# Very sad, Congestive Heart Failure - can anyone help



## ALR (Apr 16, 2014)

Both hubby and I had some very bad news from the vet today. Our cat Bubble has congestive heart failure. The vet has explained that this is a serious condition and that his life expectancy is short. 


I just wanted to know if anyone here has any experience with this condition. I want to understand what I should expect. I know Bubble will have to be in and out of the vet for heart scans in the next few weeks and months but just wanted to understand how it'll affect his daily life. If he has only a few months to live I want him to be as comfortable and happy as possible.


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## Britt (May 18, 2014)

Oh no, I' really sorry to read about Bubble's condition. Did the vet tell you what can be done?


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## ALR (Apr 16, 2014)

It's not a curable condition unfortunately. They'll give him tablets and we need to monitor to find out the right dosage. When I asked the vet about life expectancy, he sounded very dire. Basically we'll have to take one day at a time. Bubble might have weeks or months but generally cats don't live for more than 2 years on this condition.

I think the vet was saying it all depends on how effectively the tablets are working. If the tablets work he might have a normal enough life which is what I really hope for. He's just a year old so this has been devastating news


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## Britt (May 18, 2014)

Poor baby. I hope for him and you that those tabs will work.


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## catcoonz (Aug 4, 2012)

Hugs to you and Bubbles, sorry I have no advise to give you. xx


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## slartibartfast (Dec 28, 2013)

I'm so sorry.
Hope the tablets will work. Sending positive vibes, hugs and furry kisses from Potter.


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## Esemais (Sep 8, 2013)

Yes, unfortunately, I've had experience of it. 

It really all depends how advanced it is. My poor boy had to have so many tablets his kidneys couldn't cope anymore. What medication has he been given?

And I'm so sorry to read he's only a year old.


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## ALR (Apr 16, 2014)

Thanks everyone for your good wishes. 

Esemais: I'm going to pick him up at 5 pm. I'll know then what medication he's been given. I'm not sure what questions to ask the vet and I feel a bit numb so my head is not working properly. 

Could you let me know a bit more of the meds the vet gave you. Bubble is meant to have another ultra sound in 3 weeks then 3 months. If he makes it that far. 

Could I ask, what was the quality of life of your cat? If you don't mind me asking, how long did your cat live?


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## Polski (Mar 16, 2014)

Can I ask how he came to be diagnosed? Isnt Bubbles the one recently neutered?


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## ALR (Apr 16, 2014)

Yes he's was neutered last week. He also had an accident and was diagnosed with a broken rib so the vet put him under anaesthetic to do both the X-rays and neutering.

He was fine before the accident. Only after the op the vet could hear a murmur but it was soft at first. 

He went off his food this week so we took him back and were shocked to hear the vet say he had a loud murmur. We thought he might be off his food because the rib was still painful and he's been off his pain medication.


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## Esemais (Sep 8, 2013)

ALR said:


> Thanks everyone for your good wishes.
> 
> Esemais: I'm going to pick him up at 5 pm. I'll know then what medication he's been given. I'm not sure what questions to ask the vet and I feel a bit numb so my head is not working properly.
> 
> ...


He was on frusemide, fortekor, cardisure, and asprin.

His heart stabilised, and he was doing really well on the meds, they gave him a month, he lived for six months, and they were really good months at first, it was like there was nothing wrong with him, he was eating as usual, playing as usual, gained the weight he had lost. But he very quickly went downhill towards the end because of the effects the drugs were having on his kidneys. We took him to a specialist in Chester but there was nothing they could do.

Frusemide is a very harsh drug on the kidneys, if it has to be given at a high dose.

Try not to panic until you see how many meds he needs. He might not need anywhere near what my little one had to have.

Best of luck with the scan results.


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## ALR (Apr 16, 2014)

Thank you very much for this Esemais. We'd really like him to have a good quality of life even if it's for a short time.


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## Charity (Apr 17, 2013)

I'm sorry to hear this for poor Bubble. Would it be worth getting a second opinion do you think? I'm surprised he got through an anaesthetic when he was neutered if this was present though it depends I suppose on how advanced it is. Hope its not as bad as is thought.


