Heart Disease (subaortic stenosis) - Success Stories?

[bowshi]

Hi all, could really use some positivity right about now as my wife and I are quite devastated at what we just heard from our vet.

We adopted two adorable 3 month old kittens (now 6 months old) back in December 2022. Orange domestic shorthairs, indoor cats with no intention of letting them become outdoor. Records from the shelter showed a clean bill of health and both were neutered before we adopted them. We decided to take them for a welcome home checkup a few weeks back, and the vet heard a Grade 2 heart murmur in one of them. As a precautionary measure, we went for a cardiac ultrasound to confirm if it was benign.

Unfortunately, the resulting report indicated that our little man has fixed subaortic stenosis, a condition where the aorta is narrowed, requiring the heart to work harder to pump blood out to the rest of the body. The severity was mild when heavily sedated, but severe when alert. No signs of heart enlargement or any structural concerns with the heart at this time other than the stenosis, or any outward symptoms really, but the severity is really scaring me and my wife. Since he is so young, the cardiologist requested we come back for another ultrasound in 10 months once he's fully grown to establish a final prognosis. The report indicated that the stenosis would likely worsen during this time, but that remains to be seen. He's been put on 6.25mg atenolol twice a day to allow his heart to work less hard, and has been ordered to stop all rigorous exercise - a challenge considering we also adopted his brother as noted above, and they love to play and chase each other around. We've settled on a compromise of letting them play with each other, but limiting any intense exercise when my wife or I play with them (ie. no feather wand toy or laser pointer chasing).

Has anyone had any experience with this disease? Since he's so young, the prognosis for long term survival right now is guarded. In talking to the vet, they were fairly confident that he'd live another two or three years, but would be surprised if he made it to 10. This has us very distraught, not only for me and my wife, but also for his brother who we adopted alongside, who does not appear to have any heart issues and will hopefully live a long, full life. I hear all the time about cats with HCM living way longer than the vet gave them - hoping this disease has similar success stories. We are so heartbroken at this news.

Thanks

 

[FeebysOwner]

Hi. I searched this site for previous threads that could be related and found nothing. Of the few articles I ran across on the internet, this is a very rare condition in cats, so I am going to guess it will be a struggle to find much. I did see a reference or two to mild subaortic stenosis (also known as valvular aortic stenosis) cases that may not require any treatment and generally does not affect lifespan. Another indicated reduced cardiac exertion and atenolol as the recommended treatments. From what little I found it sounds like your cardiologist is following the standard approach - letting the cat mature to see IF the stenosis worsens, and taking precautions through meds and limited physical exercise in the meantime. The heart murmur being the only sign of an issue is a good thing, so don't lose sight of that!

Ask your cardiologist if there are case studies/results that they could share with you. You might also ask them if there are any support groups in existence that you could join. You may even want to ask them to put you in touch with a vet university that could provide additional data to you.

 

[silent meowlook]

Hi. I am sorry for this unfortunate diagnosis. This disease is very rarely diagnosed in cats. Just my own thoughts here, but I wonder if it isn’t more prevalent in cats but just never diagnosed. An echocardiogram has to be done to confirm it and I doubt many cat owners would do an echocardiogram on their cat if there were no symptoms. More cats may have it than is known.

This is one of those things where you just have to continue on and let the kitten have a great life for however long that life is. You can’t live your life, or his worrying about this because it will destroy any semblance of happiness you could hope to have.

Follow your vets instructions. Be aware of things that could cause problems like too much exercise, stress, IV or SQ fluids if he ever must go to an ER. and give medications as directed and do the follow ups. I would stick with your specialist for everything related to this cat.

There honestly isn’t anything else you can do and worrying will stress the cat out as well. Easier said than done. But try to think of we hat might have happened to him if you didn’t adopt him. So, no matter what his life is way better because of you.

I am sure they told you what signs of problems would be, respiratory distress, open mouth breathing, not eating, basically any abnormal behavior for him, and at the first sign, get him in.

You don’t have to do this, but for my cat with asthma, tachycardia, and tachypnea, and abnormal chest radiographs, I got an oxygen concentrator. Just in case she had a problem, I could give her flow by oxygen until I could get her to a vet. I have never used it, but it made me feel better to have it.

I honestly think many cats are running around with this condition but nobody knows about it and therefore there are no studies done.

