Dilated Cardiomyopathy: Kitty's Story

• Kitty was diagnosed February 13th, 2016 after observing the rapid breathing, and she was put down on August 2nd, 2016 at the age of 9.5.
• A year earlier, my wife and I observed the rapid breathing after coming back from vacation back in late August 2015. It went away after a day. Who knows if this was congestive heart failure/the start of DCH or something else.
• As others have shared, Kitty was on Furosemide (Lasix), Pimobendan (Vetmedin), Benazepril, and Potassium.
• Kitty was a domestic short hair with all white fur. Not blind or deaf. My wife adopted her around 8 weeks of age.

• Prior to diagnosis, Kitty always had a food addiction problem and was a bigger boned cat (14lb). When we weren't home, she'd sit in front of her food machine anxiously waiting for it to go off. When we are home, she was very cuddly and liked to sleep with us in bed.
• In 2012 or so, she developed a Urinary Tract Infection - a common issue with cats and likely unrelated to DCH. Figure I would note it anyways.
  
• I think it was 2014 or so? She began a habit of peeing on the floor a couple times a week. This is with a clean litter box. We never figured out why and vet tests, including thyroid, always came back normal. Everyone chalked it up as a behavioral issue. Thyroid levels can fluctuate making it hard to detect on normal tests and it could have explained the excessive appetite.
• Post-diagnosis in mid-2016, she acted normal aside from some lethargy (a side effect of both the medications and diagnosis). She still ate a lot. Breathing rate was constantly monitored. We didn't notice it at the time but her fur started looking unkempt -- now noticeable when looking back at pictures.
• About a week before we put her down, she seemed very distant and hung out by herself in the corner of our dining room. She didn't really get up much or move except for food and litter. That's when we knew it was nearing the end.
• In those final days, she exhibited this weird flat-footed look (instead of standing on her toes like a normal cat). Google search reveals it as a "plantigrade stance" likely due to her extremely weakened state.

• Looking back, prior to the diagnosis, we fed her all dry food -- Wellness Core Indoor Grain-Free Formula. The recent link between DCH and Grain-Free food has helped bring me a little bit of closure, even if it's not definitive in cats.
• Likely because of the dry food, she always drank a lot of water (well before diagnosis). Very unusual for a cat.
• She loved "Cat Sip" - it's milk without lactose. We gave her maybe 1/4 of the small carton every night. Looking back, I kick myself and can't help but wonder if calcium or something else played into her condition.
• After her DCH diagnosis, we switched her to a partial wet diet. Her medications were crushed with a mortar & pestle and mixed in with pate food (except for that one bitter medication, can't remember the name, but we used a pill pocket for it).
• Beyond the prescription meds, we also mixed in supplements including Taurine, CoQ10, and Fish Oil.

Problem list:

1. Dilated cardiomyopathy
2. History of congestive heart failure (pulmonary edema and pleural effusion)
3. History of a mild ventricular arrhythmia – an ECG was not performed today, but her cardiac rhythm seemed
4. regular throughout the visit
5. Mild azotemia (elevated kidney values)
6. Mild hypokalemia (low potassium)

Chest radiographs revealed evidence of congestive heart
failure (both pulmonary edema and pleural effusion). Her creatinine was 2.2 and her glucose was mildly elevated. Her total thyroid hormone level was normal (2.1). An ECG reportedly revealed an occasional ventricular premature complex.

