Disclaimer: the information provided below is not intended to replace or override the advice of your veterinarian. Both the author and the site owner assume that this information will be used to work with your vet in planning the best treatment plan for your cat

 

WHAT IS A HEART MURMUR?
HOW IS A HEART MURMUR DIAGNOSED?	WHAT IS CARDIOMYOPATHY?
IS A HEART MURMUR CAUSE FOR CONCERN?	HOW IS CARDIOMYOPATHY DIAGNOSED?
WHAT IS HEART FAILURE?	HOW DO CATS DEVELOP CARDIOMYOPATHY?
WHAT IS CONGESTIVE HEART FAILURE?	HOW CAN I TREAT MY HCM CAT?
WHAT ARE THE SIGNS OF CHF?

WHAT IS A HEART MURMUR?

A heart murmur occurs when there is turbulence to the normal flow of blood through the chambers of the heart, and is usually due to a problem in a heart valve. When a valve is thickened or damaged and unable to close fully, some of the blood escapes around the valve.   A vet can hear a squishing sound which confirms that blood is leaking out of the heart valves during contraction.

Murmurs are usually seen in older cats but it is not uncommon to see them in a young kitties.  In fact, many kittens are born with murmurs and outgrow them later in life. A lot of cats with murmurs live long healthy lives. There is a small risk that murmurs can lead to congestive heart failure.

When older pets have a valve related murmur, the incomplete valve closure is often due to bacterial deposits on the valves. A very common source of this bacteria is dental disease, so it's important to keep your kitty's teeth and gums in good condition.

A heart murmur can also be caused by severe anemia, although this is not as common as the heart valve murmur.

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HOW IS A HEART MURMUR DIAGNOSED?

Usually kitty's vet can tell by listening to the heart with a stethoscope. Murmurs are graded from I to VI based on the severity of valve damage. In addition, sometimes kitty's pulse can be weak, rapid and irregular.

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IS A HEART MURMUR CAUSE FOR CONCERN?

Not unless kitty is showing other signs of heart problems, e.g. a "cardiac cough," lethargy, poor appetite, or fluid in the lungs/heart area.

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WHAT IS HEART FAILURE?

Heart failure (HF) may occur where the heart is producing a normal cardiac output, but the metabolic needs of the tissues are increased, such as in hyperthyroidism or anemia, and so cardiac output fails to meet their needs. Thus it may occur in conditions where the strength of the heart muscle appears normal.

However, most conditions that result in heart failure occur as a result of a markedly weakened left or right ventricle, or both.

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WHAT IS CONGESTIVE HEART FAILURE?

When the volume of blood to the right side of the heart is greater than the heart's capacity to move it along, fluid builds up and congestion occurs behind it. This causes an abnormal accumulation of fluid in the abdominal cavity and/or the lungs and chest cavity, which results in congestive heart failure (CHF).

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WHAT ARE THE SIGNS OF CHF?

Sometimes you can hear the fluid by means of a stethoscope but this takes some practice.  Often the cat displays some obvious signs like poor appetite, panting, coughing after even the slightest exertion and blue lips/tongue/gums. Kitty may appear to be out of breath, and not so often your cat may even throw up a reddish colored fluid.  This may or may not be accompanied by fainting spells. CHF is a very serious disease and as such, any troubling signs warrant an immediate trip to the vet (emergency or regular).

Also, in advanced stages, CHF can lead to (or be caused by) renal failure, spleen and liver enlargement, and fluid in the abdomen.  This fluid can be aspirated by a vet but sedation is required, so this is not a risk-free procedure. :(

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WHAT IS CARDIOMYOPATHY ?

Cardiomyopathy means "disease of the heart muscle." Cats can be born with or develop three types of Cardiomyopathy: Dilated (DCM), Hypertrophic (HCM), and Idiopathic Cardiomyopathy.

In Dilated CM, the heart walls get too thin and become like a balloon.

With Hypertrophic CM, the heart walls thicken and get stiff (hence ineffective). Cats are usually affected on the left side of the heart. The right side of the cat's heart sends blood to the lungs where it is oxygenated.  This oxygenated blood from the pulmonic vein enters the heart's left atrium, after which it passes into the left ventricle via the mitral valve. The left ventricle contracts, which causes blood to exit the heart via the aorta. After this, the blood is circulated throughout the body.  In HCM, the left ventricle pumps too fast and inefficiently, so this causes the heart walls to thicken.

