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ECG for heart murmur?

Species: Cat
Breed: European Shorthair
Age: 5-8 years

We have an 8 year old european shorthair cat who was recently diagnosed as having a grade 4 heart murmur.

Currently there are no other symptoms, she is completely fine in herself and our vet is happy with her.

When he first diagnosed it (6 months ago) he took her in to do an ECG and it showed no underlying problems, just the murmur.

However, has has suggested checkups every 3 months and an ECG to be performed every 6 months.

The problem is the ECG really freaked her out last time. He sedated her but when we got her home she was so scared and hid in a cupboard for 3 days. She is an ex rescue cat and we believe she was previously abused as she is already very timid - the ECG/sedation seems to put her in a right mess.

Of course, if an ECG every 6 months is really needed then we will have it done. However, we cannot help but feel our vet may be being over-cautious (he has a reputation for this) and the extra stress and of course risk that comes with any sedation may not actually be needed.

Could you tell me what the normal process would be for a vet to follow with an 8 year old otherwise healthy cat who has a grade 4 heart murmur?

Maybe he is right but we just want to make sure we are acting in the cats best interest. We have told the vet about the stress it causes for the cat but he just said it needs doing.

Thanks for your help,


Online vet, Dr. Marie

Dr. Marie replied:

Thanks for your question Paul. Sorry to hear that Yaffa had such a traumatic experience at the vet's office.

I'll give you my thoughts on your cat's situation.

I'm a little bit concerned that Yaffa has a Grade 4 heart murmur. We grade heart murmurs on a scale of 1 to 6 with 6 being the most severe. So, a grade 4 murmur is usually a sign of something significant.

The problem is that it is often hard to know whether or not we need to be really worried. Cats will often show no symptoms of having heart disease for quite some time and then suddenly become ill.

It sounds like what your vet wants to do is to monitor Yaffa regularly so that we can intervene with medications *before* anything really serious happens. But I can understand your hesitation, especially if your cat reacts poorly to his vet visits.

I may not have an answer for you here, but I'm going to give you some facts and hopefully that can help you make a decision.

The most common problem for cats to have with their heart is a condition called HCM (hypertrophic cardiomyopathy). This is a condition where the walls of the heart are too thick. Cats can live quite happily with HCM and then suddenly go into heart failure. When this happens most cats do not live for long.

Unfortunately, an ECG does not always pick up HCM. The only way to accurately diagnose it is with an ultrasound of the heart (also known as an echocardiogram). Now, sometimes people get echocardiogram and electrocardiogram (which is an ECG) mixed up. An ECG is where they attach leads to the cat and get a tracing of what the electrical activity in the heart is doing. Personally, I do not do many ECGs in cats. They can be a little controversial amongst vets. Sometimes they can tell us if there is a problem there, but often they don't tell us much.

So, personally, I'm not sure that a regular ECG would tell us much. There are other conditions that could be picked up on an ECG but they are less common than HCM.

On the other hand, if it is an echocardiogram (ultrasound) that your vet is able to do every 6 months this will tell us a lot more information. If we start seeing evidence that the heart is struggling then there are medications that can really help a lot of cats. (We don't tend to treat heart disease until we are seeing some actual changes in the heart's ability to function - a heart murmur is not enough to make me want to treat.)

One thing that I often recommend is to have my clients measure their cat's resting respiratory rate. To do this, wait until Yaffa is sleeping and then count how many breaths he has in one minute. Write this number down and then check it again once a week. If the number starts to increase then this can be an early sign that the heart is struggling. An increase in resting respiratory rate can mean that there is some fluid in the chest as a result of a failing heart.

I'm struggling a little bit with how to conclude this. The reason for this is that I rarely want to contradict a vet's advice. Your vet knows what is best for your cat and if they have recommended these regular checks then it is probably a good idea. If you are reluctant to do this, then another option is to contact your vet and ask them what the next recommendation would be if you are not willing to come in for regular rechecks. They may make an alternate plan for you.

I hope that helps and didn't add to your confusion! And I hope all goes well for Yaffa!

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. 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.

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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.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.