Question about HCM and Prednisolone

Sillycat41

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Yesterday we got the results back on a Feline Senior Wellness Profile with Cardiopet proBNP test for my Jengo. He has CKD and IBD and was diagnosed with Hypertrophic cardiomyopathy now. I am devastated. I had been complaining to two different vets for months about his weakness and wobbliness and neither one suggested doing this test until I asked for more answers. :( Now I'm wondering how much worse it got in a couple of months.

The 2nd vet wants to put him on a drug called Pimobenden to see if it helps... plus she definitely wants him off of the Prednisolone. She says that Prednisolone is hard on the heart. Jengo's old vet wanted to keep him on Prednisolone and said that cats handling it very well without side effects. Who should I believe???

Does anyone know if Prednisolone damages the heart?? Does anyone with a cat who has HCM used Pimobenden??

I'm afraid of putting him on another medication that will stress his kidneys. I'm trying to do some research on this new drug and also on Prednisolone and heart damage but haven't found much. I'm losing my faith in vets... they contradict each other. There are no specialist vets in my area so that's not an option. :( I welcome any opinions.
Barb

 

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I am sorry to hear of Jengo's conditions. As I understand it long term use of Pred may impact the heart, as well as contribute to the development of diabetes. Budesonide is often used in lieu of Pred, for IBD, as it does not have the same impacts to either. So, you may want to ask about that for Jengo's IBD.

I know nothing about the heart med the vet has prescribed, but I did a search on this site and found only one other thread that even mentioned it. Clopedigril (plavix) Transdermal Gel | TheCatSite. The other thing you might consider is joining a forum that deals specifically with feline heard conditions - surely there would be members who have dealt with Jengo's conditions in their own cats. Try this one out - [email protected] | Home

I know you said there are no specialists nearby, but you can ask the vets if they know of ones that would be willing to act as a consult about Jengo's HCM, via teleconference - which is becoming more common in the vet world. Where are you located?

Prednisolone for Cats: Dosage, Safety & Side Effects - Cats.com
Budesonide for Cats: Dosage, Safety & Side Effects - Cats.com
 

BellaBlue82

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There are very limited studies surrounding the effects of corticosteroids on the feline heart, simply because cats have a limited reaction to this drug at low dosages. I was able to find one independent study here:
Most studies are related to CHF, and not HCM though. Unfortunately, it may come down to what are the benefits of each drug and what are the side effects. Sadie has an autoimmune disorder and she will never be able to be weaned off of her prednisolone, so we monitor every year for blood work markers and blood pressure. It's a watch a wait game with us unfortunately.

I agree with FeebysOwner FeebysOwner about the specialist consult. Sadly heart conditions in cats aren't as widely treated as dogs IMO, and I think a specialist in this case might help shed some light on which treatment plan is best.

Sending hugs and luck, I hope you're able to work things out and maybe get a specialist involved! ❤
 

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I admittedly don’t know much about this stuff but have been trying to learn more due to these recent events I’ve gone through, so all I can offer you right now is my personal experience in hopes that it will help you make your decision.

My sweet senior boy was slowing down for about a year or so, the vet assumed it was arthritis. He was then misdiagnosed with allergies when I brought him into said vet for chunks of missing fur and a few sores on his legs. He was put on prednisolone and went into heart failure two days later, and had to be put to rest. The ER vet said his heart failure was already very advanced and beyond treating, so the pred didn’t cause it, but it definitely pushed him over the edge. So I personally would be inclined to believe the vet that says it’s hard on the heart.

Good for you for pushing for more definitive answers, I wish I had done the same. I hope you can find the right answers and the gentlest possible treatment method for him soon :hugs:
 

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Has Jengo had an ECG? I have one boy with HCM, although he has never been offered nor needed pred, so I can't speak to any experiences with that. My other boy had an emergency situation a few months ago with an inability to urinate and my own vet initially ran a number of tests, including proBNP. It was in the range of HCM; however I had to take him to a specialty hospital to resolve the bladder and the internist there felt that the proBNP test was high due to stress and detected no heart irregularities and did not advise going forward with an ECG at this time.