When the heart doesn't pump properly, pressure builds up. This can often lead to lung congestion and pulmonary edema (fluid buildup in the lung sacs).

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HOW IS CARDIOMYOPATHY DIAGNOSED ?

The vet may detect signs of Congestive Heart Failure (CHF). S/he may elect to do a chest x-ray and/or Electrocardiography (ECG) exam.  Among other things, this helps show whether there is pulmonary edema present and if the heart is enlarged.  If these signs are present, the vet may refer you to a cardiac specialist who in turn will perform an ultrasound scan to confirm if the heart walls are thickened or thinning.

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HOW DO CATS DEVELOP CARDIOMYOPATHY?

Several causes of CM have been identified.

In older cats, thyroid disease (hyperthyroidism) can cause a variation of hypertrophic CM, and this is the most treatable cause.

A deficiency of taurine, an essential amino acid, will cause dilated CM, although commercial cat foods are now supplemented with taurine so this does not occur as frequently as HCM. CM is also associated with an unidentified inflammatory process within the heart muscle.

However, many cases of CM are Idiopathic (of unknown cause) and are not caused by any of these processes. There is some speculation that it is caused by renal failure and/or high blood pressure but to date, the medical establishment has no definitive answer for this question.

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HOW CAN I TREAT MY HCM CAT?

If the heart problems are as a result of renal failure and/or high BP, then treating those problems can help the heart. However, sometimes even that is not enough. HCM must be treated early, and aggressively.

Avoid commercial foods (especially dry formulations) which are very salty. If possible, prepare a home-made diet for your cat with no added salt. Add at least 500 mg of taurine to your cat's food daily or give by mouth in the form of a capsule/tablet.

Allopathic treatment consists of the use of Lasix (especially if fluid is present in the lung cavity). This drug will rob the rest of the body of valuable moisture and minerals like Potassium, Magnesium, etc.

Other allopathic drugs such as Cardizem (Diltiazem) and Norvasc are usually prescribed, but read the side-effects carefully, and check the PDR. Most of these drugs can cause renal problems and an irregular heartbeat, both of which an HCM kitty may already have.

Cats are *very* sensitive to Aspirin so check with more than one vet before you decide to administer it to your cat.

Note: Herbal alternatives to Aspirin (such as Meadowsweet and White Willow Bark) are deadly, so do not even consider them.

HERBS:

• Dandelion: A better option than Lasix, is the herb Dandelion, Mother Nature's purrfect diuretic. Get the leaf either in tea bags or in loose dried form, and brew tea using the infusion method (for information on this, check this site: http://www.acupuncture.com). Depending on the size of your cat, and severity of the problem, you can give 1 to 4  5-cc syringes (from the baby section of the drug store) per day.
• Hawthorne Berry: Another herb that has a mild diuretic action and is a general heart tonic, is Hawthorne Berry. This too can be given as a tea or in capsule/tincture form. However, some vets have expressed concerns about using Hawthorne Berries in HCM, where the heart muscle contracts too much, since one of Hawthorne's actions is to increase strength of contraction.
• Motherwort and Siberian Ginseng (avoid Korean/Red Panax Ginseng as it is too stimulating) are also beneficial. You can give each herb a few days on, and a few days off, so as not to build up a tolerance.
• Juliette de Bairacli Levy recommends rosemary tea with honey as her number one herbal remedy for heart disease and heart weakness.  She adds one level teaspoon of pure raw honey to every tablespoon of the rosemary infusion.  Heartsease (wild pansy) is another heart tonic herb mentioned by Levy and Stein, but no one on Holisticat has used this on their HCM cat..
• According to Stein, the herb Alfalfa (which is often referred to as a "superfood") reduces BP and cholesterol, and enhances the action of other herbs taken along with it.
• Stein also recommends a combination of scullcap, cayenne, and goldenseal as "a heart strengthener".  Goldenseal has a very strong, bitter taste, so cats do not tolerate this herb well, and will often foam at the mouth as a result of it.  Capsules are a good option when it comes to Goldenseal.  Also, since this herb is in danger of extinction, please consider a different herb such as Bearberry or Oregon Grape Root, both of which contain Berberine, the active ingredient in Goldenseal.