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## maisiecat (Jul 27, 2011)

I am sorry you are facing this.

I went through it a few years ago. Bob had his booster and shortly afterwards his breathing became noisy. (The booster part is relevant here).

We had been told he had a murmur when we got him but the vet didn't explain anything about it to us so we had no idea. Anyway we took him in and he was Xrayed and we were told he had 'months' to live. He was put on Furosemide and Fortekor and in case there was an underlying condition that was causing it - you might want to ask about this, either your vet, or someone on here, or even Google to get an idea we opted for a cardiologist.

He was taken to North Downs referrals for further tests and as he was already on meds it is possible that they assumed they were only looking for underlying causes and not to see if he had improved, I only realised this recently in the light of other developments. So, do ask questions, I didn't realise and therefore didn't question anything until recently.

No underlying conditions were found so he continued on the meds for about 3 years, the vets checked him 6 monthly and he had bloods and Xrays but no-one ever thought to see if he still needed the meds until we moved and changed to a new vet.

It turned out we had been giving him pills for a condition he no longer had, or perhaps never had in the first place. I remember the desolation I felt when I was first told, and then the hope as we drove to the cardiologist, and then again the sadness as we drove home after being told there was nothing else that could be done but if only we had known that reducing the meds (obviously after he was stable) was a possibility and that it might not be as bad as we thought we could have saved him who knows how many years of meds he didn't need.

I think it was brought on by the vet trip for the booster, or a reaction to the booster, I am not saying he didn't have heart disease, he did and still does, but not the one the first vet diagnosed and I will always be annoyed about that.

Sadly, many cats to have congestive heart failure and no underlying illness that can cause it and be treated, but don't just accept it, do try to find out.

There is a Yahoo Group you might find helpful called Feline Heart, I don't have a link to it now, but I joined it a few years back.

I hope you find you are dealing with similar to us and that it is not as bad as you think.

Edit to add: not sure I made it clear but Bob does not have congestive heart failure in spite of the vet assuming he did, the referrals also assuming he did and all vets at the same practice continuing to assume he still did. Our new vet suggested reducing the dose of meds gradually and monitoring carefully and I did this and he is no longer on them. He has subsequently been Xrayed, scanned and had everything else tested and he has an irregular heart beat.

If you would like to message me, I am not an expert but if I can help in any way .......


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## Polski (Mar 16, 2014)

ALR said:


> Yes he's was neutered last week. He also had an accident and was diagnosed with a broken rib so the vet put him under anaesthetic to do both the X-rays and neutering.
> 
> He was fine before the accident. Only after the op the vet could hear a murmur but it was soft at first.
> 
> He went off his food this week so we took him back and were shocked to hear the vet say he had a loud murmur. We thought he might be off his food because the rib was still painful and he's been off his pain medication.


Ok. I was just wondering why it wasn't picked up at neutering.

I'm going to throw a curve ball in here. Could the broken rib have done something to cause fluids to build up which has led to the alarmingly fast progression of the murmur? What exactly did the xray show?

I'm asking because Puss, my old healthy robust moggy got bitten/punctured on his under arm/rib cage. I took him to the vets who diagnosed an abscess growing inwards that needed an op, IV antibiotics and pain relief. I couldn't pick him up from vets the next day as they said there were complications. The following day I arrived to pick him up only to be told that he had CHF and it didnt look good. Was given 3 weeks of tablets and was told to make an appointment for when they ran out...long story short I only gave the tablets for a week because they made him so damn sleepy and lethargic, but when the next dose was due he was back to his old self and I figured I'd rather let him live 1 week as Puss than 1 month as Doped cat. I went back to vets (after the tablets _should_ have run out) and saw a different vet, explained I wasn't giving him the tablets any more and asked him to listen to my cats chest again just to pacify me. No murmur, no congestion. Official story was that it was a miraculous recovery...unofficial story was he was over-hydrated with his IV therapy or the operating vet nicked something that had healed over the 3 weeks. He lived another 4 years before sudden kidney failure took him...cant help wondering if the frusemide played a part in that because they are soooo harsh.

