Feline Heart FAQ

Frequently Asked Questions (FAQ) for the feline-heart Yahoo! Group


This is the FAQ for the feline-heart Yahoo! Group. Welcome to the group, but sorry you had to join. If your cat has just been diagnosed, you probably have a lot of questions. If you don't find the answers you're looking for here, want more details, or need a shoulder to cry on, please post to the group. We are a friendly bunch with a vast amount of combined experience in managing cats with heart disease. Wherever you are now, we have been there.

This FAQ is for informational purposes only and is not a substitute for veterinary advice. Consult your veterinarian before making any changes to your cat's treatment plan.



Table of Contents

About the feline-heart Yahoo! Group and this FAQ

Just Diagnosed

Terminology

Managing a Cat with Heart Disease

Common Medications prescribed for Heart Disease

Quick Facts

Natural Remedies

Selected feline-heart Cats and Their Stories

Questions and Answers

About the feline-heart Yahoo! Group and this FAQ

What is the purpose of the feline-heart Yahoo! Group?
The feline-heart Yahoo! Group is a place where members can discuss feline heart conditions and treatments. You are welcome whether your cat was just diagnosed, suddenly passed on, or if you just want to learn more about feline heart conditions. Collectively, the group has a vast amount of experience caring for cats with several types of heart conditions and in all stages of heart disease. No question is too basic or dumb - as one of our members likes to say, the only dumb question is the one that isn't asked. If your cat has just been diagnosed and you want to provide your cat with the best care that you can, or if you are trying to come to terms with the passing of your cat due to heart disease, the feline-heart group understands and can help. We can be found at http://groups.yahoo.com/group/feline-heart. You can participate by posting to the group or just lurk and read what others have posted. You can also search the archive of all posts since the group's inception.

Who started the feline-heart group and administrates it?
Diane created the group in April of 2000 and she is the administrator of the group. The group is not moderated, but occasionally Diane will step in if a discussion becomes heated or if spam is posted to the group. Email Diane if you have any concerns about a post that you have read on the group. Questions about your cat's situation in particular should be posted to the feline-heart Yahoo! Group.

Who contributed to and maintains the FAQ?
This FAQ was compiled and written by Sarah Ettritch and Susan Jones. Some answers are based on posts made to the group by Jen Lundgren. If you have suggestions or corrections to the FAQ, or wish to report a broken link, please email Sarah. Questions about your cat's situation in particular should be posted to the feline-heart Yahoo! Group.

Where is the most recent version of the FAQ?
The most recent version of the FAQ can be found at http://sites.google.com/site/felineheartfaq/home. If you are reading this FAQ through another link, it may be out of date. Since the field of feline cardiology is an active one with advancements being made every day, it is important that you read the most up to date information.

I posted to the group but I don't see my post. What happened?
By default, replies to posts in the group are sent by email to the author of the post you are replying to. If you want your post to be seen by the entire group and are replying using your email program, change the To: field to feline-heart@yahoogroups.com, or add feline-heart@yahoogroups.com to the Cc: field. If you are replying using the web site, choose feline-heart@yahoogroups.com from the choices next to the To: field.

I have a question that isn't answered in the FAQ.
The FAQ contains the most common questions that newcomers post to the feline-heart Yahoo! Group. It is meant to be a starting point for newcomers or for those with a cat whose situation has changed. If you have a question that isn't contained in the FAQ, please post it to the group.

Just Diagnosed

My cat has a heart murmur, what should I do?
An ultrasound of your cat's heart should be performed. Blood work should also be performed because hypertrophic cardiomyopathy (HCM) can be caused by hyperthyroidism. Chest X-rays may be required to determine whether your cat is in congestive heart failure (CHF). However, chest X-rays are not enough to properly diagnose a heart condition. An ultrasound is the most important step you can take to ensure that your cat receives the best possible treatment.