• Physical examination:
  Attitude: Bright, alert, and responsive
  BCS: 6/9
  Cardiac examination:
  HR/rhythm: 180 bpm, regular
  Murmurs: No murmur or gallop.
  Femoral pulses: Fair bilaterally, no deficits
  Mucous membranes: Pink, moist, CRT<2 sec
  Pulmonary examination:
  Resp rate/effort: 36 bpm, eupneic
  Auscultation: No abnormal lung sounds identified
  Other: Ambulatory x 4, peripheral lymph nodes and abdomen palpate within normal limits
• Diagnostic tests:
  -Echocardiogram
  Assessment:
  - Dilated cardiomyopathy (DCM). The left ventricular lumen is moderately enlarged and exhibits mild systolic (contractile) dysfunction. The left ventricular walls are globally normal in thickness. The left atrium is moderately-to-severely enlarged. Spontaneous echogenic contrast is seen in the left auricle, but an obvious formed thrombus is not seen. No valvular regurgitations.
  -No pleural effusion is seen today.
  -Blood pressure
  Method: Doppler, RFL, #2 cuff, sternal, calm
  Average results: 106 mmHg systolic – Normal
• Labwork
  Kidney profile
  Glucose 137 mg/dL (70-150)
  *BUN 34 mg/dL (10-30)
  Calcium 10.9 mg/dL (8-11.8)
  *Creatinine 1.7 mg/dL (0.3-2.1)
  Albumin 4.4 g/dL (2.2-4.4)
  *Phosphorous 2.9 mg/dL (3.4-8.5)
  Sodium 155 mmol/L (142-164)
  *Potassium 3.4 mmol/L (3.7-5.8)
  *Chloride 101 mmol/L (112-126)
  *tCO2 28 mmol/L (15-24)

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• Our local hospital was great and was able to provide us with a clay paw print.
• We buried Kitty in our backyard. We still visit her grave from time to time. Looking back, we regret not cremating her because when we move, we feel like we're leaving her behind.
• My wife and I were and are not religious at all. However, I began reading about cat souls even before Kitty passed away. This included accounts of people being "visited" by their deceased cat and b.) how cat braiding occurs where the deceased cat trades with or combines souls with a new cat's body to rejoin their owner. The logical, scientific side of me says it's hokey but I have to admit it was comforting.
• Apparently, visitation dreams after a pet's death is quite common. About 2 weeks after Kitty's death, I had a very vivid dream where we met in a classroom setting and she was equal in relative size to me. She told me she was OK and not to worry about her. The logical, scientific side of me says I subconsciously dreamt this because I had previously read those accounts.
• Every birthday, Christmas, and her death anniversary, we donate money to the Cornell Feline Health Center. They are one of the top research institutes for cat health (including DCH) in the U.S.

• Asked for a Taurine test for a.) curiosity's sake and b.) to help the Internet community compile as much information as possible. In rare cases, Taurine supplements can help the heart "heal" itself back to normal. This was unfortunately not the case for Kitty.
• I'm not a clinician but had read about a "better" Thyroid test - I think it's called T4. Kitty's intense appetite always made me wonder if all of this was because of Hyperthyroidism.
• Better regulated her food portions and/or switched away from the Wellness Core Indoor Grain Free dry food (where Peas and Potatoes were ingredients #4 and #5 as of this writing). Another post here on TheCatSite mentioned these legumes and potatoes may be contributing factors, which makes me wonder if Kitty's excessive portions exacerbated the issue.
• Post-diagnosis (which led to a partial switch from dry food) not to microwave wet food. Another post here on TheCatSite mentioned microwaving food destroys Taurine. Though the supplemental Taurine I gave her didn't ultimately impact her prognosis.

• Diabetes does cause polyphagia (increased hunger), polydipsia (increased thirst), and polyuria (frequent urination). My wife doesn't recall Kitty excessively peeing pre-diagnosis and pre-furosemide. I feel differently; it could be we never really observed the frequency, and instead focused more about the behavioral aspect (peeing inside the litter vs. on the floor).
• This 2017 study cited by the National Health Institute suggests that Feline Diabetes does result in cardio dysfunction. The dysfunction continues to progress even when placed on anti-diabetic therapy.

Problem list:

1. Dilated cardiomyopathy (DCM)
2. History of congestive heart failure (pulmonary edema and pleural effusion) – currently resolved
3. History of a mild ventricular arrhythmia
4. History of a mild azotemia (elevated kidney values) – creatinine was within normal limits today
5. Hypokalemia (low potassium)

Her creatinine during that visit was mildly elevated (2.2) and her total thyroid hormone level was normal. Her creatinine had decreased to 1.7, and her potassium was mildly low (3.4).