Now I'm not saying this is the case here and I don't want to get your hopes up or anything but a second opinion wouldn't hurt especially with the sudden acceleration of the murmur.


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## ALR (Apr 16, 2014)

Thank you. We're still shocked about this.

I think the one thing I have to ask the vet is how advance his condition is. He deteriorated very fast after his op last week


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## ALR (Apr 16, 2014)

If I get a second opinion what would I need the vet to look for. Would they need to do a scan or just listen to his heart? 

I'm not sure if I can put him through this so soon again.


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## maisiecat (Jul 27, 2011)

ALR said:


> Thank you. We're still shocked about this.
> 
> I think the one thing I have to ask the vet is how advance his condition is. He deteriorated very fast after his op last week


Agree, it might be to do with the rib, and stress can bring it on. You do need to know how much fluid there is, Xrays should show it.

Fingers and paws crossed here that it is not as bad as you think and that he will respond to the meds.

I remember it gave me a whole new reason to get up in the morning and give Bob his pills at the same time every day, a routine developed which he still expects to continue, pills in treats - fish or Lick e Lix before meals, 3 times a day.


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## maisiecat (Jul 27, 2011)

ALR said:


> If I get a second opinion what would I need the vet to look for. Would they need to do a scan or just listen to his heart?
> 
> I'm not sure if I can put him through this so soon again.


Cross posted above, so will say, we were told when he had the Xray that he had a heart problem and he was immediately put on the meds. This was about Feb. and we continued with the meds and kept a close eye on him, taking him to the cardiologist in the following June. I waited to see how he got on with the meds before subjecting him to anything else but had hope that something else was causing it, looked at taurine deficiency and the other possible causes, bloods showed it wasn't taurine.

I wouldn't stress him any more, see how he gets on for a while, and ask all the questions that I didn't.


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## Polski (Mar 16, 2014)

My second opinion just involved listening to his chest. With the recent xrays Bubble has had I should imagine that maybe those should be looked at again and more closely. I don't know what the xrays showed but is it possible he has a a small penetrative injury to his lung or heart from it? 

I really don't know and as I said I don't want to get your hopes up its just the fast progression of the murmur that made me think its worth asking for them to check again or at least explain why it should suddenly escalate...especially given the life he was living just a few short months ago


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## jill3 (Feb 18, 2009)

I am very sorry to hear that Bubble is not well.
Hearing bad news like this sends your mind into a panic mode and I know that you probably can't think straight.
I would always seek another vets opinion and take advice from other members on here whose cats have the same problem.
Maisiecat has given some good advice and hope that this helps you.

There is a lot of advice on the internet about Feline Hearts which might be of help to you.
We lost a 3 year old to HCM. He suddenly collapsed and had to be put to sleep. He had no symptoms of ill health at all. It broke my heart
Some cats have HCM and they live for years with treatment.
I don't know the difference between Congestive Heart failure and HCM but there does seem to be a lot of cats that get it and Heart murmurs too.

Stay strong and sending Positive and Healing vibes to Bubble xx


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## maisiecat (Jul 27, 2011)

Sorry for all the posts, I keep remembering things.......

Don't forget that a murmur can sound worse after travelling to the vet and being at the vet. If the vet does longer appointments (ours does 15 or 30 minute ones) taking a longer one and letting him wander about the room after travelling might help in future, before he is examined, to let him settle.

One other thing, ensure he is not petted while his heart is listened to, it can affect the sounds the vet hears. Hold his head gently to keep him still but no stroking or rubbing.


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## ALR (Apr 16, 2014)

I just got Bubble home. It's really nice to have him back.
They did an X-ray yesterday. From what I understand there was not a great deal if water in the lungs. 

I asked about the rib but the vet said the broken rib is not near his heart and it can't be that. He doesn't seem to have an answer as to the underlying cause. I did ask how advance it is, he said he's seen worse and the cat have managed to stay stable. It's not diabolical basically. 

