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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
Signs of the Aging Dog and Cat
Part 6:
Organs of the Chest: Disease of the Heart Muscle
by Kathleen M. Carson, D.V.M
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This month I will continue discussing diseases that can affect the organs of your older dog or cat’s chest or thorax. I described valvular disease/insufficiency last month. This month my subject is diseases of the heart muscle, called cardiomyopathy (CM).
The majority of the heart is made up of powerful muscle which pumps the blood around the body. Since the heart is such an important organ in the body, diseases which affect its muscle are very serious. Unlike valvular disease, cardiomyopathies are not only, or even primarily, a problem for older dogs or cats. In fact, they occur more often in middle aged and young ones. However, some dogs or cats don’t show the signs until they’re geriatric, so I’ve included a discussion of cardiomyopathy here.
When the heart muscle is diseased, it can’t contract properly. Its contractions are weaker, and there often are irregularities of the heartbeat, called arrhythmias.
Cardiomyopathies have several causes. Probably the most common cause is genetic. Certain breeds of dogs and cats are prone to CM. In dogs, these include the Doberman Pinscher, Great Dane, Irish Wolfhound, Scottish Deerhound, Newfoundland, and the Boxer. In cats, the most susceptible breeds are the Maine Coon, Persian, Ragdoll, British and American Shorthairs, and the Cornish Rex.
CM can also come about due to nutritional deficiencies, most commonly a deficiency of the amino acid, taurine. This is especially true in cats, where it causes a type of CM called dilated cardiomyopathy (DCM). The breeds most prone to DCM are the Siamese, Abyssinian, and Burmese. When this was recognized several years ago, extra taurine was added to cat foods, and we now rarely see DCM in cats.
In dogs, so far taurine deficiency has only been found to cause DCM in certain American Cocker Spaniels.
CM has also been linked with a deficiency in the amino acid, L-carnitine. This is especially true of a line of Boxer dogs but is not limited to that breed.
CM can also be caused by high blood pressure (hypertension) and an overactive thyroid (hyperthyroidism). (Note: hyperthyroidism was discussed in more detail in a recent column) Both these conditions force the heart to work much harder than usual; the resulting strain on the heart muscle leads to CM. If the CM is due only to one or both of these diseases, then correction of them resolves the CM.
Lastly, CM can be seen in animals with cancer, inflammation +/- infection, and toxicity due to certain drugs or heavy metals.
Cats have more types of CM than dogs do. Dogs usually have the dilated CM (DCM). Cats’ types include hypertrophic (HCM) (this is usually the type which is inherited; it also is associated with hyperthyroidism and hypertension); dilated (DCM) (rarely seen these days since extra taurine has been added to catfoods), restrictive (most common type in middle-aged to older cats); mixed, unclassified, and a rare type called arrhythmogenic right ventricular cardiomyopathy.
Congestive heart failure (CHF), a very serious condition in which fluid builds up in one or more parts of the body. We saw last month that CHF can result from valvular insufficiency. It also can develop in a dog or cat with CM.
In cardiomyopathy, CHF develops when the heart muscle is so diseased and weak that it can’t pump the blood through the body with sufficient force. Also, many animals with CM have heartbeat irregularities (arrhythmias). When the heart is beating in an aberrant fashion because of an arrhythmia, blood is pumped from the heart in fits and starts. Both the weak muscle and arrhythmias cause a backup of blood into the body, leading to fluid buildup in the lungs (left-sided failure) and/or abdomen and lower hind limbs (right-sided failure).
As mentioned in last month’s article, a few cats have valvular disease along with CM. If both conditions are present, CHF becomes even more likely.
As with the CHF of valvular disease, CM patients have left-sided heart failure more often than right. Even though left-sided failure predominates, though, right-sided failure occurs with greater frequency in CM than in valvular disease.
CHF is a serious, potentially fatal, condition. It can come on slowly, or (seemingly at least) all at once. It needs immediate medical care.
What signs would you see if your dog or cat has CHF from CM? In dogs, you’d see some or all of the following: exercise intolerance (can’t go very far without “pooping out”), dyspnea (difficulties in breathing), coughing, cyanosis (a bluish tinge to the gums), decreased appetite and weight loss, and possible syncope (fainting). Less frequently, you’d see vomiting, ascites (swollen belly from fluid gathered inside), and swelling of lower hind limbs and feet. Unfortunately, sometimes there is sudden death.