My point is that Jengo should see a cardiologist and have an ECG, completely aside from the pred question so that you know exactly where you stand with the HCM.

FWIW, my older HCM boy was diagnosed at 2 and is now 8. He also has bad kidneys, also diagnosed at 2 and it was the investigation into the kidney issue which lead to the ECG which uncovered the HCM.
 
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Sillycat41

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I am sorry to hear of Jengo's conditions. As I understand it long term use of Pred may impact the heart, as well as contribute to the development of diabetes. Budesonide is often used in lieu of Pred, for IBD, as it does not have the same impacts to either. So, you may want to ask about that for Jengo's IBD.

I know nothing about the heart med the vet has prescribed, but I did a search on this site and found only one other thread that even mentioned it. Clopedigril (plavix) Transdermal Gel | TheCatSite. The other thing you might consider is joining a forum that deals specifically with feline heard conditions - surely there would be members who have dealt with Jengo's conditions in their own cats. Try this one out - [email protected] | Home

I know you said there are no specialists nearby, but you can ask the vets if they know of ones that would be willing to act as a consult about Jengo's HCM, via teleconference - which is becoming more common in the vet world. Where are you located?

Prednisolone for Cats: Dosage, Safety & Side Effects - Cats.com
Budesonide for Cats: Dosage, Safety & Side Effects - Cats.com
Thanks for responding FeebysOwner. The vet that treated Jengo for 17 years was the one who put him on Prednisolone for IBD a couple of years ago. After doing some research I found out that long term Pred use is not recommended. When I asked the vet he said that cats handle it very well with few side effects. Now I am mad at myself for not getting a second opinion years ago because I suspect the Pred damaged his heart. I'm devastated... it was enough dealing with the CKD and now this!!

The 2nd vet who did the tests that diagnosed HMC said that a lot of the heart meds were hard on the kidneys. She said the Pinobenden isn't.... vut said Plavix and Lasix weren't good. It's getting so I don't know which vet to trust. Thanks for the links... I'll check them out in the morning... I''m emotionally exhausted now. Also your suggestion to have the vet consult with a specialist is a good idea... if she'll agree. I'm located in Michigan's Upper Peninsula... the population is around 22,000. No vet specialists here. :( Thanks again.
 

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Yesterday we got the results back on a Feline Senior Wellness Profile with Cardiopet proBNP test for my Jengo. He has CKD and IBD and was diagnosed with Hypertrophic cardiomyopathy now. I am devastated. I had been complaining to two different vets for months about his weakness and wobbliness and neither one suggested doing this test until I asked for more answers. :( Now I'm wondering how much worse it got in a couple of months.

The 2nd vet wants to put him on a drug called Pimobenden to see if it helps... plus she definitely wants him off of the Prednisolone. She says that Prednisolone is hard on the heart. Jengo's old vet wanted to keep him on Prednisolone and said that cats handling it very well without side effects. Who should I believe???

Does anyone know if Prednisolone damages the heart?? Does anyone with a cat who has HCM used Pimobenden??

I'm afraid of putting him on another medication that will stress his kidneys. I'm trying to do some research on this new drug and also on Prednisolone and heart damage but haven't found much. I'm losing my faith in vets... they contradict each other. There are no specialist vets in my area so that's not an option. :( I welcome any opinions.
Barb
I'm sorry to hear about your kitty. I have two cats currently on Prednisolone (not for the same issues in each cat). Each cat is under the care of a different vet (uninteresting story of why). Both of these vets have said that Prednisolone is hard on the heart and CAN cause damage over long term so it is important to keep an eye on their heart while they are taking this drug. I don't know if the following information will be helpful to you or not. One of my cats who also has potential IBD/SCL (Small Cell Lymphoma), does have a heart murmur and our vet is keeping a close eye on that. We just recently started him on Chlorambucil (chemo pill), in addition to the pred. Part of this decision is that we had to up his pred dose from 2.5mg to 5mg and we wanted to investigate if he would be a candidate for Chlorambucil. So, we did a second ultrasound (his last one was about 8 months prior). The vet who did the ultrasound said he was a good candidate and that if he does well on it, we can talk about weening him off Chlorambucil and putting him on another steroid that is apparently not hard on the heart. I forget the name of it, but I'm sure someone will know. According to our vet and some stuff I've seen online, Chlorambucil is also used with IBD and not just for SCL. As far as we know so far, my cat is doing well so far on Chlorambucil and I've been able to reduce his pred back down to 2.5mg. We did get labwork taken yesterday so I'll know more once we get the results back. Since you don't have any specalists in your area, I'm not sure if this route would be appropriate for your cat or not?
 
