Asthma or HCM?

[emiliemeow]

Prefacing this with I know she needs an ECG for us to know for sure. I’m calling them first thing in the morning to try to get one scheduled.

She woke me up around 2:30am with another coughing fit. Once I start petting her it doesn’t last long, and usually ends with a few swallows as I’m petting her and she’s purring.
She’s 17. We’ve suspected asthma for a while and have been monitoring as I’ve attempted to clean the house more. I’ll be the first to admit that I’m not great with the housework - ADHD here.
Her most recent blood panel, though, shows the proBNP at 130, where she was 78 about 5 or 6 months ago.

the plan right now is to start her with 14 days of oral steroids and then also get aFlucticasone inhaler. Ideally I’ll also get her the ECG.

The only concern here is the closest place that does the ECG is 40 miles away, and she’s awful in the car. In fact, her normal vet is house calls. It looks like they do travel to other vet offices but I’m not sure how that works if her “normal vet office” is at home.

She’s had allergies before, indicating possible asthma. She’s also once been labeled with a heart murmur, but got an ECG then (about 3 years ago) that came back normal.

my concern is about next steps. I don’t think she will survive another long drive for the ECG since she gets so stressed in the car and just going anywhere. But, I’m reading that starting steroids could make heart problems worse.

However, our vet thinks we’re in a spot where we need to start them whatever the issue is - coughing can cause more scar tissue which is not good. If she has heart disease and there’s a clot somewhere, coughing could dislodge it causing a massive clot.

has anyone been in a similar spot before? The ideal option here is that we can do an ECG at home, but if I can’t I’m going to have to decide to go with the steroid or not without more info, which worries me, but the vet is convinced it’s necessary at this point. Frankly, I do trust this vet.

thanks in advance. I’m just worried sick about here and I’m worried each coughing fit will cause the worst to happen.

 

[FeralHearts]

Hi emiliemeow I am so sorry that you are going through this. It's frightening.

To give you a bit of hope I have a cat with HCM, his heart is also at the upper limit of what his chest cavity can hold. He was diagnosed with it being mild at about 3 years old. He just turned 11. He also has asthma and has a puffer for it. Along with food allergies. It was diagnosed through ultrasound. Editto add: X-rays for the Asthma)

I understand all to well how scary this is.

He too gets serious stressed from drives. He will pant like a dog.

Did you talk to your vet about getting some Gabapentin for the drive? Have you ever tried that? It works like a charm for all my kitties Every single one of mine gets car ride panic. She might be able to have that and it's worth the ask.

Have they done an ultrasound on her heart?

 

[emiliemeow]

She has gaba for vet visits and drives already. She’s still pretty stressed even with the gaba unfortunately.

No ultrasound for a few years - I’m guessing this would be done by the cardiologist if I’m able to get her to them. It’s a full cardio clinic.

 

[FeralHearts]

Yeah mine will still get a bit stressed too with it... but it does take the edge off.

Another thing you can ask is about what's called a "loading does" the night before and then the second dose in the morning two hours before. That works with one of mine. Maybe you can ask about if it's safe to try that?

Lucky! I wish we had a cardio clinic here! So you are in good hands for sure.

How was her first ultrasound?

 

[emiliemeow]

Her first ultrasound (also about 3 years ago) was also normal. And yes - it seems to be a very good cardio clinic! Fingers crossed I can figure out a way to bring them closer so she doesn’t have to deal with a super long drive. I’m hoping even if they can’t do a home visit maybe another vet office would let me use their facilities if I temporarily switch to their vet. But home would be the easiest.
I have done the one dose the night before and one dose the morning of with the gaba but it didn’t seem to make much of a difference. I suppose I could try again though.

 

[FeralHearts]

Yeah I totally get it.

*fingers crossed for you too*

Definitely ask the vet is she is in well enough condition to try that again. It might help. Worth the try for anything to make it easier if you need to do that drive. I'm sure you've already tried feliway. It works a bit for the girls - Charlie it makes him mad.

 

[emiliemeow]

Quick update:

I tried figuring out a mobile or closer option for the cardiologist but no luck. The only option was to establish care with a local vet first, then try to get on their next visit schedule, but that would require an additional car ride and vet visit. So, I opted to book with the cardiologist directly and we will be making the trek there on Monday.

I realized while I was calling around local vet offices trying to schedule a closer facility that one option was an emergency vet that she went to earlier in the year for a mild UTI issue (I rushed her in unsure if it was a blockage). Interestingly, that emergency vet is about the same distance away as this cardiologist, so I feel a bit more at ease about the trip. She won't like it, but I know she has done a similar trip recently.