The meds he's been given are Fortekor, clopidorel, and frusemide. I asked about the frusemide causing issues to his kidneys but the vet said it's a small dose and there is no alternative to it 

He wants Bubble to have another scan next week to see how well the meds are working. 

Thanks for all your replies. There's a lot to take in at this time. I'll reread everyone's post when I feel my brain is less fuzzy but I'd like a second opinion at some point. And it did occur to me that he deteriorated just after he was put under anaesthetic. Not sure if there was a connection there. When he was injured with the rib, 2 vets listened to his heart and there were no murmurs.

Maisie: pleas don't apologise. I am really grateful for all everyone's insights. I feel a bit better now. I'm not optimistic but knowing what's happening made me a bit calmer.


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## maisiecat (Jul 27, 2011)

Sorry but there *IS* an alternative to Furosemide, it is Spironolactone which is not so hard on the kidneys.

Some people give both Spiro and Lasix (Furosemide) and for an emergency where fluid has built up then it is Lasix that is used in a high dose, which is then reduced to a smaller one. The dose given thereafter is the lowest possible on that keeps the condition stable.

See how you feel once you have absorbed all the info you have been given, both on here and by the vet, and have made sense of it. Do some reading on Google and try to work out what you think is going on. Then you will be able to ask the questions of your vet that you need to ask.

Vets never want to commit to anything with a condition like this, but sometimes can be too vague, or like ours was, once he had made his first diagnosis, he lost interest in Bob and couldn't be bothered to try anything, assuming he was on his last legs, it turned out he was wrong, apparently with the diagnosis and also with him being on the way out.

Keep an eye on your vet. Not knowing or wanting to find out about alternative meds is not what I would want for my cat. On the other hand he 'might' have been trying not to complicate things at this stage so will give the benefit of the doubt. Some vets are inexperienced with heart failure and use a one size fits all approach which is what we got. I will never again accept something without doing research and asking as many questions as it takes to get the best for my cat.

Edit: without going back over the thread, is it possible he has an infection of some kind from the rib injury? Also a lung problem does not need to be near the heart to cause breathing difficulties, a build up of fluid can be elsewhere, as can dark spots on the lungs which may not even be fluid, but a respiratory condition.


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## maisiecat (Jul 27, 2011)

If he is proposing another scan with sedation then I would ask to see the Xrays and have it all explained in detail.

There can be risks with sedation and heart problems. Is your vet experienced?


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## ALR (Apr 16, 2014)

That's the thing. The vet is meant to be a specialist and all X-rays and scans are done only by him. 

Bubble was actually not sedated for the X-rays yesterday and the scans today! He's a very gentle soul, so the vets tried to see if they could do the Scans without sedation!


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## Polski (Mar 16, 2014)

maisiecat said:


> Sorry but there *IS* an alternative to Furosemide, it is Spironolactone which is not so hard on the kidneys.
> 
> Some people give both Spiro and Lasix (Furosemide) and for an emergency where fluid has built up then it is Lasix that is used in a high dose, which is then reduced to a smaller one. The dose given thereafter is the lowest possible on that keeps the condition stable.
> 
> ...


This...the whole post but especially the bit in bold. It just seems strange to have gone from no murmur to a mild murmur to a fairly serious murmur in such a short time. Give yourself the time you need to actually get to grips with it all, read all that you can absorb. Then you will know the questions to ask.

Hugs to you and Bubble


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## Esemais (Sep 8, 2013)

I asked about Spironolactone for my boy, and was told if there's lots of fluid it isn't strong enough to clear it.

What dose is the frusemide ALR?

Glad you've got him back. 


Ahh yes clopidogrel, I knew I missed one, mine had that too.


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## ALR (Apr 16, 2014)

Initially that was my first reaction that the rib caused the issues but the vet was so adamant it isn't. This is making me rethink things. I don't know if going to another vet or specialist would clear this issue up. And how would they go about to check if the rib is infected?