 

[bowshi]

Thanks so much to the both of you for your hopeful words. It was much needed after all the doom and gloom I found when searching up this condition. My wife and I thank you for helping us see this from another perspective!

Good idea on reaching out to the cardiologist for case studies, there is not much on Google as you noticed, and what I did find was all based on very small control groups that, unfortunately, did not end well for the cats being studied. Support group would be great too as we feel all alone trying to dig up information on this condition. Appreciate your insight.

And I think I for sure will get the oxygen concentrator, that is definitely one of the scariest parts is if the little guy starts struggling to breathe in the middle of the night while we scramble to get him to the nearest 24/7 emergency vet (there aren't a lot of them). We'll try and keep our heads up and give our little Bowser the best life he can have. We certainly hope he'll be around for a long time. And you are right, my wife mentioned too that if it weren't for us and he was left at the shelter, this would not have been caught and he very well may have developed complications without early intervention.

Thanks for welcoming me to this wonderful community of like minded cat lovers. I feel much better than I did this morning.

 

[FeebysOwner]

Keep us posted please. We all care very much, particularly when there is no obvious solution and how hard it is to weed through everything to find one.

 

[bowshi]

Will do! We don't have the follow up ultrasound for a while but will definitely update this thread with anything as it happens. Fingers crossed for my little man

 

[iPappy]

I'm glad this was caught early and you can monitor and treat him. Like S silent meowlook said I feel that more cats have this than we know. In dogs at least, it is hereditary.
I have had dogs and cats with heart disease, not SAS, but my vets advice was to keep a routine, keep things as stress free as possible for them, and unless he has very high drive for anything that moves, let him play within reason.
Since this is heart related and he might have to visit the vet often, I would really encourage you to work on making his carrier a GOOD place for him. Feed him in there, make it inviting, tuck it into an area he likes to sleep anyway and make it cozy. Hide some treats or special toys or some catnip in there. And make sure it's roomy enough for him to be comfortable in it. If you're going to run to the drive through bank, or you're going to go grab some fast food, etc., get him (or both cats) into their carriers and take them on a short little drive. Let them grow up knowing that carriers and cars are just a part of their routine, and aren't anything to stress over. It takes some diligence, but it REALLY pays off when it comes to keeping their stress level low!

 

[bowshi]

Thanks! For the carriers, we have those bubble ones and they love it in there (see photo) and sometimes take their afternoon naps inside fully closed we've taken them on a few car rides and usually they're ok for a few minutes before starting to meow! We'll try and take them with us when making short trips out. They're generally ok at the vet too, but I'm sure their hearts would be working harder from the stress.

At home they're rarely ever put in stressful situations, and on the off chance they do (like if lots of people are over) they just run up to the guest/cat room, which is their safe space fully equipped with cat tree, litter boxes, water fountain, etc. Playing on the other hand, is tougher to limit. We've stopped using wand toys and laser pointers, but they still take all that kitten energy out on each other. And how can we stop that? If we keep them from doing it in front of us they just go elsewhere in the house and do it there. I know we should let them do it in moderation but they play with each other pretty vigorously... still trying to work out a solution for that one.

Thank you for the support!

 

[iPappy]

They are seriously the cutest little things! Who is who in that photo?
It sounds like you're being incredibly proactive in keeping them happy and exposed to anything they may have to deal with in the future that could potentially trigger stress. You're doing a great job IMO.
IDK if any kind of calming treat would help their playing? My cats tend to remain playful into older age, but they do calm down considerably between 1-2 years old and the crazy kitten play slows a lot. From my limited experience with pets and heart disease, I tend to watch their breathing (labored, rapid, etc.) If I see that increase, play or excitement stops immediately, and I separate them from the others. Did the cardiologist ask you to take his resting respiratory rate? (RRR?)

 

[bowshi]

Thank you, they're my little angels Bowser (the one with the heart condition) is the one in the front, with his brother Sushi in the background. You wouldn't know Bowser had a heart condition looking at him, he's always running around playfighting with his brother and making some seriously impressive jumps onto the counters! I don't enjoy separating them but moving forward I think if I see one of them getting overworked I'm going to place them in separate rooms. They'll meow at me for sure but it's a necessary evil to keep Bowser healthy. Good to know they start calming down starting at 1 year because they're still very much in crazy kitty phase right now. Not that I mind! We're cherishing these precious moments while we can.

RRR is to be monitored, but since they're kittens they tend to breathe a little faster. I've been told not to panic if I see this, at least until they're a little further along.

