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Cat Forum / Health and Behavior / December 2005TK's recent Echo...The good, the bad, and the confusing
-----BEGIN PGP SIGNED MESSAGE----- TK got his 6 month echocardiogram at Tufts last week with somewhat mixed results regarding his HCM. The Good: "TK's echocardiogram does not show any significant progression of his disease and some parameters are actually better." wIVSd = .64 was .69 wLVWd = .62 was .66 "ISACHCib Hypertrophic cardiomyopathy with minimal left atrial enlargement. There appears to have been some regression in LA size, LV wall thickness, and there may be less mitral regurgitation today" "TK has lost about 5 pounds from the last time he was here" "He is in excellent body condition" The Bad: "a IV/VI systolic murmur" (worse than the previous visit) "He had one premature beat as well while we were listening to him." wIVSs = 1.13 was .97 wLVWs = 1.18 was 1.07 The Confusing: TK's regular vet found that the murmur had almost disappeared back in August. Now it's up to a 4 - 6. The explanation that I was given at Tufts was that if the stethoscope isn't in just the right position, then it's hard to hear the murmur. This was the same vet that originally found the murmur and referred us to Tufts, so I find it difficult to believe that that she missed it in August (especially since she went for the electronic stethoscope after she couldn't hear the murmur at all with the regular stethoscope). TK was very upset at Tufts and his heart felt like it was going to explode as I held him....that may account for a more severe murmur. But to go from near 0 in August to 4 - 6 in November just does NOT sit right with me. I can't help thinking that there may be some unknown factor in play, here. The other thing that concerns me is the way he's shed weight so quickly. According to the scale at Tufts,he lost 4 lbs in 3 1/2 months (our measurement puts it closer to 3 lbs). That's quite a loss for a cat that gets 3 cans of Fancy Feast and about 10 gms of Hills m/d (dry) each day. Anyway, I can't put my finger on it, but something just doesn't "feel" right, here. I can't help thinking that there's something going on that everyone is missing. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 16 lines] > me. I can't help thinking that there may be some unknown > factor in play, here. I wouldn't be too concerned about the change in the murmur. In some cats heart murmurs can be significantly louder at higher heart rates and can disappear at lower heart rates. > The other thing that concerns me is the way he's shed > weight so quickly. According to the scale at Tufts,he > lost 4 lbs in 3 1/2 months (our measurement puts it closer > to 3 lbs). That's quite a loss for a cat that gets 3 cans > of Fancy Feast and about 10 gms of Hills m/d (dry) > each day. It certainly wouldn't hurt to have your regular vet run a blood profile including thyroid levels and a urinalysis to investigate other causes of weight loss. Remember the vet you are seeing at TUFTs is a cardiologist and may know less about other disease processes than your regular vet. J. > Anyway, I can't put my finger on it, but something just > doesn't "feel" right, here. I can't help thinking that there's [quoted text clipped - 9 lines] > =NHXj > -----END PGP SIGNATURE----- > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 13 lines] > LA size, LV wall thickness, and there may be less mitral regurgitation > today" That's not good-- that's great! > "TK has lost about 5 pounds from the last time he was here" > "He is in excellent body condition" [quoted text clipped - 27 lines] > me. I can't help thinking that there may be some unknown > factor in play, here. If he was very excited, the murmur would be more pronounced. Also, don't forget, the grading system is rather subjective. > The other thing that concerns me is the way he's shed > weight so quickly. According to the scale at Tufts,he [quoted text clipped - 6 lines] > doesn't "feel" right, here. I can't help thinking that there's > something going on that everyone is missing. When was the last time you had his T4 concentration checked? Hyperthyroidism would explain the murmur and the weight loss. Was his blood pressure checked? Phil -----BEGIN PGP SIGNED MESSAGE----- From: "Phil P." <phil@maxshouse.com> >That's not good-- that's great! I would have been thrilled with the report had it not been for the 4 - 6 murmur and the skipped beat. They did an EKG because of the skipped beat and said