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Sillycat41

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There are very limited studies surrounding the effects of corticosteroids on the feline heart, simply because cats have a limited reaction to this drug at low dosages. I was able to find one independent study here:
Most studies are related to CHF, and not HCM though. Unfortunately, it may come down to what are the benefits of each drug and what are the side effects. Sadie has an autoimmune disorder and she will never be able to be weaned off of her prednisolone, so we monitor every year for blood work markers and blood pressure. It's a watch a wait game with us unfortunately.

I agree with FeebysOwner FeebysOwner about the specialist consult. Sadly heart conditions in cats aren't as widely treated as dogs IMO, and I think a specialist in this case might help shed some light on which treatment plan is best.

Sending hugs and luck, I hope you're able to work things out and maybe get a specialist involved! ❤
Thanks for responding BellaBlue82. I have been searching for answers too and there seems to be very little about Prednisolone and heart problems. You're probably right... because cats have a limited reaction to low doses!

I also found that link you sent on congestive heart failure and corticosteroids. Yes, I think having the vet consult with a specialist is a good idea.... if her ego doesn't get in the way. :(

Sorry to hear about your Sadie. Hope she continues to do okay on Pred.
Thanks again, Barb
 

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I suspect the Pred damaged his heart. I'm devastated... it was enough dealing with the CKD and now this!! The 2nd vet who did the tests that diagnosed HMC said that a lot of the heart meds were hard on the kidneys. She said the Pinobenden isn't....
I think Pred is more of an issue with cats who are prone to heart disease in the first place. That may be why the one vet didn't think it would be an issue - and, I suspect with some cats it is not. But, don't forget to ask the vet(s) about Budesonide instead of Pred.

All meds are technically 'hard' on either the kidneys or the liver, ss they are processed by one or the other - some by both. So, it is one of those risk vs benefit judgements. You can read up on Pinobenden and see for yourself, but I am guessing the vet is telling you what they know from what they have read through documentation and studies.
 
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Sillycat41

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I admittedly don’t know much about this stuff but have been trying to learn more due to these recent events I’ve gone through, so all I can offer you right now is my personal experience in hopes that it will help you make your decision.

My sweet senior boy was slowing down for about a year or so, the vet assumed it was arthritis. He was then misdiagnosed with allergies when I brought him into said vet for chunks of missing fur and a few sores on his legs. He was put on prednisolone and went into heart failure two days later, and had to be put to rest. The ER vet said his heart failure was already very advanced and beyond treating, so the pred didn’t cause it, but it definitely pushed him over the edge. So I personally would be inclined to believe the vet that says it’s hard on the heart.

Good for you for pushing for more definitive answers, I wish I had done the same. I hope you can find the right answers and the gentlest possible treatment method for him soon :hugs:
Thanks for sharing your experience Biomehanika. I'm very sorry to hear about your sweet senior boy... it's heartbreaking. His old vet suggeste that his weakness was arthritis!! Misdiagnosed!! That was a couple of months ago... who knows how much damage was done to his heart from this delayed diagnosis. :( I am also inclined to believe the vet who wants him off of the Pred. I actually started weaning him a month ago but he is still on one dose a day. I'll print out a weaning chart and taper him off of it. Hope it's not too late. I only wish I had pushed for more answers sooner... he is very weak now. Thanks again. Barb
 
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Sillycat41

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Has Jengo had an ECG? I have one boy with HCM, although he has never been offered nor needed pred, so I can't speak to any experiences with that. My other boy had an emergency situation a few months ago with an inability to urinate and my own vet initially ran a number of tests, including proBNP. It was in the range of HCM; however I had to take him to a specialty hospital to resolve the bladder and the internist there felt that the proBNP test was high due to stress and detected no heart irregularities and did not advise going forward with an ECG at this time.