Thanks so much, we do what we can to ensure the best life for our fur babies. When things like this happen it always seems like we can't do enough, so I appreciate the kind words!

 

[bowshi]

For those of you who are curious and have some experience with cardiology, I've read through the report from the ultrasound and done a fair bit of research into Bowser's condition the last few days. What it boils down to is SAM of the MV (systolic anterior motion of the mitral valve) appears when Bowser's in an awake/alert state, worsening as he gets more stressed. This worsens his LVOTO (left ventricular outflow tract obstruction) and subaortic stenosis to be more severe. Interesting thing is that when he is heavily sedated, similar to sleeping state, his SAM of MV goes away and the LVOTO and subaortic stenosis becomes mild only. And of course, the hope here, as FeebysOwner mentioned above, is that mild subaortic stenosis can allow him to live a normal lifespan, albeit on heart medication for the rest of his life - a fair trade for saving the little guy and allowing us to love him for some additional years.

Although research on specifically aortic stenosis is scant, I found a case study done in the Netherlands regarding the effectiveness of atenolol on SAM. Results are not definitive but shows a hint of promise in SAM getting resolved through daily atenolol treatment, especially since Bowser's heart is currently normal with no hypertrophied parts at this time. All the more reason for us to get started on atenolol as soon as they pills come in, as based on the report it looks like SAM is the driving factor in the severity of his condition.

It's not much at the moment but it's a glimmer of hope, which has been in short supply this past week. I will keep you all posted on any developments. Thank you for everyone's support. You are a wonderful community and my wife and I are so happy we found you, you've made us feel better each and every day since we found out about poor Bowser.

 

[Kflowers]

this is just a thought, but I think Bowser might be more relaxed and comfortable if, when you took him to the vet (any of them) you bring Sushi along in the same carrier. I found that my cats who were close buddies found it made trips less stressful to be with their bestie.

 

[bowshi]

Hi Kflowers, yes we have decided that we will likely do that moving forward. It's not going to be the most fun for Sushi but at least it may help Bowser keep a little calmer. We do keep them in their own carriers but they can easily see that their brother is there along with them. They are inseparable and it's adorable!

 

[Kflowers]

I hadn't thought of this when I suggested it, sometimes when you take one in and not the other, they don't recognize each other when you get back home and then they fight. All I'd thought of was they like to hold onto each other and this would help for being scared in the carriers in the car and at the vet. A light sheet or towel over the carrier helps too.

 

[iPappy]

For those of you who are curious and have some experience with cardiology, I've read through the report from the ultrasound and done a fair bit of research into Bowser's condition the last few days. What it boils down to is SAM of the MV (systolic anterior motion of the mitral valve) appears when Bowser's in an awake/alert state, worsening as he gets more stressed. This worsens his LVOTO (left ventricular outflow tract obstruction) and subaortic stenosis to be more severe. Interesting thing is that when he is heavily sedated, similar to sleeping state, his SAM of MV goes away and the LVOTO and subaortic stenosis becomes mild only. And of course, the hope here, as FeebysOwner mentioned above, is that mild subaortic stenosis can allow him to live a normal lifespan, albeit on heart medication for the rest of his life - a fair trade for saving the little guy and allowing us to love him for some additional years.

Although research on specifically aortic stenosis is scant, I found a case study done in the Netherlands regarding the effectiveness of atenolol on SAM. Results are not definitive but shows a hint of promise in SAM getting resolved through daily atenolol treatment, especially since Bowser's heart is currently normal with no hypertrophied parts at this time. All the more reason for us to get started on atenolol as soon as they pills come in, as based on the report it looks like SAM is the driving factor in the severity of his condition.

It's not much at the moment but it's a glimmer of hope, which has been in short supply this past week. I will keep you all posted on any developments. Thank you for everyone's support. You are a wonderful community and my wife and I are so happy we found you, you've made us feel better each and every day since we found out about poor Bowser.

Your dedication, knowledge and research is already paying off. You guys are awesome!! And Bowser is in the absolute best hands he could be in! I really hope the treatment helps him. Research and learning really helps me feel better, too, just knowing as much as I can about what I'm dealing with.

 

[iPappy]

Hi Kflowers, yes we have decided that we will likely do that moving forward. It's not going to be the most fun for Sushi but at least it may help Bowser keep a little calmer. We do keep them in their own carriers but they can easily see that their brother is there along with them. They are inseparable and it's adorable!