The frusemide dose is 20mg per day. Don't know if that's a lot or not.


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## ALR (Apr 16, 2014)

Tonight I'll enjoy Bubble he seems more alert today. Yesterday he was having difficulties breathing .

Then tomorrow I'll read as much as I can to understand this issue.


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## maisiecat (Jul 27, 2011)

Ahhh, I chose our new vet because 2 of the vets had an interest in cardiology, according to the website. The first one we saw was the one that told me to reduce the meds and we ultimately got him off them, but when we saw him again he didn't seem able to help with other things.

The other one, followed the procedures but his attitude was one of 'I am right and don't ask me questions, I am too busy and important to answer them'. So we went elsewhere, to a vet that doesn't say he specialises in anything, but he does have experience, and patience, and time to explain.

There are procedures that they follow with tests, what type of meds are given but it is down to the individual vet whether they listen, take on board what is said and consider possibilities. Our first one just lumped all heart patients into the same box and I am concerned that you may be facing similar.

There are variables to consider, not all heart patients are the same. I won't question the diagnosis, but furosemide works fast so you should see a change if it is a fluid issue.

An Xray would show if there is fluid, and an abnormal shape to the heart (enlargement) this is what you need to ask to see. Heart rhythm checked? If not, it would be worth doing, if they have the equipment, not just a stethoscope.

I may need to go back over the thread but what were the symptoms that led to the heart diagnosis?

Laboured breathing, cough, loss of appetite, lethargy? These are symptoms of heart problems but can also be symptoms of a respiratory infection or lung problem.


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## Polski (Mar 16, 2014)

ALR said:


> The frusemide dose is 20mg per day. Don't know if that's a lot or not.


I have 40mg doses and it kills my kidneys so only take it when absolutely necessary so 20mg sounds quite high.


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## maisiecat (Jul 27, 2011)

I would say that is high and it should work very fast at that dose.

We started with 1/4 tablet twice a day and saw a fairly quick improvement although more gradual due to the dosage. Only increased it when we thought his breathing was getting worse, which actually turned out to be something else - another problem that the vet couldn't diagnose but not relevant here.


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## ALR (Apr 16, 2014)

Polski said:


> I have 40mg doses and it kills my kidneys so only take it when absolutely necessary so 20mg sounds quite high.


Are you saying 40mg is the dose for a human! Then that is high.

Bubble's breathing was laboured yesterday. And he went off his food completely. Those were the symptoms. When the vet did the X-ray, she said the heart was enlarged and there was sign of fluid in his chest area.


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## ALR (Apr 16, 2014)

I should also mention that he had antibiotics for the rib, Noroclav, which ended on Sunday. His painkillers were over on Sunday too. From Tuesday I started noticing the food changes etc. That's why I thought he might need more antibiotics.
But the vets thought it was the heart.


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## Ceiling Kitty (Mar 7, 2010)

I have read this thread, but a few things have confused me. I'll try and read it through again.


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## Polski (Mar 16, 2014)

Yes, the 40mg dose is for me as a human. I have a lung condition which means I accumulate fluids, when these build up too much I definitely get cardiac symptoms although an hour long echo of my heart showed up no abnormalities in my heart. 


How did Bubble break his rib? Did the xray show a piercing injury from the rib that required antibiotics? I cant see why antibiotics would be prescribed otherwise but i'm no vet so maybe someone could enlighten me on this.


ETA - is it possible hes allergic to penicillin? loss of appetite and breathing difficulties are symptoms although I would have thought they would show up sooner


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## Esemais (Sep 8, 2013)

20 mg is high, but he might just be on that dose to stabilise him and then there's a possibility it will be reduced after the scan. They reduced my boys but he went into failure again.

The symptoms my boy had - weight loss, which was being investigated, but never attributed to his heart by the vets. 

One night he had rapid breathing and was hunched up, we rushed him to the vets, who said to take him immediately to the emergency vets. There he had to be placed into an oxygen tent and had fluid drained off. They got a mobile cardiologist out the next day who diagnosed HCM. 