BCS: 6/9
Cardiac examination:
HR/rhythm: 200 bpm, regular
Murmurs: No murmur or gallop
Femoral pulses: Fair bilaterally, no deficits
Mucous membranes: Pink, moist, CRT<2 sec
Pulmonary examination:
Resp rate/effort: 36 bpm, eupneic
Auscultation: No abnormal lung sounds identified
Other: Ambulatory x 4, peripheral lymph nodes and abdomen palpate within normal limits

Diagnostic tests:
-Chest radiographs
Assessment: VHS=9.0. Generalized cardiomegaly. Normal cranial pulmonary vasculature. Very mild diffuse bronchointerstitial pulmonary pattern. No evidence of residual congestive heart failure.

Labwork
Kidney profile
Glucose 125 mg/dL (70-150)
*BUN 35 mg/dL (10-30)
Calcium 10.9 mg/dL (8-11.8)
Creatinine 1.4 mg/dL (0.3-2.1)
*Albumin 4.4 g/dL (2.2-4.4)
*Phosphorous 2.7 mg/dL (3.4-8.5)
Sodium 155 mmol/L (142-164)
*Potassium 3.0 mmol/L (3.7-5.8)
*Chloride 105 mmol/L (112-126)
*tCO2 25 mmol/L (15-24)

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Cardiology Update

BCS: 6/9
Cardiac examination:
HR/rhythm: 180 bpm, regular
Murmurs: No murmur, but a continuous gallop rhythm is heard today
Femoral pulses: Fair bilaterally, no deficits
Mucous membranes: Pink, moist, CRT<2 sec
Pulmonary examination:
Resp rate/effort: 44 bpm, eupneic
Auscultation: No abnormal lung sounds identified
Other: Ambulatory x 4, peripheral lymph nodes and abdomen palpate within normal limits

She has a history of congestive heart failure secondary to dilated cardiomyopathy. During her last visit on 3/2/16, chest radiographs revealed no evidence of congestive heart failure. Her kidney values looked okay, but her potassium was low (3.0). Spironolactone was started, and so we’re rechecking her renal values/electrolytes today.

Labwork
Kidney profile
Glucose 144 mg/dL (70-150)
BUN 28 mg/dL (10-30)
Calcium 11.1 mg/dL (8-11.8)
Creatinine 1.3 mg/dL (0.3-2.1)
*Albumin 4.9 g/dL (2.2-4.4)
*Phosphorous 2.6 mg/dL (3.4-8.5)
Sodium 154 mmol/L (142-164)
*Potassium 2.5 mmol/L (3.7-5.8)
*Chloride 100 mmol/L (112-126)
*tCO2 28 mmol/L (15-24)

Kidney values have thankfully continued to decrease, and both her BUN and creatinine are normal today. Unfortunately, her potassium has also continued to decrease, despite the initiation of spironolactone. I am therefore starting her on potassium supplementation today (see below). As long as she continues to do well at home, I’d like to recheck her here in Cardiology in 2 months.

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Problem list:

1. Dilated cardiomyopathy (DCM)
2. Suspect very mild congestive heart failure (pulmonary edema)
3. History of a mild ventricular arrhythmia
4. History of a mild azotemia (elevated kidney values) – creatinine was within normal limits today
5. Hypokalemia (low potassium)

She has overall been doing well at home since that time, however for the past few weeks she has seemed lethargic on and off, and when she purrs she sounds congested. She is eating very well, and her respiratory rate (18-22 bpm) and effort have been stable. A couple
of weeks ago she developed an abnormality to the appearance of the skin along the dorsal and proximal aspect of her tail. She is not licking or biting at this region.