My kitten has a heart murmur. Should I be concerned?
Soft heart murmurs in kittens may be innocent, meaning that they will go away in time. However, a soft heart murmur in a kitten can also be due to congenital heart disease and there is no way to distinguish between an innocent murmur and congenital heart disease just by listening to the murmur. If you wait to see if the heart murmur goes away, there is a small chance that the kitten will end up having congenital heart disease, however most kittens with soft murmurs will end up having innocent murmurs or mild disease. Given this, there is no clear answer about what to do if your kitten has a soft heart murmur. It is up to you and your vet to decide if an ultrasound should be performed. If the heart murmur is a moderately loud to loud murmur, an ultrasound should definitely be performed because moderately loud to loud murmurs are almost never innocent.

My cat has a gallop rhythm, what should I do?
Gallop rhythms should be investigated further. Unlike heart murmurs, which may be innocent, gallop rhythms are usually an indication of underlying heart disease. The same diagnostic tests should be performed for a gallop rhythm as would be performed for a heart murmur. See My cat has a heart murmur, what do I do?

My cat has fluid in his/her chest, what does this mean?
If your cat has fluid in his/her chest, then your cat is in congestive heart failure (CHF). Because fluid in the chest can be life threatening, the priority will be to drain the fluid. If a large amount of fluid is outside the lungs (pleural effusion), the vet will drain it manually by inserting a needle into the chest (referred to as tapping the chest). Your cat will then be placed on a diuretic. If the fluid is inside the lungs and/or only a small amount of fluid is outside the lungs, diuretics will be used to drain the fluid. Depending on how much fluid is in the chest, your cat may have to remain at the veterinary clinic so that diuretics can be administered intravenously. Your cat will have to remain on a diuretic until the chest has been completely cleared and in some cases, indefinitely. After the initial crisis has passed, your vet will attempt to determine the smallest dose of diuretic that is required to keep your cat's chest clear, since diuretics can affect kidney function (see How can Lasix (and other diuretics) affect the kidneys?). Your cat should also be placed on medication that will help the heart pump blood more efficiently. If an ultrasound hasn't been done, one should be performed to determine what heart medication(s) your cat should take. An ultrasound is the most important step you can take to ensure that your cat receives the best possible treatment.

My cat has a saddle thrombosis, what does this mean?
It means that a blood clot has lodged itself in the artery that supplies your cat's back legs with blood. As you are aware, this paralyzes the back legs and is extremely painful for the cat. Your cat will be placed on anti-coagulants, which will try to help your cat's own system dissolve the clot and restore movement to the back legs. Sometimes the clot cannot be dissolved and euthanasia may be raised as an option. Each case is unique, and you as the owner are the only one in a position to decide what is best for your cat and for yourself. Make sure that you discuss all available treatments and their chances of success with your vet before making a decision. There are several members of the group who have faced this situation, so if you are looking for advice from people who have been in the same situation that you are in now, please post to the group.
(see Arterial Thromboembolism for an in-depth article about blood clots, including treatment and prognosis)

What does "thrown a clot" mean?
When the heart is not pumping efficiently, blood can pool in the heart's atria and blood clots can form. Sometimes one of these clots leaves the heart and will block an artery. The most common place for the clot to get stuck is where the aorta splits to become the femoral arteries to the back legs, hence the term "saddle thrombosis". Other places the clot may lodge are the brain or the lungs. When a blood clot leaves the heart and blocks an artery, the cat has "thrown a clot". Sometimes a clot will partially block an artery, allowing some circulation to continue. When this occurs, a cat may appear to have a "lazy foot", may shake their legs often, or their legs may be more sensitive to touch.

My cat has been diagnosed with hypertrophic cardiomyopathy (HCM), what do I do?
If your cat hasn't had an ultrasound, you should have one done immediately. If your cat has already had an ultrasound, she/he will have been placed on medications that will help the heart pump blood more efficiently. Your cat has most likely been prescribed a beta-blocker, a calcium channel blocker, an ACE-inhibitor, or some combination of the three. If your cat is in congestive heart failure, a diuretic should also have been prescribed. Aspirin may be prescribed if your cat is at a high risk for developing blood clots. If your cat has not been tested for hyperthyroidism, you should ask that your cat be tested. Hyperthyroidism can be an underlying cause of HCM. Once all of this has been done, it's up to you to ensure that your cat receives his/her medication and lots of TLC. You may want to read the Managing a Cat with Heart Disease section.