My point is that Jengo should see a cardiologist and have an ECG, completely aside from the pred question so that you know exactly where you stand with the HCM.

FWIW, my older HCM boy was diagnosed at 2 and is now 8. He also has bad kidneys, also diagnosed at 2 and it was the investigation into the kidney issue which lead to the ECG which uncovered the HCM.
Thanks for responding Fionasmom. No Jengo has never had an ECG. Now you have me wondering if Jengo proBNP test was really high because he's a very nervous cat when he goes to the vet. I'm sure that he was super stressed. The vet did detect a heart murmur though... I think there is a connection between that and HCM.

Unfortunately I live in Michigan's Upper Peninsula where the largest town in only 22,000 and there are no veterinary specialist here. The closest one is about 190 miles one way. :( I have no idea about HCM stages. Hope your boys hang in there. Thanks again. Barb
 
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Sillycat41

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There are very limited studies surrounding the effects of corticosteroids on the feline heart, simply because cats have a limited reaction to this drug at low dosages. I was able to find one independent study here:
Most studies are related to CHF, and not HCM though. Unfortunately, it may come down to what are the benefits of each drug and what are the side effects. Sadie has an autoimmune disorder and she will never be able to be weaned off of her prednisolone, so we monitor every year for blood work markers and blood pressure. It's a watch a wait game with us unfortunately.

I agree with FeebysOwner FeebysOwner about the specialist consult. Sadly heart conditions in cats aren't as widely treated as dogs IMO, and I think a specialist in this case might help shed some light on which treatment plan is best.

Sending hugs and luck, I hope you're able to work things out and maybe get a specialist involved! ❤
I'm sorry to hear about your kitty. I have two cats currently on Prednisolone (not for the same issues in each cat). Each cat is under the care of a different vet (uninteresting story of why). Both of these vets have said that Prednisolone is hard on the heart and CAN cause damage over long term so it is important to keep an eye on their heart while they are taking this drug. I don't know if the following information will be helpful to you or not. One of my cats who also has potential IBD/SCL (Small Cell Lymphoma), does have a heart murmur and our vet is keeping a close eye on that. We just recently started him on Chlorambucil (chemo pill), in addition to the pred. Part of this decision is that we had to up his pred dose from 2.5mg to 5mg and we wanted to investigate if he would be a candidate for Chlorambucil. So, we did a second ultrasound (his last one was about 8 months prior). The vet who did the ultrasound said he was a good candidate and that if he does well on it, we can talk about weening him off Chlorambucil and putting him on another steroid that is apparently not hard on the heart. I forget the name of it, but I'm sure someone will know. According to our vet and some stuff I've seen online, Chlorambucil is also used with IBD and not just for SCL. As far as we know so far, my cat is doing well so far on Chlorambucil and I've been able to reduce his pred back down to 2.5mg. We did get labwork taken yesterday so I'll know more once we get the results back. Since you don't have any specalists in your area, I'm not sure if this route would be appropriate for your cat or not?
Jengo old vet just watched for diabetes when he put him on Pred... insisting that problems would show up. Well, they did show up at HCM now!! I feel to stupid listening to the vet but I have been going to him for 30 yrs. He also didn't detect a heart murmur but the 2nd vet did and she wants him off the Pred. I did start weaning him off of it... too little too late I'm afraid as the heart damage is done. :( He is only on a 1/3 of a 5 mg pill.... 1.67 mg. Next will reduce the dose to every other day for a while. I'm glad that your cats are doing well and the your vet is on top of things. I'm depressed about listening to my old vet.
Barb
 
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Sillycat41

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I think Pred is more of an issue with cats who are prone to heart disease in the first place. That may be why the one vet didn't think it would be an issue - and, I suspect with some cats it is not. But, don't forget to ask the vet(s) about Budesonide instead of Pred.

All meds are technically 'hard' on either the kidneys or the liver, ss they are processed by one or the other - some by both. So, it is one of those risk vs benefit judgements. You can read up on Pinobenden and see for yourself, but I am guessing the vet is telling you what they know from what they have read through documentation and studies.
 
