Enlarged heart in senior cat question & advice

[sillywoody]

I have another ailment to add to my beautiful 17 year old fluff Silly's list...enlarged heart

-he has had a stage 4 heart murmur for approx 4 years
-conducted echocardiogram 2 years ago, cardiologist determined his heart murmur was physiologic
-today, his insurance-included chest x-ray determined his heart is enlarged (9 vertebral heart score, where 6.7-8.1 and below are normal)
-he has CKD with his only symptom of high bp, on highest dose of Amlodipine, but still lost eye sight

My goal for him is ensure he is in no pain, he takes gabapentin every 12 hours, and trazadone at night to help with dimentia meowling.
My vet suspects Hypertrophic cardiomyopathy, but would not put him on any meds until he is looked at.

Getting him looked at around here costs about $500 Canadian for an ultrasound, and well over $1000 to see an actual cardiologist, which I've already done for him before. My gut tells me not to investigate/go to a specialist for each of his ailments if hes not in pain (for budget reasons)...I could make him his own organic chicken and fish side dishes for months with that budget which would make him so happy.

But I'm worried there could be some medication that could help him that he'll miss out on if I don't take him to at least the ultrasound.

What do you guys think? Thank you

 

[fionasmom]

You certainly have taken excellent care of Silly for all those years and I can see where you are coming from with the questions about more specialists, meds, etc. At 17, having a wonderful life, having had great medical care, do you go to the next step?

My Jamie is 4 and was dxed with hypertrophic cardiomyopathy recently. He had previous ultrasounds to try to dx a kidney issue and then signs began to point to the fact that there was something else and we did the echocardiogram. He was referred to a cardiologist and we did go for the consultation.

Jamie had initially be put on Atenolol and Plavix by the doctor who ordered the echo. The cardiologist took him off of both meds as she said his case was not advanced enough. However, she did indicate scenarios in which cats are placed back on those meds such as LA enlargements or LVOT obstructions.

I think that your dr is being cautious not to introduce the meds unless you know something for sure. Echocardiogram was about $500 for me, but the cardiologist accepted it because it had been so recent. Initially she was going to do another one, but I pushed the issue a little bit. Consultation was about $250 which would have been about $750 if she had redone the echo. What is your cardiologist doing that costs so much in addition to the echo? Silly is not going to be having heart surgery or a heart transplant, so more than likely this will amount to medication, or not.

Given that Jamie's issues started at 2 years old with the suspicious kidney numbers, and the HCM was caught at 4, I did feel as if I wanted to move forward and give him a chance at some more time. If he had been 17, I am not sure what I might have done. HCM can progress to CHF and issues with clots. Maybe having a talk with the vet about the risks/benefits of trying to treat this or not would help you decide.

 

[mrsgreenjeens]

Yes, I think discussing this with your Vet to see what they think the risks are if you do nothing, or if he should perhaps go on Lasix or some other drug without seeing a cardiologist would help. I've read that an enlarged heart can lead to congestive Heart Failure, but I'm sure that isn't always the case, and have no idea how long that takes, etc.

But I believe that quality of life outweighs quantity of life, and it sounds like you do too, since you said you just want to make sure he isn't in any pain, so if you can only afford to make him his "happy meals" if you don't take him in for an ultrasound and to the cardiologist, then it seems like the choice is being made for you. If it helps, we had a 16 year old with CKD, and when she developed liver issues, the Vet said she could do an Ultrasound to try to figure out what was going on. We declined because it's not like if she had tumors on her liver we would put her through surgery . And in the end, she passed from neither the CKD nor liver issues, but not for another year or so.