This doesn't deal with cats, but when my older dog was diagnosed with cancer last year, I took my younger dog (who has some mild anxiety) with him to every single appointment, and there were MANY appointments over the span of almost 2 years (sometimes 2-3 times a week.) Not only was it good for my older dog, but it really helped my younger dog not be anxious in the car, at the vet, etc. because she did it so often. She went from being slightly anxious in the car and whining during the appointments to sleeping in the car and calmly laying by my feet at the appointments. And when the vet was working on my older dog it was nice to have a familiar pet to hold and cuddle with. I think it was good for all of us. I'm sure Sushi will learn it's just another Day Out with his brother and his people!

 

[bowshi]

Kflowers - understood! Sushi was actually very cool with Bowser after he came back from the ultrasound appointment (which he attended himself). It's actually normally Bowser who bullies Sushi a bit... Sushi's such a sweet boy! But absolutely noted. It'll be good for Sushi too, to get him used to going to the vet's office, as he's currently the one who gets a little more nervous outside of the house.

iPappy - Thanks for your vote of confidence I'm sure anyone here would do the same when faced with a bad diagnosis for their little friends with no answers readily available. I do admit I'm a little more neurotic than average and most of my friends would think I'm crazy with the depth of research I've done on a subject I'm not very knowledgable in, but what can I say, these little guys are my life and I'll do anything to help them. We appreciate your kinds words and will keep doing our best for Bowser Thanks for sharing your story about your dogs too, it's so rewarding to see their behaviours changing the way you intend them to. Hope your old dog is doing OK, and if not I'm sure you gave him the absolute best life he could have!

 

[bowshi]

Hi everyone, a small update - Bowser's atenolol pills will be coming in shortly. Not that I am having second thoughts but I'm wondering how atenolol would affect a kitten of his age mentally? Will he still be the same lovable furball who comes running for cuddles every evening? Or will he be not so happy taking it twice daily? We've been practicing pilling him with dry kibble, to some success but he obviously doesn't like it.

I have asked to be referred to a board certified cardiologist for a second opinion on the results in the report (which was written by the mobile sonographer - a vet himself). Not that I doubt his abilities, but with the disease being as rare as it is, it may not be as well understood outside of cardiac specialists. Would be nice to understand every option we have for treatment.

 

[fionasmom]

You are doing the right thing. I have an almost 7 year old boy with HCM, diagnosed at 2. While Bowser does not have this condition, I do want to add that Jamie has done well for the last 5 years. As to the board certified cardiologist...Jamie's first ECG was done by a well known mobile sonographer who frequents this area. He and the vet then drew up a treatment plan, the vet being one with decades of practice. I asked for a referral to a cardiologist and she made several changes and was a little concerned that a vet and sonographer would make up a treatment plan at all. I am not saying that you will encounter this or that your vet is not competent, but there are specialists for a good reason. Your boy has a rarer condition, so I would definitely want a second opinion.

As I recall, the amount of atenolol that Jamie took was very minute in size, although he was later taken off of it. You may be able to hide it in a pill pocket or paste. There are a lot of idea here on TCS that we can refer you to.

 

[bowshi]

fionasmom - That's great to hear, sounds like Jamie is happy and in good hands, hope that continues for years to come! When you did the referral for the cardiologist, did you redo the whole echo? Or just had your vet send the images and report from the sonographer over for interpretation? I would tend to think that the images would be fine, just maybe a second opinion on the implications of those images would be in order. And I did have similar reservations regarding the treatment plan as well. It means 2x daily medication for Bowser for life... best to cover all bases before continuing on with it. From what I've read, atenolol does seem to be a suitable treatment for his condition, but cardiologist can confirm or revise as required for sure.

Pilling has not started yet... we will be starting tomorrow as both my wife and I will be home for two days so we can monitor Bowser for any side effects. By the sounds of it Jamie remained the same lovable kitty as he was prior to medication - hope we can say the same for our little guy. Thanks for the words of encouragement, and if we have trouble with the capsules we will for sure refer to some ideas on here! We have a seemingly good system right now where we coat the "pill" (ie. dry kibble) in his favourite wet squeeze treat, drop it in his mouth, and immediately follow up with syringe applied water mixed with that same wet squeeze treat to help him swallow. He's already perking up now when he sees the syringe, so hope all goes well when we switch the kibble piece to an actual capsule.