My cat has been diagnosed with restrictive cardiomyopathy (RCM), what do I do?
RCM cannot be diagnosed without an ultrasound, so if your cat has not had an ultrasound, the diagnosis of RCM is premature and you should request an ultrasound immediately. Once an ultrasound has been performed and your cat diagnosed with RCM, he/she will be placed on an ACE-inhibitor and/or a calcium channel blocker. The medication prescribed will depend on the condition of your cat's heart. Beta-blockers are generally not prescribed for RCM. RCM is a rarer and more severe heart condition than HCM, so most likely your cat will be in congestive heart failure and will also be placed on a diuretic. Aspirin may also be prescribed if your cat is at a high risk for developing blood clots. Once all of this has been done, it's up to you to ensure that your cat receives his/her medication and lots of TLC. You may want to read the Managing a Cat with Heart Disease section.

My cat has been diagnosed with a heart problem but it isn't HCM or RCM.
This FAQ addresses HCM and RCM because they are the most common types of heart disease in cats. If your cat has been diagnosed with another disease, please post to the group. While most of our members have cats with HCM or RCM, the group includes members with cats that have other types of heart disease.

Should my cat have an ultrasound or are chest X-rays adequate?
Your cat should definitely have an ultrasound. Chest X-rays can determine if your cat is in congestive heart failure and can give a general idea of whether the heart is enlarged, but they do not provide the veterinarian with the information that is required to differentiate between different types of heart disease and to prescribe the appropriate medications for your cat. An ultrasound is the most important step you can take to ensure that your cat receives the best possible treatment.

I have a detailed report from my cat's ultrasound. How do I interpret it?

  • M-modes and B-modes take pictures of the heart itself; they can look at widths, measure changes in size of different portions of the heart as it beats.
  • LAD is the measurement of the left atrium. This is an indication of the amount of hypertrophy or extra thickness in the top part of the left side of the heart.
  • AOD is the measurement of the aorta, the main blood vessel leaving the left ventricle. LA/Ao is the left atrium to aorta ratio; thus the measurement of the LA size to the aorta size. IVS is the interventricular septum width. This is the part between the two ventricles that divides the lower part of the heart into two. This width is also increased in HCM.
  • The small s and d after the two IVS refers to the diastolic and systolic phases of the heart. Systolic is the active contraction of the ventricles and diastolic is the relaxation of the ventricles.
  • LVID is the left ventricular internal dimension, the size of the inside of the left ventricle, with measurements for the systolic and diastolic phases listed.
  • LVFW is the left ventricular free wall measurement. This is the outer part of the left ventricle that moves with each contraction. Increases in width of this wall indicate severity of the hypertrophy.
  • FS is the percentage of fractional shortening of the left ventricle; meaning how hard the left ventricle contracts during the active systole phase. Doppler mode is the echo mode that looks at the blood flow through the heart They examine speeds of flow and any back flow or regurgitation that might be taking place.
  • MV peak velocity is the speed that the blood passes through the mitral valve. This is the valve between the left atrium and ventricle. It is a very strong valve that prevents the back flow of blood from the left ventricle to the left atrium. This back flow if it happens is called mitral regurgitation. It reduces the efficiency of the blood flow through the heart. In HCM, mitral regurgitation is usually the result of the hypertrophy of the left ventricle which interferes with the valves action (especially the papillary muscles, which hold the valve and keep it from allowing leakage and moving backwards.)
  • AO peak velocity is the speed of the blood leaving the left ventricle through the aorta. Often our cats get subaortic obstruction (may be dynamic caused by the movement of the heart itself, or static, meaning it is there all the time due to structural changes in that part of the heart.)
  • Laminar means the flow is smooth, there is no turbulence in the flow out of the heart. This is normal flow.

