Silent but violent

While some folks would associate the title of my post with something else entirely, I have heart disease on my mind at the moment, and that's how is strikes me. For all the detail that one can put into a physical examination, sometimes cardiac disease can be extremely elusive. Sure, there are times where you hear a murmur, or the history obviously fits in with heart disease, but there are many times where the heart sounds absolutely normal up to the day a cat dies of a heart attack. I just got off the phone with a client whose cat whose heart disease has been in stealth mode until very subtle signs appeared the other week. The cat was walking a little strangely, and we were able to identify a congenital problem with the knees that could account for that. The problem was, the cat barely improved on pain control. We tried stronger medications, but still no improvement. A few days later, the appetite was reduced, and we were left scratching our heads. Thankfully, we moved to have the cat stay in the hospital, and finally a clue presented itself that perhaps the problem was with the heart. Fast forward a bit, heart tests were conducted, hypertrophic cardiomyopathy was identified, and appropriate management was implemented. 6 days later, things are just about the way they always were.

This is what I would ask you to focus on: a cat showed no signs except for a slightly different walk, showed absolutely no signs of heart disease on exam, but is just about normal now that the heart disease is being treated.

So heart disease can be silent on exam - and from time to time, a cat will die and no one knew things were heading that way. I saw a different cat last week who did show obvious abnormalities on exam: this cat had a heart murmur so loud that both Dr. Cornelius and I initially thought we were listening to the cat rapidly breathing. While this unsuspecting client was expecting a routine visit in preparation for a health certificate and a flight to England, what she received was the upsetting news that her cat had dramatic heart abnormalities that we aren't even sure how to treat. We convinced her to have a boarded cardiologist weigh in on the findings, but I just cannot imagine what can be done (within reason). This cat definately should not fly, and will very likely no longer be with us in 2008.

Am I giving up on this cat - certainly not - but I am being realistic about our limitations regarding treating certain diseases. And feline cardiology is among the most frustrating sections of feline medicine given how every few months a new study comes out that completely contradicts the previous one. This reality makes certain days very challenging, and sometimes there just aren't enough cute kitten exams to compensate.