18yr old just been diagnosed with heart failure. What to do?

[Natcat]

Hello

My lovely Millie has been rushed to the vets today with rapid and noisy breathing. The vet has said that heart failure is at the top of her list and explained we can medicate if she finds that it's not too bad today.

It does mean that Millie will need a tablet everyday for the rest of her life but she hates having tablets. She has also been diagnosed with CRF. She's about 18. Should we be saying enough is enough now? Would she be telling us I'm done now if she could talk?

She was fine yesterday, she drinks quite a lot but eats her food ok. She has taken to sleeping in a dark corner or the litter tray which are both changes in her behaviour but otherwise she seems fine. I wish they could talk. I want to do what's best for her and not for me!!

Would anyone like to give some thoughts on this one? Thank you.

Natalie

[Kay]

alas, Natalie, this is the one question none of us can answer for you, because only you know your Millie enough to judge when she has had enough - most of us have tortured ourselves with this dilemma at one time or another, and those that haven't will almost certainly have it to come

the tablets are most probably diuretics, which will make her pee more, and this in turn will reduce the fluid build up which is making her short of breath, so you should see some improvement quite quickly, and will be able to judge then if it is enough to keep her going a bit longer

make lots of fuss of her now, take plenty of photos, and hope she will be with you a little longer

[booktigger]

This is a tricky one. Can the medication be given in a different format that might be less stressful for her?

[Natcat]

Hello

Thanks for your replies - I'm not sure if it comes in any other form, I'll ask the vet tomorrow. The vet has just called and said that there is fluid around her lungs that they are now medicating. It's not bad enough for them to have to go in and drain the fluid so I guess that's good news. She'll have to stay in over night as her breathing hasn't improved yet and she'll ring in the morning.

Does fluid around the lungs indicate heart failure? I'll look it up now.

Thanks again.

[JulieandBarney]

Oh Natalie, I so feel for you, but sleeping in her litter tray and hiding is a sure sign that she may be in pain or discomfort......I had this with my boy last year who was in a lot of pain, but he hid it in this way, by hiding away, I took him on his final journey to the vet, to pass in peace and dignity, before he was in a lot of pain, I could not do that to him, only you know what is best but please remember that "better a day too early than a day too late" please don't wait until he is suffering.... .....thinking of you both ...xx

[Natcat]

Thank you. The vet called this morning and said that her breathing is much better and that she can come home! The tablets will be small enough to put in her food and they're going to give her blood tests to work out what's going on and then we can medicate from there.

I think that because she's bright, eating and drinking we will carry on a bit longer but any sign of her not being happy then that will be time. I realise with all of this illness and being 18 she's not going to have much longer left with us and I totally agree about not leaving it too late. We need to enjoy the time we have left now and I'll be watching her like a hawk!!

Thank you for your replies.
Natalie xx

[sarie]

Natalie, I just dropped you an email. I forgot to mention in the email that heart failure can be caused by treatable things such as lung worms and hyperthyroid. If it turns out that her bloodwork shows up any of these things then there's a chance her heart failure can be reversed once she's treated for the underlying condition and the heart failure will stop.

If it turns out that the underlying cause of her heart failure is heart diesease then this can't be cured or reversed but it can be treated and you can manage the heart failure - it's not completely hopeless She may be an older lady but if she has a good quality of life then you may still have her for a little while to come

Many of the cats on the Yahoo heart group have heart failure, heart disease and CRF and are still living a decent quality of life on the correct medications. I linked you the yahoo heart group in the first email I sent you. Obviously, you know Millie better than anyone and if she starts to show signs of giving up then there's an incredibly tough decision to be made for her, but don't make that decision just yet as when heart failure first sets in kitties can become very sick and seem like they've given up but once they're treated and it's under control they often bounce back Enjoy her, she sounds absolutely lovely and do keep us informed on how she gets on

[Natcat]

Hello Sarie

Thank you so much for your replies - they were all really helpful and encouraging.

The vet rang today and said that Millie does just have heart disease and renal failure so that will make the heart disease a little trickier to treat. She thinks that Millie has had heart failure for a while now so I'm guessing the disease is quite advanced.

However, since she's been home she's been so well!! She's on diuretics which must be making her feel better and she hasn't slept in a dark corner all day - she's just followed me bless her. She's fast asleep right next to me now on the sofa. She's been eating and drinking well so for now all is good with Millie.

I'm now always checking her breathing because I know that she could go down hill again at any time. The vet said she wants to check her blood pressure and give her a heart scan. My husband is worried that will mean more pulling her around and thinks we should let her be now and just treat her with the diuretics to keep her comfortable??????

Thank you also for the link.

I will know when she's had enough, it's just so horrible waiting for that time because I know it might be soon. However it is definitely not yet - she's way too well right now!!!!

I will let you know how she's getting on. Thanks again for all of your help.

Natalie x

[sarie]

Aww I'm pleased to hear she's back home and doing well on her diuretics - I bet she's loving all the fuss now she's back

The main thing with heart disease and heart failure is not to assume that all hope is lost or think that she's dying so you should just keep her comfortable. This absolutely isn't the case. She may be an older lady but if she's otherwise fairly well in herself then it's certainly worth treating her heart disease
Many older cats who suffer with advanced heart disease will die of something completely unrelated before the heart disease becomes fatal if it's treated correctly.

