Abdominal distention
Exercise intolerance
Fainting or collapse
Respiratory distress
Increased breathing rate and/or increased heart beat rat

Fluid IN the Lungs, Fluid Around the Lungs, and Chylothorax

Let's discuss congestion or CHF a bit more. Fluid in the body is comprised of fluid-water from food and drinking, things digested that the body breaks down, and blood. HCM, which is the enlarging of the heart valves, can lead to fluid build up in the lungs, known as CHF-congestive heart failure. The heart is unable to handle the fluid in the body, is unable to pump it out or take it all into the valves. The leftover fluid then backs up into the lungs. This is called pulmonary edema. When the drainage system in the body goes awry-various reason due to heart disease:

Increased hydrostatic pressure as a result of congestive heart failure (CHF)
Hypoalbuminemia (low levels of protein in the blood)
Changes in blood vessels-hey become "leaky"
Obstruction of lymphatic drainage/abnormal lymphatic function
Chylothorax (accumulation of chyle, a lymphatic fluid that originates in the intestines and has a high concentration of fat).
Diaphragmatic hernia
Hemothorax (bleeding into the pleural space)
Pulmonary thromboembolism (a blood clot in the lungs)
Bacterial, viral or fungal infection of the lungs
Cancer

-fluid can gather outside the lungs in the area between the lungs and chest, called the pleural sac, leading to pleural effusion. Regardless where is the fluid in or around the lungs, a diuretic is necessary to get rid of congestion. BUT fluid in the pleural sac can be drained if the diuretic is not working effectively. However, the necessity to drain the lungs often damages the lungs over time, creating pockets from the needle where fluid can gather and not be reached by draining, making breathing difficult and CHF still likely. Increasing the diuretic dosage is often necessary to further fight CHF.

It is possible for HCM cats, with advanced heart disease, to have the thoracic system fail and allow the buildup of chylothorax, a fatty white fluid that builds up in the pleural sac, causing CHF. This is an added complication and almost impossible to fight. It must be drained with a needle. Myrna developed this the last year of her life and lived 8 months with it. We had fluid drained every other week, increased the lasix, changed the diuretic to a harder one called Torsemide, and tried a supplement called Rutin which is supposed to help. Either she needed more or it wasn't working but it did not seem to end the chylothorax. A low fat diet is recommended also for this condition but I'm not sure what foods are low in fat; we didn't try that with Myrna. Chylothorax further damages the lungs because it is a caustic substance. You can read more here: https://vcahospitals.com/know-your-pet/chylothorax-in-cats
Chylothorax and the necessity to constantly drain the lungs due to pleural effusion, can lead to death-damage to the lungs and increased CHF; and because it is a sign of the heart system failing. Myrna lived eight months with pleural effusion/chylothorax which surprised her cardiologist and the vet hospital where we took her for her necropsy (animal autopsy.)