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Sillycat41

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From what I've read recently I think you're right... Pred is only an issue in cats prone to heart disease. My old vet never detected Jengo's heart murmur and even when I went back to him after seeing the 2nd vet and saying that she detected a murmur, he listened for several minutes in 3 places and still said he didn't have murmur. I'm so depressed about this... I should have been more aggressive and had the old vet run more tests because the 2nd vet ran this senior proBNP test and discovered advanced HCM. I'm sure Jengo's life had been shortened by my neglect or trust in the wrong vet. :(

I have been reading about this new med he's on... Pimobendan... and some of the older studies on Tanya's site question it's use. Now I'm worried about giving it too him. This is so stressful... making decisions that could shorten his life. :(
 

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Sillycat41

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Has Jengo had an ECG? I have one boy with HCM, although he has never been offered nor needed pred, so I can't speak to any experiences with that. My other boy had an emergency situation a few months ago with an inability to urinate and my own vet initially ran a number of tests, including proBNP. It was in the range of HCM; however I had to take him to a specialty hospital to resolve the bladder and the internist there felt that the proBNP test was high due to stress and detected no heart irregularities and did not advise going forward with an ECG at this time.

My point is that Jengo should see a cardiologist and have an ECG, completely aside from the pred question so that you know exactly where you stand with the HCM.

FWIW, my older HCM boy was diagnosed at 2 and is now 8. He also has bad kidneys, also diagnosed at 2 and it was the investigation into the kidney issue which lead to the ECG which uncovered the HCM.
Hi Fionasmom - Just re-read your post and have a question for you. You said that your older HCM boy's HCM was uncovered when he had an ECG. Do you remember what the ECG revealed? Is he on any medication for the heart issue?

I'm also curious about your internist's comment that the proNBP test was high due to stress. The vet put Jengo on a drug = Pimobendan/Vetmedin that is being used off-label for cats and I have read on several websites that it should not be used for HCM just congestive heart failure. I've very concern about giving him this drug and so far haven't found anyone else on forums that is giving this to a cat with HCM. There are no specialists in my area so I can't get a 2nd opinion. I'm very worried. :( Barb
 
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I'm sorry to hear about your kitty. I have two cats currently on Prednisolone (not for the same issues in each cat). Each cat is under the care of a different vet (uninteresting story of why). Both of these vets have said that Prednisolone is hard on the heart and CAN cause damage over long term so it is important to keep an eye on their heart while they are taking this drug. I don't know if the following information will be helpful to you or not. One of my cats who also has potential IBD/SCL (Small Cell Lymphoma), does have a heart murmur and our vet is keeping a close eye on that. We just recently started him on Chlorambucil (chemo pill), in addition to the pred. Part of this decision is that we had to up his pred dose from 2.5mg to 5mg and we wanted to investigate if he would be a candidate for Chlorambucil. So, we did a second ultrasound (his last one was about 8 months prior). The vet who did the ultrasound said he was a good candidate and that if he does well on it, we can talk about weening him off Chlorambucil and putting him on another steroid that is apparently not hard on the heart. I forget the name of it, but I'm sure someone will know. According to our vet and some stuff I've seen online, Chlorambucil is also used with IBD and not just for SCL. As far as we know so far, my cat is doing well so far on Chlorambucil and I've been able to reduce his pred back down to 2.5mg. We did get labwork taken yesterday so I'll know more once we get the results back. Since you don't have any specalists in your area, I'm not sure if this route would be appropriate for your cat or not?
Mac and Cats - Hope your kitty's labwork was okay. The more I read online about Prednisolone and heart problems, the more I am upset with myself for listening to my vet. Jengo has been on Pred for a couple of year and last week he was diagnosed with HCM. Did the Pred cause it? I'll never know... but I feel l ike I shouldn't have taken a chance and trusted the vet. Now I'm upset because the 2nd vet put Jengo on a heart medication that is not recommended for HCM. She says she had used it successfully on other cats with HCM but I'm not sure I trust this vet either. I'm so depressed. :-(
 
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Sillycat41

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I think Pred is more of an issue with cats who are prone to heart disease in the first place. That may be why the one vet didn't think it would be an issue - and, I suspect with some cats it is not. But, don't forget to ask the vet(s) about Budesonide instead of Pred.