Should my cat see a feline cardiologist?
Yes. Even if your regular vet is well versed in the field of cardiology, a cardiologist will know about the latest advances in treatment. If there are no cardiologists in your area, your cat should see an internal specialist (ACVIM). Internal specialists receive more training than general practitioners. Usually the cardiologist/internal specialist and your regular vet will work together in managing your cat's case.

Where is a cardiologist/internal specialist in my area?
You can check the American College of Veterinary Internal Medicine Specialists and the European College of Internal Veterinary Medicine - Companion Animals, which also includes specialists in countries outside of Europe. If your area is not listed in the directory, please post to the group and someone in your area may be able to recommend a cardiologist or internal specialist.

How long will my cat live?
This is the number one question that everyone wants answered when their cat is diagnosed, but unfortunately there is no definite answer. Studies have shown that asymptomatic cats live longer than cats in congestive heart failure, who in turn live longer than cats who have experienced a thromboembolism (thrown a clot). Also, the survival time for cats with HCM is usually longer than for cats with RCM. However, these are just guidelines. When you read the feline-heart Yahoo! Group, you will read about cats at all stages of heart disease. You will read about cats who have lived quite well with the disease for several years, cats who are struggling with congestive heart failure, and cats who pass away just a day or two after their owner has joined the group. Each cat's heart is unique. If your cat has been diagnosed with HCM or RCM, your cat is living with an illness that can go into crisis at any time. You cannot control when this will happen or prevent it from happening. Make sure your cat receives the best care possible and cherish each day you have with your cat. Try not to think about what will happen and when. It is very difficult to do this at first, and most of our members struggle with this for a time after initial diagnosis, but eventually most people achieve some level of acceptance of their cat's illness and our wish is that you will as well. It helps to tell your story to people who understand, so please post to the group and tell us about your cat and your story so far.

Should I treat an asymptomatic cat?
There are no studies examining whether it is beneficial to place an asymptomatic cat on heart medication. Some members who are treating asymptomatic cats have noticed increased exercise tolerance, but this evidence is anecdotal in nature. You should make a decision about your own cat by discussing your cat's case with your regular vet and your cat's cardiologist or internal specialist.

Terminology

What is hypertrophic cardiomyopathy (HCM)?
Hypertrophic cardiomyopathy (HCM) is a heart disease where areas of heart muscle enlarge and thicken. The left side of the heart is most commonly affected. The heart's ventricle becomes smaller in capacity due to the thickening of its walls. Because the ventricle holds less blood, the heart must beat faster (tachycardia) to pump the same amount of blood to the body. As a result, the heart spends less time in diastole (the time between heartbeats) and therefore the ventricle does not fill as well. This decreases the amount of blood pumped out which again leads to an increased heart rate. While all this is occurring, the left atrium has to handle the same amount of blood returning to the heart. Since less is going into the ventricle with each beat, the atrium begins to stretch to accommodate the extra volume. Also, as changes in walls and pressures occur, the mitral valve (between the left atrium and ventricle) starts to leak, or regurgitate, blood back into the atrium when the ventricle contracts. This adds to the overload in the atrium. The mitral valve can also interfere with the blood flow out of the left ventricle, causing obstruction to the blood flowing out to the body.

What is restrictive cardiomyopathy (RCM)?
Restrictive cardiomyopathy (RCM) refers to a group of disorders in which the heart chambers are unable to fill properly with blood because of stiffness of the heart muscle. It presents in the same way as HCM, except that the ventricle becomes smaller not due to thickening of the walls, but due to fibrosis (scarring) of the heart muscle. The heart cannot relax normally in diastole (the time between heartbeats). Usually cats with RCM have a dramatically enlarged right atrium and are in congestive heart failure when diagnosed. Unfortunately, RCM is the least understood of the feline cardiomyopathies and the prognosis for cats with RCM is poorer than for those with HCM.