This is just my advice based on what I know.. don't take it all as fact but hopefully it might help you think about your options. I apologise in advance for going into "fact mode" but there's not an easy way to sugarcoat all the information so I've just sort of laid it all out in the hope it helps you to understand Millie's condition better. Please give her some fusses from me

So, the diuretics Millie is taking will dry out the fluid as it builds up in her chest but they won't prevent the fluid from building up in the first place. The congestive heart failure is just a symptom of her underlying heart disease and by treating her symptoms but not addressing the cause you may struggle to keep her out of trouble. If the vet is fairly certain of the diagnosis of heart disease then she ideally needs an additional drug to control her blood pressure and help her heart pump better and she also needs to be taking a blood thinner called Plavix, or alternatively baby aspirin to prevent blood clots.
Whether or not you decide to go down the route of having further tests done, I'd certainly discuss adding these drugs to Millie's treatment if the vet hasn't discussed them already, as the diuretics alone won't keep her heart condition under control and you may find she relapses suddenly or gets a blood clot. Clots unfortunately can't be prevented but the risks can be minimised by treating with a daily blood thinner and it's vital that if she has advanced heart disease that she takes something to lower this risk as blood clots are just awful and usually fatal.
Also, under no circumstances should Millie be taken off the diuretics. The vet may decide to lower the dose after an initial fluid buildup is under control but she shouldn't ever be taken off them. Some vets who aren't overly familiar with heart conditions will suggest that diuretics are removed once the fluid has been successfully treated but unfortunately this just allows for the fluid to build back up again. The diuretics will be required for the rest of her life in order to keep the fluid under control. My vet didn't have a great deal of experience with heart conditions and she suggested taking the diuretics away after 3 weeks but thankfully I spoke to a cardiologist before I did and he said that I absolutely mustn't take the diuretics away. If your vet has experience with heart conditions then they should be aware of everything I've mentioned above but many vets aren't specialists in heart disease as they're more like GP's and obviously can't understand every single illness in great depth. That's not to say they're not good vets, they just can't know everything. Certainly it's important to trust your vet but do ask questions - they'll look into anything you ask if they don't know the answer, my vet did

The heart scan the vet has mentioned may be an echocardiogram and this can be done while she's awake if she'll tolerate it but it will require her to have a patch shaved from her chest. The echocardiogram takes an indepth look at the heart and will show how the heart is pumping and will allow the vet to measure the thickness of the heart walls and confirm what stage Millie's heart disease is at. Alternatively, if your vet doesn't have the equipment for an echo (as these are often done by a cardiologist) then they may be looking to do an ultrasound as this is less detailed but will also show up any abnormalities of the heart.
The blood pressure test is similar to that a human would have so neither test is particularly invasive and both the scans and BP tests can be done without sedation or anaesthesia in many cases, but they do require her to go into the vets for a few hours and if she won't tolerate the tests then they'd have to sedate her. Given her age and her condition, sedation is fairly risky so I'm not sure I'd want that if she were mine.
It was risky enough for Harvey (he had to be sedated as he's not at all tolerant of being poked) when he was poorly but he's only 5 and didn't have any other health issues.
They can also use a simple x-ray to look for enlargement of the heart without doing the more advanced echocardiogram test (again, if she sits still they can do this while she's awake) but the x-rays give limited information. However, an x-ray is far more straight forward than an echocardiogram or ultrasound and could be enough to show up enlargement which would confirm the heart disease diagnosis and at this point, confirmation of that is all you really need to be sure you're treating her for the right condition.

If she's fairly laid back then it may not phase her too much and the tests will give the vet some figures to work with regarding how advanced her heart disease but given that she's already in congestive heart failure I'd expect the scans will only confirm what you already know.
In a younger cat the vet would do all the scans and then create a treatment plan to help the cat live a healthy life for as long as possible, as with the right care they can sometimes go for a couple of years after congestive heart failure occurs, but given Millie's age it may not be worth putting her through the stress involved just to confirm the diagnosis. The vet can treat her for heart disease without the test results, it's just not an ideal scenario as obviously they're not certain of what they're treating.

I think if it were me I'd perhaps just discuss treatment options with your vet and see if they'd be happy to treat for the heart disease on the assumption that it's fairly advanced.
You could look at the BP test as that's a lot less stressful than the other tests and will at least give the vet a little information to go on, but only you and your husband know whether or not Millie is likely to be stressed by having it. Your vet may not be prepared to put her on any BP medication without at least performing this test as it if it turns out her BP isn't high then it could be dangerous.

The general drug treatment for heart disease and CHF is a combination of three drugs and is fairly standard:

- Benazepril, Atenolol or Semintra - These are all designed to lower BP and help the heart pump better. As I mentioned in my email, Semintra is usually used for kidney disease so it could be a good option and it's a liquid
- Furosemide - A diuretic to keep fluid off the lungs - I believe there's a liquid version of this available if required - ask your vet if you think you need it
- Plavix or baby Aspirin - This is given daily in advanced heart disease patients to prevent blood clots as a cat with advanced heart disease can throw a clot at any time and these are usually severe and often fatal

I hope all of that helps, I'm sorry for all the overly factual info there but hopefully it gives you a better understanding of what you're dealing with. If there's anything there that doesn't make sense then feel free to ask as I know that was a bit of an information overload

Good luck with everything, whatever route you take. It sounds like Millie is at least feeling much better right now and hopefully that continues for a good while to come; I'm sure it will with all the love and fuss she'll be getting

Take care

Sarah

[leylataghiyeva]

Hi! PLEASE READ EXTREMELY IMPORTANT FOR MY BABY My 3.5 year old Persian cat has laboured breathing and fast heart beating, she has a heart disease with fluid in her lungs, is on medication for 3-4 months, with breaks, however, as there is no cardiomeasuring machine or expert for animals in my country (Azerbaijan), we cannot identify the exact diagnosis and what kind of heart disease it is for better treatment. What do you suggest us to do? is there any other way to understand heart condition without cardiogram or echocardiogram tests? THANK YOU FOR YOUR RESPONSE IN ADVANCE, IT IS REALLY LIFE OF DEATH MATTER.