BCS: 6/9
Cardiac examination:
HR/rhythm: 180 bpm, regular
Murmurs: No murmur or gallop
Femoral pulses: Normal bilaterally, no deficits
Mucous membranes: Pink, moist, CRT<2 sec
Pulmonary examination:
Resp rate/effort: 28 bpm, eupneic
Auscultation: No abnormal lung sounds identified
Other: Ambulatory x 4, peripheral lymph nodes and abdomen palpate within normal limits; Proximal half/dorsal aspect of tail has pinpoint regions of hyperpigmentation, suspected to be at the origins of the hair follicles. No alopecia.

Diagnostic tests:
Chest radiographs
Assessment: VHS=9.25 (previously 9.0). Generalized cardiomegaly. Normal cranial pulmonary vasculature. No pleural effusion is seen. Mildly increased interstitial pattern in the caudal lung fields when compared to radiographs performed in March. Suspect mild/early congestive heart failure.

Labwork
Kidney profile
*Glucose 223 mg/dL (70-150)
BUN 23 mg/dL (10-30)
Calcium 11.3 mg/dL (8-11.8)
Creatinine 1.2 mg/dL (0.3-2.1)
*Albumin 4.8 g/dL (2.2-4.4)
*Phosphorous 3.3 mg/dL (3.4-8.5)
Sodium 151 mmol/L (142-164)
*Potassium 3.1 mmol/L (3.7-5.8)
*Chloride 103 mmol/L (112-126)
tCO2 22 mmol/L (15-24)

Physical exam was good/stable today, however her chest radiographs revealed evidence of probable very early congestive heart failure. The radiologist who reviewed the radiographs does not believe there to be evidence of heart failure, but I disagree. I measured her heart to be slightly larger today than it was in March, and the blood vessels in her lungs are not as crisp in appearance as they were in March (indicating a probable mild/early accumulation of fluid in her lungs). Considering these findings and the fact that she has been a little lethargic and has had sounds of congestion, I am increasing her furosemide and benazepril doses today to help remove any excess fluid that is building up in her lungs. Kidney values look great today. Despite starting her on the potassium supplementation, her potassium level is still too low (although it has increased a little since starting the potassium). Since an increase in furosemide is likely to further decrease her potassium level, I’m recommending an increase in her potassium supplementation (see below).

Please continue to monitor for signs of progressive heart disease or congestive heart failure, which can include exercise intolerance, increased respiratory rate or effort, lethargy, decreased appetite, weakness, or collapse.

I recommend that her tail is examined if the abnormal region of skin gets larger, looks
progressively abnormal, or starts to cause discomfort/itchiness. She has a recheck with me on Saturday, June 4 @ 1:40pm. We will be rechecking her kidney values and electrolytes, and possibly be rechecking chest radiographs. Please let me know in the meantime if you have any questions or concerns about her.

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Problem list:

1. Dilated cardiomyopathy (DCM)
2. History of congestive heart failure (pulmonary edema)
3. History of a mild ventricular arrhythmia
4. History of a mild azotemia (elevated kidney values) – creatinine was within normal limits today
5. Hypokalemia (low potassium) – persistently low despite potassium supplementation

In February ’16 she was diagnosed with congestive heart failure (pulmonary edema and pleural effusion) secondary to dilated cardiomyopathy. On 5/25/16, during a routine
recheck, you noted that she was on and off lethargic and sounded congested when purring. Chest radiographs revealed some changes from her previous films, and therefore suspicion of early congestive heart failure. Her bloodwork revealed stable kidney values but a persistently low potassium. Furosemide, benazepril, and potassium chloride doses were increased.

Over the past week, she has been doing well. Her appetite is now more normal for her (ravenous), and her energy level has improved. You have not heard any more sounds of congestion with breathing. She is breathing comfortably. Her meow possibly seems slightly weaker than normal for her.