What is congestive heart failure (CHF)?
A cat is said to be in congestive heart failure (CHF) when pulmonary edema or pleural effusion is present. It occurs when the heart is no longer able to meet the demands for pumping blood around the body. Blood backs up into the lungs, leading to fluid leaking into the lung tissue (pulmonary edema) or around the lungs (pleural effusion). This prevents the lungs from functioning normally, leading to breathlessness and lethargy. An X-ray provides the most readily available means to identify pulmonary edema. The treatment for heart failure tends to be independent of the form of cardiomyopathy present. Cats with acute heart failure tend to present in severe respiratory distress and can easily become critical without proper care. Initial management focuses on managing the dyspnea or respiratory distress. The dyspnea can be from pleural effusion, pulmonary edema or a combination of the two. Less commonly, congestive heart failure can lead to pericardial effusion, which is excess fluid within the sac that contains the heart (pericardial sac).

What is dyspnea?
Dyspnea means difficult or labored breathing.

What is pulmonary effusion?
Pulmonary effusion is fluid in the space around the lung. If the amount of fluid is large, the fluid will be removed with a needle, which is known as a chest tap or tapping the chest. Sometimes Lasix may be used to try and remove the fluid system. If the amount of fluid is small, Lasix is used to drain the fluid rather than a chest tap.

What is pulmonary edema?
Pulmonary edema is fluid in the alveoli or breathing sacs of the lungs. It can sometimes be heard with a stethoscope as crackles (sounds like rice krispies in milk) when the cat breathes in and out. Sometimes, the fluid is only seen on X-ray. The edema can be acute (sudden onset) or chronic.

What is pericardial effusion?
The pericardial sac is the sac that contains the heart. Normally there is a small amount of fluid between the heart and the lining of the sac. Excess fluid in the sac is known as pericardial effusion and can lead to problems with heart function. The liver and kidneys can also be affected by this condition. Congestive heart failure is one of the possible causes of pericardial effusion.

What is a heart murmur?
Heart murmurs are abnormal, extra heart sounds that are of a relatively long duration. Heart murmurs occur as a result of turbulence within the heart created by disturbed blood flow. Murmurs are graded, with 1 being the least severe and 6 being the most severe:

  • Grade 1: a very soft, localized murmur detected only in a quiet room after minutes of intense listening.
  • Grade 2: a soft murmur, heard immediately, localized to a single valve area.
  • Grade 3: a moderate intensity murmur that is evident at more than one location.
  • Grade 4: a moderate intensity to loud murmur; radiates well; but a consistent precordial thrill (vibration) is not present.
  • Grade 5: a loud murmur accompanied by a palpable precordial thrill (vibration).
  • Grade 6: a loud murmur with a precordial thrill (vibration), audible when the stethoscope is removed from the thorax.

What is a gallop rhythm?
A gallop rhythm is an extra heart sound that is heard with a stethoscope. It sounds like horses hooves galloping in your cat's chest.

What is an echocardiogram/ultrasound?
An echocardiogram is an ultrasound examination of the heart. The ultrasound is the definitive test to assess function and chamber size in the heart; it is also the only true way to distinguish between the three forms of cardiomyopathy. Because most general practice veterinary clinics do not own or have the expertise to evaluate an echocardiogram, you may be referred to a specialty veterinary practice, either to an Internal Medicine or Cardiology specialist. The ultrasound is a completely non-invasive diagnostic test. In the vast majority of cases even sedation is not required. Your cat may or may not be shaved and you may or may not be present during the exam to help hold and calm your cat.

