Question about HCM and Prednisolone

[Sillycat41]

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.

I'm a nervous wreck worrying about Jengo being on Pimobendan because I have read on legitimate medical sites, including the drug manufacturer's website, that it is not used for HCM but for CHF. The vet didn't say he has CHF though and she has never mentioned doing an ECG... probably doesn't have the equipment as she is just a small town vet. His HCM number was high... 354 ... normal range is 0 - 100... so that's not good.

She insists that she has used Pimo with other cats successfully. Yes, I'm going to check with another vet tomorrow morning and I'm looking for a veterinary cardiologist who could do a teleconference consult. Is MSU Michigan State Univ? I'll check that out this morning. Thanks for the tips.

 

[FeebysOwner]

Is MSU Michigan State Univ?

Yes. I did numerous searches and finally found 2-3 vet cardiologists at MSU. There are others, but as you said, farther away. Because they are affiliated with a university, I was hoping, perhaps, they'd take a greater interest than others in their field.

 

[Sillycat41]

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 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.

Thanks for sending the HCM report on Jamie. The report I got on Jengo wasn't as thorough as that... just gave the number related to the HCM... his was 354 and normal was between 0 -100. Also Jengo has CKD.... apparently Jamie does not, correct?? That is definitely a consideration when prescribing meds that are hard on the kidneys. Also the new vet (in her 30s) said Jengo has a heart murmur and his old vet (in his 60s) listened for several minutes in different spots and said that he doesn't have a heart murmur. ??? Who do I believe... the one with the most experience??

I am trying to find a veterinary cardiologist who does teleconference consults. I really need his meds to be confirmed by a specialist... I'm not comfortable with this new vet's assessment. I don't want his life cut short but some med that he shouldn't be on. I imagine this new vet will be upset if I request a consult with a specialist... we'll see.

Glad to hear that Jamie remained stable. Thanks again. Barb

 

[Sillycat41]

Yes. I did numerous searches and finally found 2-3 vet cardiologists at MSU. There are others, but as you said, farther away. Because they are affiliated with a university, I was hoping, perhaps, they'd take a greater interest than others in their field.

I hope that they will do a teleconference consult. I don't have a car and cannot drive 450 miles one way with Jengo.

 

[FeebysOwner]

I hope that they will do a teleconference consult. I don't have a car and cannot drive 450 miles one way with Jengo.

Do a distance check, I thought the mileage was a fair amount lower than that. but that was just based on using generic locations. Also, while the vets I saw were affiliated with MSU, they may not actually be located at the university. I was also hoping one of these vets might be familiar with a place you could go to for an ECG/EKG that was closer by.

 

[FeebysOwner]

I can't seem to find the specific vet cardiologists I found before, but I did find this - and the front page talks about telemedicine.
Board Certified Veterinary Cardiologists (cavalierhealth.org)

 

[Sillycat41]

Do a distance check, I thought the mileage was a fair amount lower than that. but that was just based on using generic locations. Also, while the vets I saw were affiliated with MSU, they may not actually be located at the university. I was also hoping one of these vets might be familiar with a place you could go to for an ECG/EKG that was closer by.

Used Google maps to check the mileage. In my health I couldn't do a long trip like that myself. Hope I can get a teleconference call and find a local vet that can do an ECG.

 

[fionasmom]

Veterinary Cardiology
This is another directory. It mentions mobile care as an option.

According to IRIS guidelines, Jamie is stage 2.

 

[Sillycat41]

Veterinary Cardiology
This is another directory. It mentions mobile care as an option.

According to IRIS guidelines, Jamie is stage 2.

Thanks for the link... I'll check it out. Hope Jamie's progression is slow... that's all we can hope for with CKD.

 

[Sillycat41]

I can't seem to find the specific vet cardiologists I found before, but I did find this - and the front page talks about telemedicine.
Board Certified Veterinary Cardiologists (cavalierhealth.org)

Thanks for the link... I'll check it out!