I'm no expert but how does a cat go from a mild murmur to congestive failure in such a short time?


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## GingerNinja (Mar 23, 2014)

I'm so sorry and shocked to hear about poor Bubble 

Please take time to read through the posts of the other members that have experience of this to see the similarities and ask lots of questions of your vets. If they don't like it, change vets.

I would think that many things can cause a heart murmur, Luna had quite a severe murmur with her anemia so I would think that any number of things like anesthetic, broken rib etc might influence it. But hey, I'm not a doctor /vet.

Lots of positive vibes xxx


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## Ceiling Kitty (Mar 7, 2010)

Right, I've re-read. My understanding is as follows - please correct any mistakes or misunderstandings I have made.

Bubble is 1 year old. He had an accident and was diagnosed with a broken rib via X-ray, and was neutered at the same time. After the op, he was diagnosed with a soft heart murmur - this had not been heard before. This was last week. He was given antibiotics for the broken rib.

This week he went off his food and his breathing became laboured. His murmur had become louder. An X-ray showed fluid in the lungs and an enlarged heart. He was diagnosed with CHF and is now on frusemide, Fortekor and clopidogrel.

Right...

First, here's some general stuff about feline heart murmurs I posted on another forum a few weeks back. I haven't altered it so it may not be specifically relevant to Bubble (it was directed at someone with an older cat, for a start) but it might help any other readers/lurkers and you'll get the gist of it:



Me said:


> Murmurs are very common in older cats. A murmur is not a diagnosis, merely a symptom of underlying heart disease. In cats, this is usually HCM (hypertrophic cardiomyopathy, caused by a thickening of the heart muscle) - but other causes exist so an echo (heart scan) would be needed to confirm the diagnosis behind the murmur.
> 
> HCM can occur in any cat and may have genetic components, but as cats get older they can also be prone to other diseases such as high blood pressure and hyperthyroidism, both of which can contribute towards the development of HCM and a heart murmur. Both of the above are treatable with medications. From this point of view, further tests such as a blood screen (especially for kidneys and thyroid) and blood pressure measurement may be warranted if you choose to go down that route, even if you think extensive cardiac diagnostics are not on the cards given her age.
> 
> *While a murmur is a sign of heart DISEASE, this is distinct from heart FAILURE.* Many cats have murmurs but live normal lives and pass away of something completely unrelated. Others, sadly, go into heart failure and will develop symptoms that ultimately are fatal. Signs of this can be very subtle in cats but include heavy or rapid breathing, weight loss and general lethargy. In some cases, the signs of heart failure can come on suddenly and lead to acute respiratory distress with open-mouth breathing, very laboured breathing and collapse.


There is also some reliable information about heart murmurs in general on the iCatCare site: Heart murmurs in cats | international cat care

Is the underlying cause of Bubble's heart murmur known? In a young cat HCM is still is a possibility, as is some kind of congenital heart defect such as a malformed heart valve or a hole in the heart. There are reports of heart murmurs brought on by trauma (usually due to bruising of the heart or tearing of the valves) but these are really, really, _really_ rare. I've never heard of a broken rib piercing a heart, certainly not in a patient who survived anyway, so overall I would place the physicality of trauma very low on the list of possible causes.

However, maisiecat is correct in saying that stress can affect the grade and nature of murmurs and that stressful events can precipitate CHF. So, on this basis, I guess we wouldn't be able to rule out the stress of hospitalisation and surgery as a factor (albeit not the original cause).

Has he had any scans yet?

I would be interested to know the results of any echocardiograms (heart scans) Bubble has, as this would provide us with the diagnosis behind the heart murmur and, ultimately, the CHF. Sedation is sometimes used for echoes in cats but is avoided wherever possible, partly due to safety concerns but mainly because sedatives can affect the findings on the scan. If Bubble is, as you say, quite amenable then it is likely that he may not require sedation for an echo.

I guess HCM being the most common cause of pathological murmurs in cats, this would be the working diagnosis until proven otherwise. Has your vet mentioned HCM at all?

