Heart disease and heart murmurs in cats
Heart disease and heart murmurs in cats
It is not normal for a cat to have a heart murmur.
So what is a heart murmur and should my cat's heart murmur be treated?
Recognizing heart murmurs in cats
First, how does your veterinarian diagnose heart murmurs? One of the reasons I am such an advocate of the annual veterinary exam is because I want to "take your cat in my hands" and perform a thorough physical exam. Part of my exam is to auscultate (or "listen" to) your heart and lungs with a stethoscope - actually listening for abnormal sounds and rhythms. You can see your vet listening between your cat's armpits. That's because anatomically the heart sits near the front of the chest cavity (in the third to fifth rib area).
So what are we listening for? When we listen to the heart, it should be a normal, clear, distinct heartbeat. There should not be any unusual "whistling" sound. If I hear that "whooshing" or "rushing" sound, that's a sign of a heart murmur.
Next, I listen to the pulse to see if there is a cardiac arrhythmia, which is an abnormal heart rhythm. In cats, the heart rate should be between 160 and 220 beats per minute (bpm). (Although this sounds very fast, it is because many cats are agitated or nervous in the veterinary clinic. At home, your cat's resting heart rate should be around 140-160 beats per minute). If you can imagine a metronome, your cat's heart should have a steady, fast rhythm. If your cat has a cardiac arrhythmia, it means that there is an unusual pattern in the heartbeat, such as pause-pause-pause-pause. Sometimes cats also have a heart arrhythmia called "galloping," named after the sound of a galloping horse. Regardless, a cat should not have a heart murmur or arrhythmia.
How heart murmurs are "evaluated" in cats
In veterinary medicine, heart murmurs are rated on a scale of 1 to 6, with 6 being the loudest and 1 being the quietest. Sometimes a heart murmur and/or arrhythmia can be innocent and not caused by a primary disease. Sometimes we hear it with pain, nervousness, dehydration, or anemia; it's usually quiet (like a 1 or 2/6 heart murmur). But sometimes the heart murmur and/or arrhythmia can be caused by primary heart disease or defects/malfunctions (e.g., >3/6 heart murmur). This is much more serious as it can lead to congestive heart failure, acute stroke and death.
Unfortunately, cats can get frustrated when it comes to diagnosing heart disease. It is estimated that 50% of cats with significant heart disease (or even heart failure) do not have the heart murmurs we can detect with our stethoscopes. Confusing, but the bottom line is that if a heart murmur and/or arrhythmia is heard, an examination would be warranted.
Why the age of diagnosis is important
The age at which your cat was diagnosed with a heart murmur affects how aggressively I recommend veterinary therapy by a board-certified veterinary cardiologist. If your kitty is diagnosed with heart murmurs early in life, it should be checked frequently! If the heart murmur does not go away after a couple of weeks, a more thorough medical examination is needed, as the heart murmur often has a congenital cause. A congenital defect means that the kitten is born with a defect that can be caused by improper nutrition, exposure to medications or drugs, environmental conditions, infection, poisoning, or, more commonly, hereditary causes. Heart defects ranging from holes in the heart (e.g., atrial or ventricular septal defect) to valvular defects (e.g., valve dysplasia) to abnormal narrowing of parts of the heart or major blood vessels (e.g., patent ductus arteriosus, aortic stenosis, etc.) can be fatal without diagnosis and treatment.
The sooner we diagnose a heart murmur in a kitten, the sooner we can intervene and treat it. I should know that the cat I fostered years ago had a severe congenital heart defect (with a heart murmur 6 out of 6) and only survived until she was 3 years old.
So what if your healthy pet was just diagnosed during a visit to the vet for a routine checkup and had no symptoms? Well, as your cat gets older, it's important to know if the heart murmur is getting louder - from 2/6 one year to 3/6 the next. If it is, a checkup is a must.
Causes of heart disease in cats
The most common types of primary heart disease in cats (excluding congenital causes) include:
- Hypertrophic cardiomyopathy (HCM).
- Dilated cardiomyopathy (DCM).
- Restrictive cardiomyopathy (RCM)
- Unclassified Cardiomyopathy (UCM)
In HCM, the heart muscle thickens too much. In DCM, the heart muscle becomes too "flexible" and loses its ability to contract. DCM is often associated with a lack of taurine, an important amino acid needed in cat food (this is one of the reasons I am a strong advocate of AAFCO-approved, balanced cat food). In RCM, there is too much scar tissue or fibrosis in the ventricle, which prevents an effective heartbeat. Unclassified cardiomyopathy means that there are cardiac abnormalities but they do not fit into any of the above categories.
As for secondary causes, you should know that heart murmurs can occur in cats with certain conditions such as hyperthyroidism (overactive thyroid), chronic anemia, or hypertension. If your cat has been diagnosed with any of these conditions, treatment is very important. Otherwise, your cat may die from other complications or have long-term side effects (such as heart failure)!
Signs of heart disease in cats
Signs of heart disease in cats include:
- Pale gums.
- Increased breathing rate.
- Open mouth, panting.
- Rapid heartbeat
- Collapse
- Sudden paralysis of the hind legs (called saddle sores).
- Screaming in pain
- Inability to walk
- Fainting
- Sudden death
Investigation of heart murmurs in cats
A heart murmur investigation includes a thorough physical examination, particularly of the thyroid gland, pulses, kidney and bladder size. Blood pressure is also measured, routine blood tests (to rule out the above medical problems), and chest and lung x-rays. Depending on what these tests show, the next step may be a referral to a board-certified veterinary cardiologist for an echocardiogram (ultrasound) of the heart. These tests usually cost between $500 and $800 for an ultrasound and examination, but they are very important in determining if your cat has a life-threatening heart condition.
Depending on the results, your cat may be treated with heart medications that will make the heartbeat more effective. Even with treatment, heart disease can eventually lead to heart failure and a secondary accumulation of fluid directly in the lungs (called pulmonary edema) or outside the lungs in the chest cavity (called pleural effusion). Both can be life-threatening and can lead to heart failure.
Treatment for heart murmurs in cats
When it comes to heart murmurs in cats, it's important to remember that the sooner we diagnose them, the sooner we can treat your cat with the right medications so that the heartbeat is more effective and prevents heart failure. Some of these medications may include:
- Beta blockers to slow the heart rate.
- Calcium channel blockers to relax the heart and lower blood pressure
- Diuretics to prevent fluid accumulation in the lungs or chest.
- Angiotensin-converting enzyme (ACE) inhibitors to make the heart beat more effectively and treat high blood pressure.
- Anti-stroke medications such as aspirin or clopidogrel
Remember that these medications do not treat heart disease in cats. Instead, they help prevent exacerbation of heart disease.
Prognosis
Your cat's prognosis for heart disease depends on the type of heart disease and the severity of the heart ultrasound findings. If in doubt, talk to your veterinarian about long-term control and treatment of your cat's heart murmur. Most importantly, prevent feline murmurs and feline heart disease with annual veterinary exams!
heart murmurs in cats
cat murmur
feline heart murmur