Managing a Cat with Heart Disease

How do I pill my cat?
For instructions on how to pill a cat, see How to Pill a Cat in the Animal Sheltering How To Series. You can also view the following videos from the Cornell University's Partners in Animal Health Video Chapters: Giving Your Cat Liquid Medications and Giving Your Cat a Pill or Capsule. Always follow a pill with some water or a bit of food to ensure that the pill dissolves in the cat's stomach rather than in the esophagus. To give some water, use a syringe and squirt the water from the side of your cat's mouth horizontally across the tongue. Never squirt the water in the direction of your cat's throat because it can be aspirated into the lungs.

Other tips: dip the pills in butter, put multiple pills into a gel cap (which can be purchased at pharmacies) and dip it in butter, or put the pill inside a cat treat. Pill the cat at counter height in the kitchen or bathroom, or pill against the back of upholstered furniture, with the cat tucked under one armpit, hand cupping chest. This leaves one hand free for pilling, and because the cat's claws are attached to the upholstery, you have a relatively immobile subject. Another technique is to sit on the floor and hold the cat between your legs, leaving hands free for pilling.

My cat is hard to pill. Are there other ways of giving medication?
Yes. There are compounding pharmacies that can provide the medication as a liquid, paste, transdermal gel, or in the form of treats. The liquid can be squirted into the cat's mouth using a syringe. The paste can be licked up. The transdermal gel is rubbed on the inside of the ear. And treats are eaten. Compounded medication is a bit more expensive than getting medication in pill form but the reduction in stress around medication times, for both you and your cat, can make the extra expense worthwhile. Most vets have a couple of compounding pharmacies that they work with, however some vets will charge a premium to order compounded medication so it's best to ask around.

Is it cheaper to buy my cat's medication at a regular pharmacy?
It might be. Because our cats are on medicine developed for people, you can purchase the medicines with a prescription from your vet at any pharmacy or online pharmacy. You'll have to shop around and do price comparisons. In the US, Wal-Mart and Target are reportedly more reasonable than CVS and Walgreens. Some of the group's American members order medications online from pharmacies in Canada. Please post to the group if you want more information or recommendations for reputable online pharmacies.

Where can I find a compounding pharmacy?
This will depend on where you are located and on what medication you would like compounded. Please post this question to the feline-heart Yahoo! Group so that members who currently order compounded medications can recommend the best one for you.

What should I feed my cat?
You should discuss your cat's diet with your vet. Nutritional requirements and restrictions will vary depending on a cat's medical history, stage of cardiac disease, and the existence of other medical conditions. For a general discussion on nutrition and heart disease, see Nutritional Therapy of Heart Disease.

What about sodium restriction?
Your cardiologist or internist is the best person to answer this because sodium restriction is usually not initiated until a certain stage of heart failure.

Why won't my cat eat?
There are a number of reasons why your cat may have stopped eating or is picking at his/her food. The most common one is because your cat is feeling nauseous due to the medications s/he is taking. Your cat may also be depressed emotionally because s/he feels lousy. It is very important that your cat eat. Because of feline metabolism, cats can quickly develop fatty liver disease if they stop eating. You should call your vet and discuss the situation with them. You may also want to visit the Feline-Assisted-Feeding Yahoo! group, which is run by one of the feline-heart members. For some tips on how to entice a cat to eat, see Diagnostic and Therapeutic Approach to the Anorectic Cat.

My cat is losing weight. What is going on?
It is very important for your cat to maintain optimal body weight since both obesity and weight loss can adversely affect health. If your cat is losing weight, s/he is not getting enough calories. You may want to ask your vet about prescription critical care canned foods, such as Hill's A/D and Eukanuba Maximum Calorie. For more information about nutrition and heart disease, including what foods and treats are appropriate for a cat with heart disease, see Nutritional Therapy of Heart Disease.

Should my cat be vaccinated?
In some jurisdictions, annual rabies vaccines are mandatory. The recommendation of the group would be that cats in CHF not be vaccinated regardless, especially if their vaccinations had previously been up to date. Whether to vaccinate asymptomatic cats or cats with mild HCM is a question best discussed with your vet.