• Coenzyme Q10 a.k.a. CoQ10 - 30 mg a day
• L-Carnitine - 250 mg a day. (Jean's note: My Saski doesn't do well on L-Carnitine so I've stopped using it.)
• Apple cider vinegar (ACV) in the water bowl or in/on food is a potassium supplement for pets on diuretics.  ACV is very tart, so it is unlikely that a cat will accept this, but worth a try.
• Raw honey and /or bee products for strengthening the heart.  Both have high nutritive value
• Garlic for lowering high blood pressure and cholesterol levels.  There is no final word as of yet, on whether garlic causes Heinz-body anemia the way onion does, in cats.  And if so, how much garlic would it take to cause a kitty harm.  In light of this, best to be conservative in garlic supplementation.
• Kelp for lowering blood pressure and alleviating angina pain.  In herb books for humans e.g. David Hoffman's "Holistic Herbal", kelp is mentioned as a herb that "normalizes thyroid function".  Alas, there is very little information on kelp and its use in cat diseases.  And since it is said to stimulate the thyroid gland, some people do not give kelp to cats with hyperthyroidism.
• Stein recommends substituting trace mineral powder (Sandy's note: I prefer liquid trace minerals) for the kelp in Anitra Frazier's Vita-Mineral Mix if kitty has low BP.
• Both fish body oils, and Borage or Evening Primrose oil (which contain GLA), are beneficial

• Vitamin C in the form of Calcium Ascorbate - 500 - 1000 mg a day
• Vitamin B-Complex - 25 mg a day
• Vitamins B6 and B3 (niacinamide form)
• Vitamin E - d -alpha tocopherols - 100 IU daily for cats
• Vitamin A - Give 10,000-25,000 IU of vitamin A per week [See list owner's note below]
• Vitamin D - 400-800 IU per week. (if using cod liver oil, adjust Vitamins A and D accordingly)
• Magnesium: regularizes the heart rate
• Potassium: is beneficial for all muscles, but be very careful as potassium can also stop the heart if too much is given.  Apple Cider Vinegar is a safer alternative but don't overdo that either.
• Zinc:  5-10 mg of daily
• Chromium, Manganese, and selenium as part of a liquid trace mineral complex.

There are many remedies in homeopathy which are excellent for the heart.  Please read more about them in a Repertory and Materia Medica for more information.

Below are some commonly used remedies, and their main actions (as written up in Diane Stein's book):

• Crataegus, homeopathically prepared hawthorn, is the remedy for the animal with extreme breathlessness on exertion, when she has irregular, weak or intermittent pulse, when symptoms worsen as the environment worsens, when she has high blood pressure and is nervous and irritable.
• Convallaria majalis (lily of the valley) increases heart action and regulates heart rate; it is recommended when there is difficulty breathing, dropsy, angina, palpitations from the least exertion, and lung congestion.
• Digitalis (foxglove) is used after faintness or prostration following exertion; the pulse or heartbeat is abnormally slow; the animal may collapse; she may have a blue tongue; and there may be liver involvement.
• Apis is indicated when there is edema (water retention, dropsy).
• Strophanthus hispidus is for heart weakness due to valve problems (murmurs); there is a weak, irregular pulse and difficult breathing. The pet may be obese and have skin problems.
• Carbo veg aids breathing.
• Spongia is for dry, gasping heart coughs.
• Aconite is a first-aid measure.
• Give Cactus Grandiflorus for emergencies and for general heart dis-ease symptoms; the animal may respond to Cactus where other remedies fail. Crataegus and Cactus are the two primary remedies for pets or people with heart dis-ease.

List owner's Note: Please check out all this information carefully by doing your own research. I have some concerns about some of the authors' recommendations, e.g.:

• Juniper is a no-no for cats in kidney failure, as it irritates the kidneys.
• Similarly Uva Ursi a.k.a. Bearberry is for short-term use only, and must not be used for cats with compromised kidneys.
• Goldenseal, Bearberry, and Oregon Grape Root are all herbs that should not be used long-term
• Fat-soluble vitamins such as E and A are stored in the liver and it is possible to overdo them, especially with cats who have very delicate livers.
• Ascorbic Acid may be too harsh for some cats (it can cause tummy upsets) so calcium ascorbate might be a better choice. Cats in kidney failure have rather acidic systems, so it's better to stick to more alkaline herbs/supplements.

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