things looked pretty normal. The report says "NSR with a rate of 200 bpm and a LV enlargement pattern (R wave)" >If he was very excited, the murmur would be more pronounced. Also, don't >forget, the grading system is rather subjective. TK was VERY upset about the whole ordeal. Plus he had a few different people handling him. They were running a bit behind at Tufts so we had to wait a while, also. First a 4th year student checked him out, then he was back in the carrier, then a cardiologist (resident) checked him out and did some instruction with the 4th yr student, then back in the carrier, then into the ultrasound room, then he was held down on the table for Dr Rush to do the ultrasound (and gave the 4th yr student a nip to express his displeasure with the whole thing which then got him "the hood"), then back in the carrier, then out again for the ekg, then back in, then out again for Dr Rush to check something else with the ultrasound (some type of aortic velocity profile (doppler). Add in a 1 3/4 hour drive in Thanksgiving traffic to get there and 2 1/2 hours to get back and the poor little guy had a rough day. The doppler showed "The aortic velocity is still increased at 2.7 m/s with dagger profile and E-A reversal is still noted". I'm not quite sure what that means, but Dr Rush said it's somewhat expected with TK's condition. >When was the last time you had his T4 concentration checked? >Hyperthyroidism would explain the murmur and the weight loss. Was his blood >pressure checked? They didn't check his bp this time. I would have liked to have it done but I didn't even think of it in the middle of all the activity. After TK's echo in May he had to get a recheck on a low white count in a blood test about a month earlier. I asked his regular vet about doing a thyroid check and she said it didn't need to be done because of his young age (we guess he's about 2 1/2 yo, now). She said increased T4 is not an issue in cats under 6 yo and in 17 yrs as a vet, she's never seen hyperthyroidism in a cat under 8 yo. Dr Rush never mentioned hyperthyroidism as a possible cause, either. Although I never explicitly asked about it. If you know of an exception to the "no hyperthyroidism in young cats" rule, though, I'll bring him to the vet and get him tested. I hate having to disagree with vet's, but it wouldn't be the first time. I think the weight loss can be attributed to your suggestions as to how to keep him on a proper diet, the shift to canned food, and my suspicion that the scale at Tufts may be a bit out of calibration. They even put him on the scale twice because the number seemed low. But he seems to be in "great shape". He's getting a little bit more food, now, so we'll see if his weight stabilizes. Since Thanksgiving, his weight has not changed (I wish I could say the same thing about myself :) ). TK's a lucky cat to have so many good people looking after him. As always, Thank's for your concern, help, and advice. Any suggestions are greatly appreciated. > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 28 lines] > in Thanksgiving traffic to get there and 2 1/2 hours to get > back and the poor little guy had a rough day. I'd say that would do it! Did he say where the murmur is (e.g., mitral)? Tell your wife you want a Littmann 4000 electronic stethoscope for Christmas. The new ones come with sound analysis software so you can see what you're hearing through the steth on your computer monitor-- you can save the file to disk and send it to Dr. Rush as a record of TK's heart sounds when he's calm at home. I tried to order the software for my 9000 but they said it won't work- I don't see why it wouldn't- both units record and send the recording to a computer. I think they're just trying to sell me a new 4000! > The doppler showed "The aortic velocity is still increased > at 2.7 m/s with dagger profile and E-A reversal is still > noted". I'm not quite sure what that means, but Dr Rush > said it's somewhat expected with TK's condition. E:A reversal is a LV relaxation abnormality- its the reversal of early and late filling waves. Dr. Martin can explain it much better than me- he's a vet and also trained in ultrasonography. (I'm glad he's back!) Aortic velocities of 2 to 4.5 m/sec.are usually characteristic of the obstructive form of HCM. Did Dr. Rush say TK has the obstructive form of HCM? > >When was the last time you had his T4 concentration checked? > >Hyperthyroidism would explain the murmur and the weight loss. Was his blood [quoted