Is it okay to give my cat catnip?
This depends on the cat. If your cat has never had catnip before, now isn't the time to start, so the answer is no. If your cat has had catnip before, it depends on how your cat typically reacts to it. If your cat goes into a hyper state for more than a few minutes, then it's not a good idea to give your cat catnip. If your cat becomes mellow or is hyper for a very short period of time, then the risk associated with giving your cat catnip is very low. Of course, if you want no risk at all, the best thing to do is not to give your cat catnip.

How can Lasix (and other diuretics) affect the kidneys?
Diuretics act on the kidneys to increase the amount of fluid being removed from the body. This will place a strain on the kidneys, which in turn can adversely affect kidney function in some cats. A few days after your cat is first placed on a diuretic, or when your cat's dose of diuretic is increased, blood work will be performed to determine how well your cat's kidneys are tolerating the increased demand on them. Often, treating a cat in congestive heart failure becomes an exercise in balancing kidney function against fluid accumulation. Cats have different tolerance levels for diuretics, so some cats can tolerate large amounts of diuretics, while others will experience impaired kidney function on small doses. Because of this, your vet will attempt to determine the smallest dose of diuretic that is required to keep your cat's chest clear after any crisis associated with fluid has passed. It is very important that you monitor your cat's general attitude and appetite when your cat is taking diuretics. If your cat stops urinating, urinates more than usual (after taking into account the effect of the diuretic), has a decreased appetite, and/or is lethargic, it is possible that your cat's kidney function is being affected by the diuretics and you should consult your veterinarian immediately. The Feline-Heart-CRF Yahoo! Group is a support group for people with cats that have both heart disease and Chronic Renal Failure. It is also open to people whose cats don't have CRF but who are trying to balance kidney function against fluid accumulation due to congestive heart failure.

I'm worried about my cat because... What should I do?

  • My cat is not eating: If your cat doesn't eat within 24 hours, call your vet. Do not delay calling any longer than this because your cat may develop fatty liver disease.
  • My cat is not urinating/defecating: See your vet as soon as possible.
  • My cat's breathing is labored: See your vet as soon as possible.
  • My cat's breathing is rapid: If your cat's respiration rate is higher than 30 breaths per minute at rest, call your vet as soon as possible.
  • My cat is breathing with an open mouth: This is an EMERGENCY. Take your cat to a vet immediately or your cat may die.
  • My cat's gums/paw pads are bluish in color: This is an EMERGENCY. Take your cat to a vet immediately or your cat may die.
  • My cat is lethargic: Call your vet.
  • My cat is picking at his/her food: If your cat's appetite doesn't improve within 24 hours, call your vet.
  • My cat is coughing frequently: Call your vet.
  • My cat's rear legs are paralyzed: This is an EMERGENCY. Take your cat to a vet immediately because your cat is in extreme pain.
  • My cat's rear legs seem weak: See your vet as soon as possible.
  • My cat had a seizure: See your vet as soon as possible.
  • My cat is having problems seeing: See your vet as soon as possible.
  • My cat is unable to find a comfortable position/is having problems sleeping: Call your vet.

Common Medications prescribed for Heart Disease

What is an ACE-inhibitor?
ACE-inhibitors end in pril. For example: Enalapril (Enacard, Vasotec), Benazepril (Lotensin, Fortekor), Lisinopril (Prinivil, Zestril). ACE inhibitors dilate blood vessels and moderate excess hormone activity that occurs with heart failure, resulting in less resistance in the blood vessels against which the heart must pump. Angiotensin converting enzyme (ACE) inhibitors reduce resistance in the blood vessels to reduce work load of the heart.

What is a beta-blocker?
Beta-blockers end in -ol. For example: Atenolol, Propanolol or Carvedilol. Beta-blockers slow the heart rate which allows the ventricle a longer time to fill. They also reduce the heart's oxygen demand, and help control certain rhythm disturbances. Adverse effects are usually related to excessive beta blockade and individual animals vary considerably in their response; thus, low doses are used initially and slowly increased to effect. Dosage and frequency of administration also depends on the drug used. Adverse effects can include excessively slow heart rate, worsening of heart failure, low blood pressure, depressed attitude, and possibly masking early signs of low blood sugar (especially in diabetics). Beta-blockers should not be given to a cat in congestive heart failure (CHF) unless the cat was already on one when asymptomatic.

