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Limping cat with heart problems.

Species: Cat
Breed: Domestic Short Hair
Age: Less than 3 mon
Hudson is a 10 year old indoor house cat. He originally came from a garbage dump in Romania, then lived 6 months at my mother's in Canada, before moving with me to China. Since he was a baby, he has always eaten too much food and then vomited it up (he is a glutton). His weight, all his life, has shifted from very fat to skinny. He is very picky with his food. For a few years, he'll only eat Science Diet. Then he'll only eat Whiskas. He is stubborn and will actually starve himself rather than eat food he doesn't like.

Three times in the past 4 months, he has started limping in his left paw, followed by dramatic weight loss. Each time, I take him to the Chinese vet who administers a drip solution of "vitamins" and runs some blood tests. Each time, they tell me that his heart is getting worse and worse. They keep giving me "medicine" to give him, but when I read the ingredients, they say silly things like "honey, orange juice, and malt."

Last week Hudson became painfully skinny and developed a VERY serious limp in his left leg, so I started him on their "medicine" again. He started to gain weight. Then I switched him to Science Diet Kitten and he started to gain more weight. He is now outgoing. He plays with the other cat. He jumps up on my lap. He climbs 3 flights of stairs to see me in the morning. He is full of good spirits... but he is limping awfully (he has stopped using his leg completely) and the vet keeps telling me his heart is going.

They gave me his file, and it says this:
DATE: 2011-10-10
ECG: HR: 156 11 x2
VPC: 00:00 None VPC
SP02:00 RR:00 x1/2
TEMP: T1/T2 - 0.0//00.0C
NIBP: 00/00 - 00 mmHG

His blood work said:
WBC 3.4 (out of 5.5 - 19.5)
#GR 1.8 (out of 1.9 - 14.6)
ALT 95.6 (out of 5.0 - 80.0)
AST 52.1 (out of 8.0 - 38.0)
CR 128.7 (out of 60 - 110)
LDH 441 (out of 100)
CK 235.3 (out of 8 - 60)

Here are my questions:
#1. Is a limping of the front left paw a sign of heart failure?
#2. Does his blood work indicate heart failure?
#3. What are some real medicines for heart disease OR do these homiopathetic medicines actually work?

Thanks for your advice,
Amy




Online vet, Dr. Marie

Dr. Marie replied:

Hi Amy and thanks for your question.

I'm sorry to hear that Hudson is having problems. I'll see if I can clarify a few things for you.

It is definitely possible for a heart problem to be connected to limping. It's possible that he has a blood clot that is affecting the circulation to his front leg. While we more commonly see back legs affected by blood clots, a front leg can be affected instead.

A normal cat heart will not throw a blood clot. But, if there is a heart disease then this can happen. Usually when this happens we will notice that the affected foot feels much colder than the other feet. Can you notice a difference? Sometimes, if the pawpads are pink we can notice that they are more pale on the affected foot.

Unfortunately if there is a blood clot there is not a whole lot that can be done. There are some medicines that can help prevent more clots from forming but it's hard to get a clot to go away. I have heard of a few cases where a blood clot got better on its own. However, because the heart is diseased, usually a new one will form.

I'll see if I can explain the blood tests for you. It looks like the first set of tests is an ECG (electrocardiogram). It's hard to tell too much from what they've written here though. I would have to see the actual test to see if there is a rhythm abnormality.

In the next block, he has slightly low white blood cells. This likely doesn't mean a whole lot. He has a mildly elevated ALT which is a liver enzyme. At this level it doesn't tell us a lot. AST and CK are muscle enzymes. We will often see them elevated with heart disease. However, in my experience the CK is usually much higher with significant heart problems but it doesn't always have to be. Likely CR is creatinine. This is slightly elevated. This can mean kidney problems or possibly some mild dehydration at the time, which is more likely. LDH stands for lactate dehydrogenase. This level is quite high which can support heart disease as well.

There is a test that I like to run called a BNP level. If your vet is able to do this, this can tell us a lot more about whether there is a heart problem. Have they mentioned if there is a heart murmur? Another test that would be helpful would be to measure his blood pressure on his affected front foot as compared to the back feet. If it is low on the front foot this supports a clot (and also heart disease as well.)

Ultimately, if you were able to have an ultrasound done on his heart this would be the best thing. An ultrasound can often tell us exactly what the problem is and whether or not we can do anything for it.

The most common heart problem in cats is something called HCM (hypertrophic cardiomyopathy). This is a condition where the walls of the heart are too thick. There is no cure for HCM. If he has some rhythm abnormalities then there are medicines that can help his rhythm to stabilize and could possibly reduce the risk of him throwing more blood clots. But, my experience with heart disease in cats is that they tend to go downhill quickly.

It's hard for me to say whether the homeopathic remedies will work. I'm not a huge believer in a lot of natural remedies....but then there are likely a lot of medicines out there that I am not familiar with.

I wish I could give you more concrete information on what is going on with him. I really hope he improves. Let me know if you have more questions. I'll be online till about 10pm eastern tonight but if I miss you I'll check in again in the morning.

Dr. Marie.




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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Hi,

Thanks for your very thorough reply. When living in "hardship postings," it's hard to tell what is conventional medical knowledge and what is erroneous or lost in translations.

So my next steps are a BNP level, an ultrasound and to check whether he has rhythm abnormalities. There is a veterinary hospital in my city, so I'll make sure I take him there this week.

Cheers,
Amy


Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome Amy. Just a little bit more information about those two tests:

The BNP level is a new test. We've only had it for about 6 months or so so I'm not sure if it will be available to you. It costs around $50 or so in my clinic.

The ultrasound would need a specialist to do it. While many regular vets can do ultrasounds, heart ultrasounds need special equipment. This is not to check for rhythm abnormalities but rather to see if the heart walls are thickening and possibly tell us the exact status of the heart. This test is a lot more expensive (think $400 or so).

If this were my case I'd likely run a BNP and if it was really high then I'd be satisfied that this is a serious heart problem. If it was not high, or if the results were only a little bit high then I'd be thinking there is something else going on.



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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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