text clipped - 16 lines] > in young cats" rule, though, I'll bring him to the vet and > get him tested. The youngest I've heard of is 4 but never 2 1/2. I forgot TK is that young. HCM in a cat his age is rare. For HCM to occur in a cat his age, I think its probably congenital. Familial HCM has been documented in several breeds, so, I don't see why it can't haapen in DSHs. I hate having to disagree with vet's, but > it wouldn't be the first time. No, I think he's right. > I think the weight loss can be attributed to your suggestions > as to how to keep him on a proper diet, the shift to canned [quoted text clipped - 5 lines] > weight has not changed (I wish I could say the same thing > about myself :) ). He shouldn't lose more than a pound/4 weeks. Fancy Feast averages about 80 kcal/3 oz. can- the seafood varieties average about 60. 10 g of m/d = about 40 kcals. 280 kcals a day is about right for a 13-14 lb cat. How much does he weigh? > TK's a lucky cat to have so many good people looking > after him. I think you lucked out with Dr. Rush- and TK lucked out with *you*! Btw, did you ever get around to reading the articles I sent you by Dr. Rush? > As always, Thank's for your concern, help, and advice. > Any suggestions are greatly appreciated. I think you're on the right road. Best of luck, Phil -----BEGIN PGP SIGNED MESSAGE----- From: "Phil P." <phil@maxshouse.com> >I'd say that would do it! Did he say where the murmur is (e.g., mitral)? It seems like it's mostly coming from the mitral regurgitation. The report says "IV/VI systolic murmur right sternal border, III/Vi systolic murmur left sternal border. Prominent apex beat." >Tell your wife you want a Littmann 4000 electronic stethoscope for >Christmas. I wouldn't know what to do with it. One thing I have learned about stethoscopes is that there's a real art to working with one. Hell, the 4th year vet student that checked TK needed some coaching from the resident cardiologist to place the steth properly. >E:A reversal is a LV relaxation abnormality- its the reversal of early and >late filling waves. Dr. Martin can explain it much better than me- he's a [quoted text clipped - 3 lines] >obstructive form of HCM. Did Dr. Rush say TK has the obstructive form of >HCM? "SAM/Dynamic LVOT obstruction" Is that as bad as it sounds? I assume that the higher velocities are worse. >The youngest I've heard of is 4 but never 2 1/2. I forgot TK is that young. >HCM in a cat his age is rare. For HCM to occur in a cat his age, I think its >probably congenital. Familial HCM has been documented in several breeds, >so, I don't see why it can't haapen in DSHs. DSH? The apparent diminishing of the murmur in August is driving me nuts. I can't help thinking that there was something that was not affecting him over the summer that is now. The murmur seems to have developed over last winter. Midsummer it's almost gone. November it's back again. House closed up in winter...windows open in summer. I keep wondering if it's something environmental in this house, but, damn, I can't single anything out except the apparent connection to the house being closed up in winter. I've got 2 CO detectors that read 0. We keep the house clean, run 5 air filters (HEPA 99%) throughout the house, no air fresheners, mostly pet safe cleaners and even those are used carefully. I'm drawing a blank, but I can't get the seasonal correlation out of my mind. I've even had the thought of "maybe I should let him go outside". Then I think about the den of coyotes that the Fish and Wildlife Dept. found a mile from our house last year where they picked up over 40 pet collars scattered around the area, and realize letting him out may not be such a good idea. >He shouldn't lose more than a pound/4 weeks. Fancy Feast averages about 80 >kcal/3 oz. can- the seafood varieties average about 60. 10 g of m/d = about >40 kcals. 280 kcals a day is about right for a 13-14 lb cat. How much does >he weigh? According to the scale at Tufts, TK weighed 9 lbs 5 oz. But I'm suspicious of it's accuracy. TK should have a weight of about 10 lbs. On roughly 3 cans of FF, mostly grilled chicken, and 10 gms of the m/d, his weight dropped from 13 lbs in the beginning of August (vets office) to the 9 lbs 5 oz (Tufts). We weigh him at home (cheap scale but good repeatability) and thought he was just a little over 10 lbs. He is a pretty energetic cat (we describe him as having 2 speeds.......sleeping, and HOLY sh.t!!). >Btw, did you ever get around to reading the articles I sent you by Dr. Rush? Sure did. You must have done a good job of educating me about HCM because I actually understood what I was reading. >I think you're on the right road. I wish I was sure of that. Actually, I wish the proverbial light bulb would flash on and I could go "Aha, that's what's causing the problem!" and I could correct it and TK would get better. >Best of luck, > >Phil Thank's > DSH? Domestic shorthair.  