 

[Sillycat41]

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.

Hi again FeebysOwner - I haven't been getting an email saying that someone responded so I'm behind on this forum. The vet finally got back to me late last Thurs. March 7th. She suggested doing an ultra-sound and EC=KG and sending it out for interpretation. I'm going to call and schedule that today. Hope it doesn't cost $$$$ but I just don't feel right giving Jengo Pimobendan if he isn't a true candidate for it.

She also said that because he has CRF there is a limit to which drugs can be used for heart problems. Said that she would look into the use of Solensia for arthritis... also because of his kidneys. But I hate giving drugs if we are not sure of the diagnosis. How do they test for arthritis? Thanks, Barb

 

[Sillycat41]

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 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.

 

[Sillycat41]

Hi Fionasmom - Sorry I'm so late responding but it didn't get an email announcement that there was a post. Anyway, I appreciate you sharing the report from your cardiologist and how she objected to the medications Jamie was put on. I feel like my situation with Jengo is similar. I finally got a resonse from his vet on Mar. 7th and she said she could do and ultrasound and EKG and have a veterinary cardiologist interpret the results. I'm going to schedule that today but I am also going to questions whether he should be off of this medication... Pimobendan... before having the tests done for a more accurate result. Does that make sense? I have a stethoscope and have listened to Jengo's heart a couple of times and don't hear a murmur just a regular beat. Now I'm wonder if nervousness can cause a murmur. She is basing his heart problem not just on the proBNP test results but also a murmur. Sigh... this is so stressful. Thanks for you input. Barb

 

[FeebysOwner]

How do they test for arthritis?

Arthritis is usually detectable via x-rays. It will show if there is any increased fluid or swelling, hardening of bone underneath cartilage, new growths protruding from healthy bone (think spurs), and possibly that the joint space has become smaller. Any or all are signs of arthritis.
If you get x-rays done, make sure they not only do his neck/spine, but his legs as well.

 

[fionasmom]

I came across my younger boy's proBNP score the other day and it was 109. 100 is the cutoff for normal and the internist did put it down to nervousness and not a heart condition, if that helps. However, you are saying that there may/may not be a murmur with Jengo. I would go ahead with the testing as you are planning and your question about the Pimobendan is a good one to ask. Do so well in advance of the test as some medication which can affect a test result for a longer period of time than you might think.

 

[Sillycat41]

Arthritis is usually detectable via x-rays. It will show if there is any increased fluid or swelling, hardening of bone underneath cartilage, new growths protruding from healthy bone (think spurs), and possibly that the joint space has become smaller. Any or all are signs of arthritis.
If you get x-rays done, make sure they not only do his neck/spine, but his legs as well.

Okay, thanks FeebysOwner.

 

[Sillycat41]

I came across my younger boy's proBNP score the other day and it was 109. 100 is the cutoff for normal and the internist did put it down to nervousness and not a heart condition, if that helps. However, you are saying that there may/may not be a murmur with Jengo. I would go ahead with the testing as you are planning and your question about the Pimobendan is a good one to ask. Do so well in advance of the test as some medication which can affect a test result for a longer period of time than you might think.

Unfortunately Jengo's proBNP test was done on Feb. 16th and his score was 354... way above the 100 cutoff... which the vet said was HCM. The vet put him on Pimobendan right away so I didn't have a chance to research it until after he started on it. I don't like the idea of using this med if it's not absolutely necessary... and it's an expensive med besides. I've read that it is used for CHF not HCM but she insists that she's had success with it. I want to have a echo done to see how bad his heart it. Need to schedule that soon. Take care, Barb

 

[fionasmom]

With that score I would proceed with any test that might bring some clarity.

 

[Sillycat41]

With that score I would proceed with any test that might bring some clarity.

RIght. I've been doing some research online and hoping to find some info on false positives... like maybe some other health issues are causing this test to be elevated.