What is a calcium channel blocker?
Calcium channel blockers are used to help control certain heart rhythm disturbances. Diltiazem is a calcium channel blocker that is used to help control certain heart rhythm disturbances and to promote heart muscle relaxation in hypertrophic cardiomyopathy (especially in cats). Adverse effects are uncommon at standard doses but can include decreased appetite, slow heart rate, and rarely, other stomach/intestinal or heart effects.

What is a diuretic?
Diuretics ("water pills") are often used to remove excess fluid. Lasix (Furosemide) is the diuretic most often used to promote the loss of excess fluid in patients with congestive heart failure. The dosage varies depending on the clinical situation and the patient's response, but generally the lowest dose that controls signs of congestion is used for chronic therapy. Adverse effects of Lasix are usually related to excessive fluid and/or electrolyte losses (especially potassium) resulting in dehydration and weakness.

What is Atenolol?
Atenolol is a beta-blocker.

What is Enalapril, Benazepril (also known as Fortekor), or any other medication ending with -pril?
Medications ending in -pril are ACE inhibitors.

What is Diltiazem?
Diltiazem is a calcium channel blocker.

What is Lasix (also known as Furosemide)?
Lasix is a diuretic.

What is Spironolactone?
Spironolactone is a potassium-sparing diuretic. It has the same effect as Lasix, but doesn't affect potassium metabolism.

Why is my cat taking Aspirin? I thought it was toxic to cats.
Your cat is taking Aspirin in the hope that it will help prevent blood clots. Studies are inconclusive as to whether Aspirin does reduce the risk of throwing a clot. Most vets will prescribe it for cats that are at high risk of developing clots because something is better than nothing. The maximum dose of Aspirin that can be given to a cat is 1 baby Aspirin (80mg) every 3 days. Many vets will prescribe half that amount (40mg) every 3 days. Higher doses of Aspirin are toxic to cats, so make sure you follow your vet's instructions carefully.

Quick Facts

What is a cat's normal respiration rate?
15-30 breaths per minute. Respiration rate should be taken when your cat is at rest. To take your cat's respiration rate, count how many times your cat inhales within a 15 second period and then multiply by 4.

What is a cat's normal heart rate?
Heart rate is extremely variable in cats. At home at rest it is usually down in the 130 to 140 beats/minute range and in a veterinarian's office it's common for it to be up to 240 beats/minute and sometimes even beyond that. There should be no difference in the heart rate heard through a stethoscope and the pulse rate.

What is a cat's normal blood pressure?
In a calm cat, the systolic pressure should be less than 150 mmHg using a Doppler unit. Diastolic pressure can't be reliably measured in cats and should be disregarded. Almost all high blood pressure in cats is secondary to some other disease process, with kidney disease/failure and hyperthyroidism being the most common. Cats that get into problems with high blood pressure (most commonly retinal bleeding) usually have a systolic blood pressure over 200 mmHg. That leaves a big gray zone between 150 and 200 mmHg that is abnormal in some cats and normal in others just because they are in a veterinarian's office. This makes diagnosing anything other than quite severe high blood pressure very difficult.
(mmHg = A unit of measurement for pressure, millimeters (mm) of the metal mercury (Hg))

Natural Remedies

What about natural remedies?
Some members of the group are using natural remedies as a part of their cat's treatment plan. Natural remedies should not replace conventional medications and should be used under the supervision of a holistic veterinarian. Please post any questions that you have about the use of natural remedies to the group.



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Last Updated: August 14, 2009
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This FAQ is for informational purposes only and is not a substitute for veterinary advice. Consult your veterinarian before making any changes to your cat's treatment plan.

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