SignatureWeb site: http://www.slywy.com/ Message board: http://www.slywy.com/phpBB2/ Journal: http://slywy.blogspot.com/ > -----BEGIN PGP SIGNED MESSAGE----- > [quoted text clipped - 5 lines] > The report says "IV/VI systolic murmur right sternal border, > III/Vi systolic murmur left sternal border. Prominent apex beat." Yep, its a regurgitant murmur- a systolic murmur in the mitral area. > >Tell your wife you want a Littmann 4000 electronic stethoscope for > >Christmas. > > I wouldn't know what to do with it. What's so nice about the 4000 is that you don't have to know anything- it records all the heart sounds. Your cardiologist can interpret the sounds and explain what they are and what they mean. Its a great way to learn. All you really need to know is where the heart is! ;) Making a recording of TK's heart sounds while he's calm at home is more accurate than when he's stressed and excited. A II/VI can become a IV/VI when a cat is excited and can make you think the murmur is a lot worse than it really is. One thing I have learned > about stethoscopes is that there's a real art to working > with one. Auscultation is truly an art-- especially in cats! Their hearts are so tiny- less than an ounce- and they beat so fast that its not easy to distinguish between heart sounds. I was lucky when I was learning because my vet had a teaching steth- a steth with two headsets connected to the same chestpiece- so he could explain each sound as I was hearing it. I still have trouble sometimes. Hell, the 4th year vet student that checked TK > needed some coaching from the resident cardiologist to > place the steth properly. The murmur of mitral regurgitation is usually heard best at the left apex. A murmur can radiate to areas of the heart other than its point of origin. A cat's heart is so small that its sometimes difficult to pinpoint the source with a standard size chestpiece. I find it easier to pinpoint the source with a small infant or pediatric steth. If an electronic steth is out of the question, you might want to pick up a good Littmann Pediatric steth- they only cost about $80. Here's picture of the different sizes. The steth on the right is my electronic 9000; the steth in the middle is my Master Cardiology with an adapter that reduces the diameter of the chestpiece and the small pink steth is my pediatric steth.(I know, pink- I didn't specify a color) The pediatric steth works a little better than the Master with the because is easier to maneuver on a cat: http://www.maxshouse.com/instruments+equipment/stethoscopes.jpg > >E:A reversal is a LV relaxation abnormality- its the reversal of early and > >late filling waves. Dr. Martin can explain it much better than me- he's a [quoted text clipped - 5 lines] > > "SAM/Dynamic LVOT obstruction" SAM= systolic anterior motion. LVOT= left ventricular outflow tract. SAM is usually the cause of dynamic left ventricular outflow obstruction in cats with the obstructive form of HCM. The hypertrophy of the septum interferes with the ejection of blood through the LVOT. Thus, the LV must generate higher pressure to get the blood through the LVOT- the higher pressure creates a venturi effect that pushes or pulls the mitral valve leaflet into the LVOT when the LV contracts (systole). That's basically what systolic anterior motion means. Mitral regurgitation occurs when the mitral leaflet is pulled away from the mitral opening and blood leaks back. I hope Dr. J will correct me if I didn't explain it properly. > Is that as bad as it sounds? "bad" is relative. Its not good because it indicates heart disease. But its basically "normal" for cat with obstructive HCM. > I assume that the higher velocities are worse. Yep. His isn't very bad. > >The youngest I've heard of is 4 but never 2 1/2. I forgot TK is that young. > >HCM in a cat his age is rare. For HCM to occur in a cat his age, I think its > >probably congenital. Familial HCM has been documented in several breeds, > >so, I don't see why it can't haapen in DSHs. > > DSH? Domestic short hair. Wait- didn't you say TK is Maine Coon mix? Familial