I figure even if we ordered the steroids today (which I still will to have on hand, I don't mind if we end up not needing them) it will take at least until Monday for them to get here. With such a quick turnaround time for the cardiologist appointment, I'll be able to have more answers before she would start taking the steroids at the earliest anyways. I told the cardiologist I would likely insist on a chest X-ray as well, especially if the ECG and EKG come back inconclusive, since we will already make the trek out there.

So, in short, Monday will be a tough day for her, but I will get all the answers I possibly can this way so I can feel more comfortable with the plan to move forward, whatever it ends up being. I also talked to my vet quite a bit today and she assured me that I don't need to be in panic mode yet - we're doing all the right things and her numbers are still pretty good so she isn't concerned, but wants us to act with urgency to make sure it doesn't progress, whatever it is.

Thank you. I'll try to remember to update Monday.

 

[FeralHearts]

I am so glad you have a plan in place and are prepped and feeling better about it now.

You got this!

*Fingers crossed for good things*

Yes, please update Monday!

 

[silent meowlook]

Hi. I would strongly suggest the inhaler for the steroids since it will target the lungs and not systemically like the oral steroids will do. Also recommend Gabapentin the night before and the morning of the appointment. Also, chest X-ray will confirm asthma. Cats don’t usually cough with heart disease. That is a significant rise in the BNP so you are right to be concerned.

 

[emiliemeow]

We are leaving for the cardiologist in about 30 minutes. She had some gaba last night and another dose about 30 minutes ago. Hoping the car ride isn't too stressful for her.

 

[FeralHearts]

Good thoughts headed your way. XO

 

[emiliemeow]

This clinic is so lovely. They immediately brought us to a private room with calming music and feliway, and everyone has been so calm and caring. Already feeling more at ease just knowing she’s getting good care.

 

[emiliemeow]

We are back with good news.

Diagnosis:
1. Equivocal left ventricular concentric hypertrophy - R/O early hypertrophic cardiomyopathy (HCM) vs. variation of normal
2. Tricuspid valve regurgitation - trivial
3. Cough - suspected feline asthma, R/O bronchitis (allergic/chronic), infection, other lower airway
Prognosis: Good

Jemima's heart structure and function is overall normal aside from a very small leak in his tricuspid valve (likely degenerative) and equivocal thickening of his left ventricular free wall. The thickening of this free wall may be a variation of normal, but it may also represent early hypertrophic cardiomyopathy (HCM). Luckily, these changes are minimal and they are not expected to cause any clinical signs in the near future.

Since Jemima's heart is not quite normal, it is possible that she may be sensitive to potential fluid retention secondary to corticosteroid administration. That said, such minimal abnormalities should not negate therapy, if needed, but I recommend careful monitoring of sleeping respiratory rate and effort if administering corticosteroids. Long-term corticosteroids should be avoided.

Since Jemima has had near resolution of her coughing since the owner has implicated environmental changes (air filters, closing the doors, etc), she may not require long-term corticosteroid administration as long as her respiratory signs remain minimal. If she does require therapy in the future, I recommend avoiding long- acting corticosteroids.

The plan moving forward is for me to still get the asthma inhaler to have it ready and start getting her used to it slowly. However, I will continue to attempt environmental fixes before using the inhaler. I think the easiest ones of keeping the air purifiers always running and not keeping the patio door open should help. (We are both sad about keeping the door closed but it'll be worth not having to do a daily inhaler if it works.) She will go back to the cardiologist in a year to check on her heart, or sooner if her behavior deems it necessary.

Honestly, this is probably the best news possible. We have answers that explain the recent bloodwork and her coughing, but they're minor enough that continuing to monitor is fine. They also assured me that everything else looked normal/excellent, which is great for her age. PHEW!

 

[FeralHearts]

This is really good news! You must be so relieved in a lot of ways!

I can tell you from experiences with Charlie that Asthma inhalers are great. They cats metabolize those different than the oral steroids so as far as I have been told and as S silent meowlook pointed out - it targets the lungs.

All The changes you have been making I am sure will make a world of difference.

It takes about 2 weeks of daily use for the inhalers meds to really get into the system. So do be aware of that. It's not instant. (Unless of course they are giving you an ER one - which - by the sounds of it they aren't.)

I am so very happy for you both!

 

[emiliemeow]

thank you - that’s very good to know about the two weeks. It’s not the emergency one - I already have one of those for myself (LOL) so in a pinch I’ve been told I can use that with her special little aerokat device.

and thank you for the reassurance about the inhaler. Yes, it would be great if not needed, but I will of course use it if these other minor changes don’t help.

Thank you all again. I’m so excited to spend this evening relaxing - I’ve been on edge all week!