BCS: 6/9
Cardiac examination:
HR/rhythm: 180 bpm, regular
Murmurs: No murmur. Mild continuous gallop rhythm.
Femoral pulses: Normal bilaterally, no deficits
Mucous membranes: Pink, moist, CRT<2 sec
Pulmonary examination:
Resp rate/effort: 24 bpm, eupneic
Auscultation: No abnormal lung sounds identified
Other: Ambulatory x 4, peripheral lymph nodes and abdomen palpate within normal limits

Diagnostic tests:
-Chest radiographs
Assessment: VHS=9.5 on right lateral (previously 9.5). Generalized cardiomegaly. Normal cranial pulmonary vasculature. No pleural effusion is seen. Static, mild interstitial pattern in the caudal lung fields.

Labwork
Kidney profile
*Glucose 181 mg/dL (70-150)
BUN 27 mg/dL (10-30)
*Calcium 12.0 mg/dL (8-11.8)
Creatinine 1.3 mg/dL (0.3-2.1)
*Albumin 4.5 g/dL (2.2-4.4)
*Phosphorous 3.2 mg/dL (3.4-8.5)
Sodium 151 mmol/L (142-164)
*Potassium 2.5 mmol/L (3.7-5.8)
*Chloride 99 mmol/L (112-126)
*tCO2 26 mmol/L (15-24)

Chest radiographs were nearly identical compared to those performed last week. Given the improvement in her symptoms at home since increasing her cardiac medications, I suspect she was on the edge of having congestive heart failure last week. Today’s radiographs will be considered her new “normal” baseline in regards to heart size and lung appearance.

Kidney values have overall remained stable since the medication adjustments last week, which is great news. Her potassium level has decreased again, however. Her potassium supplement dose is therefore being increased today (see below)

Recheck scheduled with me on Saturday, August 6 @ 1:40pm. We will be rechecking her bloodwork and chest radiographs again. Please let me know in the meantime if you have any questions or concerns about her.

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PushPurrCatPaws said:

Hi. I've seen a lot higher readings than that for the blood glucose with diabetic cats, but you're right, they are higher for those last two dates than what you show for the earlier dates.

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Weasel21 said:

Sorry for your loss. I lost my two boys to dilated cardiomyopathy over the winter. We have some similarities. I wish I had done a taurine test (I asked for one but the vets talked me out of it, because my cats weren't on a homemade or vegetarian diet). My boys were also fed Wellness Core in their younger years, though we switched to other grain-free foods when they were about 3/4 years old (all of which are implicated in dog DCM cases). Wish I hadn't fallen into the marketing trap and fed those foods. I wonder how many cases go undiagnosed, since there are probably many cats that die before they get a specific diagnosis for cardiomyopathy type (cats are so good at hiding illness). I'll have to look up the Cornell Feline Health Center... would love to support more research on cat heart health. If you haven't already, would you consider reporting information about your cat's case to the FDA? With so little information on cats, every report matters in determining whether or not there is a link to these foods. You can send me a message if you need help finding information on how to report.

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comp625 said:

What's an average "bad blood glucose level" in diabetic cats? In Kitty's 5/25/2016 report, her Glucose was 223 mg/dL which is well above the 75-150 range noted. I look back and wonder if she was diabetic well before DCM hit (which would explain the ravenous appetite).



I'm so sorry to hear about both your boys. Were they biologically related? The science community often points to genetic predisposition for feline dilated cardiomyopathy. Did you also get and keep any clinical notes? Curious if there were any correlations with Kitty's notes.

I kick myself about using Wellness Core and Grain-Free food, too. Though logically, correlation doesn't mean causation. Food being grain-free may not be trigger to DCM, but rather, it may the high content of peas, potatos, lentils and other legumes that somehow deplete Taurine. The FDA report did show Dog DCM occurring even in those who ate non-grain-free.

Can you share that FDA link and process here (so others can also report too on behalf of felines)?

For research donations, we chose Cornell because their College of Veterinary Medicine has a department dedicated strictly to felines ("Cornell Feline Health Center"). A lot of other schools also research feline diseases, such as Tufts, UC Davis and UPenn, but they don't have a standalone department.

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