HCM was first discovered in a family of Maine Coons- HCM is an autosomal dominant defect in the breeds in which inheritance is known. > The apparent diminishing of the murmur in August > is driving me nuts. I can't help thinking that there was [quoted text clipped - 3 lines] > back again. House closed up in winter...windows open > in summer. That's a good point for environmental allergens and cats with asthma or hypersensitivity reactions when the concentration of allergens increase because the house is closed up- but not for a murmur. Different mechanism. If his breathing became labored or short- I'd say could be. But not for a murmur. I keep wondering if it's something environmental > in this house, but, damn, I can't single anything out > except the apparent connection to the house being closed [quoted text clipped - 8 lines] > over 40 pet collars scattered around the area, and realize > letting him out may not be such a good idea. I'm telling you- I really think the murmur *seemed* worse because he was highly stressed and excited. Murmurs are always more pronounced when a cat is excited- especially when his heart rate increases to >200 bpm. So, relax ;) > >He shouldn't lose more than a pound/4 weeks. Fancy Feast averages about 80 > >kcal/3 oz. can- the seafood varieties average about 60. 10 g of m/d = about [quoted text clipped - 10 lines] > over 10 lbs. He is a pretty energetic cat (we describe him > as having 2 speeds.......sleeping, and HOLY sh.t!!). My guess is the scale at Tufts is out of calibration- the students probably sit on it or use it for a snack table and knocked it out of calibration. You'll always find variations between scales- except Tanitas! You could probably pick up a Tanita 1583 pediatric scale on eBay cheap. They're very accurate. I love mine. > >Btw, did you ever get around to reading the articles I sent you by Dr. Rush? > > Sure did. You must have done a good job of > educating me about HCM because I actually > understood what I was reading. Naa, he's just very easy to understand. I like his writing style. Is he that easy to understand in person? The next time you see him, ask him about nattokinase. Its a new dietary supplement made from fermented soybeans that's supposed to have potent fibrinolytic properties that's supposed to prevent and even dissolve blood clots (aortic thromboembolism). Clots are one of the most devastating complications associated with HCM. I haven't been able to find any reliable clinical studies- just tons of anecdotal reports praising the stuff. > >I think you're on the right road. > > I wish I was sure of that. Actually, I wish the proverbial > light bulb would flash on and I could go "Aha, that's what's > causing the problem!" and I could correct it and TK > would get better. You caught it early enough to make a *big* difference. I think putting him dilatizem right away was a *very* wise move and was probably the reason why his hypertrophy *decreased*. If his HCM was progressing, the IVS and LVW thickness would be increasing- not decreasing. So, I guess you can say he *is* getting better! ;))). Just keep going the way you're going and TK will be around for many more years. Best of luck, Phil If an electronic steth is out of > the question, you might want to pick up a good Littmann Pediatric steth- > they only cost about $80. On second thought, the Cardiology III has two tunable diaphragms- one side is for use on adults, and the other side is a pediatric size. The sound quality and intensity of the Cardiology III is a lot better than the Classic II Pediatric and Infant Stethoscopes. Phil -----BEGIN PGP SIGNED MESSAGE----- From: "Phil P." <phil@maxshouse.com> >Auscultation is truly an art-- especially in cats! Their hearts are so >tiny- less than an ounce- and they beat so fast that its not easy to >distinguish between heart sounds. I was lucky when I was learning because >my vet had a teaching steth- a steth with two headsets connected to the same >chestpiece- so he could explain each sound as I was hearing it. I still have >trouble sometimes. I've had a whole 10 minutes of training with TK's regular vet (switching the headset back and forth). She thought it was rather funny when I showed up with my own stethoscope, but humored me by explaining what she was hearing and also showed me that my steth tended to muddle the sound. Hers was significantly clearer. >Domestic short hair. Wait- didn't you say TK is Maine Coon mix? Nope, TK's just a mutt cat as far as I know. Just one of a