Signs in cats can be more vague: lethargy, decreased appetite, hiding. Cats with CHF usually don’t cough. CHF cats are dyspneic (have breathing difficulties), seemingly with a sudden onset. In actuality, the dyspnea has probably come on more gradually, but early dyspnea in a cat is difficult to detect for an untrained person. As the CHF progresses, the dyspnea becomes more pronounced until it’s obvious they’re struggling to breathe. A dyspneic cat also has an increased respiratory rate. If you note your cat taking 30 or more breaths per minute, this calls for medical attention.
***Warning***: a dyspneic cat must not be stressed. Handle him/her very gently and make every effort not to upset thim/her, for this can lead to sudden death.
Occasionally a cat with CHF will go into shock, becoming semi-conscious and feeling cold to the touch, especially the extremities.
Since cats tend to hide their symptoms more than dogs, if you see the above symptoms in your cat, it indicates advanced disease. Take your cat immediately to your veterinarian or emergency center.
Unfortunately, some cats with CM just die suddenly without any warning. Usually, however, you have some warning sign(s), though they may be subtle, as mentioned above.
Luckily, the understanding, diagnosis and treatment of CM and CHF in dogs and cats have expanded a great deal in the last 10-20 years. Modern veterinary diagnostic tools for CM and CHF include not only the EKG and X-rays, but more sophisticated methods like the echocardiogram (ultrasound of the heart).
In cats, an echocardiogram is necessary to differentiate between the different types. In both cats and dogs, the echocardiogram also reveals how severely the DM has affected the heart structure, and it shows just how the sick heart is functioning. It is a very important tool in diagnosing heart disease.
X-rays (radiographs) of an animal in CHF would show fluid collecting within the lungs, outside of the lungs, and/or within the belly. They would also show an enlarged heart (cardiomegaly). (In fact, in dogs with CHF, coughing can be due to the enlarged heart pressing up against the trachea, in addition to being caused by fluid in the lungs.)
An EKG (aka ECG) in an animal with arrhythmia would show the irregular beating of the diseased heart.
In the past, a cat or dog with CHF from CM would be expected to die within a few days or weeks of diagnosis. Nowadays, while this sometimes still happens, many CHF patients live several months or even a year or more beyond the initial diagnosis.
The treatments for CM are too complex to go into much detail here. Generally speaking, initial treatment of an animal with signs of CHF which are acute and life-threatening is geared to reducing/reversing the worst signs and preserving life. They include oxygen, removing free fluid in the chest or abdomen, diuretics, drugs to correct arrhythmias if present, and drugs which strengthen the heart and make it easier for the sick heart to do its job of pumping blood around the body.
Longterm therapy can include some or all of the above. The treatments usually change with time, some drugs being added, some discontinued, depending on the results of followup checkups.
The longterm treatment of cats with CM will differ depending on which type of CM a cat has.
Longterm treatment of CM also includes treating other medical conditions which can lead to CM, like hyperthyroidism and hypertension. If deficiency of taurine and/or L-carnitine is diagnosed or suspected, supplmentation with these amino acids is started.
What if your veterinarian picks up a heart murmur or arrhythmia on a routine exam of your dog or cat? Should treatment(s) be started? The answer to this varies. In cats, a murmur may or may not be associated with actual heart disease. (On the other hand, cats with CM may have no murmur at all, or it may be inconsistent!) Even if CM - without CHF - is diagnosed in a cat, treatment may not be necessary right away. On the other hand, if a type of arrhythmia called the gallop rhythm is heard, this usually indicates significant heart disease and needs to be investigated and treated.
In small to medium dogs, a murmur is most often due to valvular insufficiency (VI), and, as mentioned in my last article, VI sometimes never cause problems. On the other hand, a murmur in a large, especially a giant, breed is more likely to be caused by CM, and therefore is more a cause for concern. Arrhythmias also are a cause for concern.
Taking all of this into consideration, and also evaluating your dog or cat’s history, breed, age, and the results of a thorough physical, your veterinarian may or may not immediately recommend pursuing the matter with the diagnostic tools discussed above.
Next month I’ll continue discussing the organs of the thorax. |
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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