All meds are technically 'hard' on either the kidneys or the liver, ss they are processed by one or the other - some by both. So, it is one of those risk vs benefit judgements. You can read up on Pinobenden and see for yourself, but I am guessing the vet is telling you what they know from what they have read through documentation and studies.
FeebysOwner - After research Jengo's recent heart diagnosis I found that Bengal (and other breeds) are more prone to HCM. I feel that my old vet should have know this and not insisted that he continue to take Prednisolone if he is prone to heart problems. This is so upsetting.

I have been reading up on Pimobendan/Vetmedin and found that it is a veterinary drug for dogs with CHF... used off label in cats with CHF. A statement on the drug company's website says:


"Is VETMEDIN safe for use in all dogs?
VETMEDIN should not be given in case of hypertrophic cardiomyopathy, aortic stenosis, or any other clinical condition where an augmentation of cardiac output is inappropriate for functional or anatomical reasons."


If it should not be used in dogs with HCM, then why is the vet putting my cat with HCM on it!!?!?! I'm so worried... I need some confirmation from a veterinary cardiologist that he should be on this drug... it could be making things worse!!
Barb
 

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A lot of drugs are used off-label. especially when it comes to cats. But, that doesn't explain or answer your question about CHF vs HCM. First thing to do is ask the vet and see what they say. I do know that CHF can be caused by HCM. I also know that HCM requires an ECG and/or EKG to determine the impacts to the heart. There are cats with HCM, if not severe, that may not require any drugs for years. Secondly, have you talked to this vet, or any of the vets you've seen about consulting with a specialty vet - regardless of distance? Surely, they must be aware of some, and could at least ask for a teleconference/phone consult. There are at least a couple of cardiology vets at MSU who might be willing to act as a consultant. You won't know if you don't pursue this angle.
 

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This is the first report from the cardiologist. She accepted the ECG which had just been done a week earlier as valid, but objected to the medications. It was the original vet and the ultrasonographer who decided that Jamie needed Plavix and atenolol and the cardiologist was very arch about saying that non-specialists should keep their nose out of what they don't know and took him off of both medications.
The original ECG concluded that the findings were consistent with HCM. They determined that the 200BPM were what necessitated the atenolol, but the cardiologist said that the BPM were not concerning for a nervous cat.

Active
• Hypertrophic cardiomyopathy
PATIENT HISTORY
Presenting concerns: Cardiology consultation - Was diagnosed with HCM in May. Started on atenolol and Plavix at that time. Asymptomatic for cardiac disease.;
Activity and exercise history: Normal energy level;
Appetite history: Normal appetite;
Medication history: Current medications - Atenolol 6.25 mg BID (able to give ~3/4 of the time), Plavix 18.75 mg SID
Respiratory history: No labored/rapid breathing;
Vitals
(12:06): Temp (F) 102.6 | HR (/min) 200 | RR (/min) 100 | CRT (s) < 2 | MM color Pink | Wt (kg) 7.52
EXAM FINDINGS
Thorax: All lung fields - Tachypneic, normal bronchovesicular sounds - Nervous
Cardiovascular: Heart - No murmur
Pulse quality - Strong and synchronous pulses
Cardiac rhythm - Regular rhythm
ASSESSMENTS
Hypertrophic cardiomyopathy
LV concentric hypertrophy with no LA enlargement and no LVOT obstruction
PLANS
Hypertrophic cardiomyopathy
Based on review of the record and echocardiogram, no cardiac medications are currently indicated. Plavix is not indicated since there is no
current LA enlargement. Atenolol may be given for HCM, but is of no proven benefit in this scenario. Benefit of atenolol is more likely in patients
with SAM causing LVOT obstruction, which has not been identified in Jamie. Therefore, both medications will be discontinued. We will reduce the
atenolol to 6.25 mg SID for one week then discontinue to help avoid rebound tachycardia.

Jamie has remained stable, fortunately, and is one of those cats as mentioned by FeebysOwner FeebysOwner who do not progress with this condition.

I don't know if any of this is helpful to you; I do agree that if you could in any way consult with other vets through your own vet or remotely it would be helpful.
 
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