million stray black cats out there. Fate just placed him in the catnip patch in our yard one day. Skinny, dirty, and smelling REAL catty (my eyes used to water when we let him in the house). The strange thing is that the day before he showed up, a friend was visiting and asked me if we'd "ever get another cat". I told him "Maybe, but we've never actually "gotten" a cat, they've always just came to us." The next day, there he was. We joke that God must have been listening to me that day and said "Oh....so that's what it takes....they come to you.....Ok, HAVE I GOT A CAT FOR YOU!!!" So now TK is often referred to as our "gift from God". And now TK's matured into a clean, non-stinky, muscular, handsome little guy. You wouldn't know by looking at him that there's anything wrong with him, medically. But I'm rambling, now. >That's a good point for environmental allergens and cats with asthma or >hypersensitivity reactions when the concentration of allergens increase >because the house is closed up- but not for a murmur. Different mechanism. >If his breathing became labored or short- I'd say could be. But not for a >murmur. You know, I think this is the first time I have to disagree with you. I think there's a lot that hasn't been discovered, yet. If 20 yrs ago you said that cats were developing medical problems because something was lacking in their diet, the experts would have called you a nutcase. Then they found taurine. Hell, just a few years ago a nutcase doctor said most stomach ulcers were caused by a bacteria that was considered benign to humans. A lot of "experts" laughed at him until he was proven to be right. It had slipped my mind, but just today I remembered that Dr. Rush had said during TK's first echo that he has seen HCM mostly in indoor cats. If that's true, there could be several reasons for that. One could be skewed statistics, outdoor cats not living long enough to develop HCM, or maybe people with outdoor cats aren't as dilligent about seeing to the cat's medical care. I think the assumption is that indoor cats are less active and possibly more obese than outdoor cats. Or maybe cats need to kill and eat a mouse once in a while (another missing nutrient?). Or maybe a bacterial factor that actually helps prevent HCM in outdoor cats. But maybe, just maybe, there could be some environmental cause that exists in an indoor life. Cleaning chemicals, gasses from paints and construction materials, dust, fibers, dust mites or dust mite sh.t, or even electromagnetism from house wiring (I'm really "reaching" on that last one). But I could go on and on with possibilities. But the point is that while I don't know of anything indoors that could cause HCM, I don't think anyone truly KNOWS that there isn't anything, either. About Dr Rush >Naa, he's just very easy to understand. I like his writing style. Is he >that easy to understand in person? He's pretty easy to talk to. If anything, he tends to oversimplify things when talking to clients (probably more due to the lack of knowledge of the normal client). When he sees that you know a little bit about what's going on, he'll detail things more. But all in all, he's much better at answering questions than I am at asking them. >The next time you see him, ask him about nattokinase. Its a new dietary >supplement made from fermented soybeans that's supposed to have potent >fibrinolytic properties that's supposed to prevent and even dissolve blood >clots (aortic thromboembolism). Clots are one of the most devastating >complications associated with HCM. I haven't been able to find any reliable >clinical studies- just tons of anecdotal reports praising the stuff. It sounds like good stuff. Do you know any of the details of its use with cats. We discussed Fragmin therapy, but Dr Rush doesn't think it's necessary at this time, and real expensive at about $200 a month with, I believe, twice a day injections. If TK needs it, though, he'll get it. >You caught it early enough to make a *big* difference. I think putting him >dilatizem right away was a *very* wise move and was probably the reason why >his hypertrophy *decreased*. If his HCM was progressing, the IVS and LVW >thickness would be increasing- not decreasing. So, I guess you can say he >*is* getting better! ;))). Just keep going the way you're going and TK will >be around for many more years. I do hope you're right. We're kinda fond of the little guy. >Best of luck, > >Phil Thank's again. |
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