Good info here, again from iCatCare: Hypertrophic cardiomyopathy (HCM) and testing | international cat care

If you haven't yet seen them, I would ask to see the X-rays of his chest. They should be able to show you his broken rib, the enlarged 'cardiac silhouette' and the pulmonary oedema (fluid in the lungs) that has led them to the diagnosis of CHF.

Here's a cat with an enlarged cardiac silhouette. It is important to remember that having a large heart does not always mean CHF - in the same way that not every cat with a murmur is in CHF.










And here, for comparison, is a 'normal' cat chest. Yes, that is a needle in the stomach. But it's heart sure looks fine.










So, murmur = heart disease. But NOT necessarily CHF.
Big heart = heart disease. But NOT necessarily CHF.

How is the diagnosis of CHF made? Answer: pulmonary oedema.

Pulmonary oedema is fluid in the lungs (don't confuse it with pleural effusion, which is fluid in the chest _around_ the lungs). Pulmonary oedema can occur for a number of reasons, including electrocution, an obstruction in the upper airways or extremely high blood pressure. But the most common cause by far is CHF.

Hence, with a finding of a murmur, a large heart AND pulmonary oedema, it is reasonable to make a diagnosis of CHF.

Here's pulmonary oedema on X-ray. Lungs should be black on X-ray, as they are full of air. Any white patches are fluid. You can see the fluffy white-grey patches all over the lungs just to the right of the heart. This is a really nice X-ray - not all cases of pulmonary oedema are this obvious (especially not in cats, as compared to dogs).










You do mention that the vets saw all of this, so it does point to CHF. You can always seek a second opinion if you have concerns. Dyspnoea (difficulty breathing) could also occur due to asthma (common in young cats). And I've never had a broken rib, but I'm told they're bloody painful and can make breathing difficult and uncomfortable.

Medication wise, the diuretic frusemide is the mainstay of therapy for CHF. It makes them pee, so they drain their lungs of the pulmonary oedema. If only there was a way to dehydrate the lungs alone, and not the rest of the cat... but sadly there isn't, and using frusemide will always cause a degree of dehydration and can strain the kidneys.

At lower doses the strain on the kidneys is pretty minimal, even though cats are ultra-sensitive, but as the dose increases the impact will be greater. A normal starting dose for oral frusemide is considered to be 1-2mg/kg. Severely affected cats may need to start higher, for example at 3-4mg/kg. Doses up to 8mg/kg can be given, but at those kind of levels you are really pushing those kidneys.

Unfortunately, as CHF progresses, it is normal to have to gradually increase the frusemide dose according to worsening clinical signs. Regular blood tests can assess the state of the kidneys, but it is a bit of a catch-22 as you can't really withdraw frusemide therapy in CHF.

As mentioned above, spironolactone (Prilactone) is another diuretic that can be used. Esemais mentioned that it isn't as strong, which is true. Therefore it is rare to use spironolactone instead of frusemide (I've never seen it done, anyway), but it can be added into the regime so that a lower dose of frusemide can be given. Spironolactone is a potassium-sparing diuretic: it allows the kidneys to retain potassium in the body whereas frusemide causes you to pee it out. Low blood potassium levels can affect the heart and cause muscle weakness.

Fortekor is benazepril, one of a family of drugs called ACE inhibitors which lower blood pressure and thus reduce the strain on the heart. They are a pretty standard therapy for cats in CHF. There's a cheaper version called Nelio as well, if cost is an issue.

The clopidogrel is an interesting addition to the regime. It is an anti-platelet drug that aims to stop blood clots from forming. Cats with HCM can be particularly prone to forming large blood clots in the left atrium (one of the heart chambers). This is because the chamber is stretched by the heart disease, blood flow through it becomes a bit 'stagnant', for want of a better word. And it can clot.

If that big clot suddenly shifts one day and gets into the bloodstream, it can lodge in the major arteries supplying the hind legs. This is why we sometimes see cats with the devastating and painful condition called ATE (aortic thromboembolism), secondary to heart disease. They are paralysed on their back legs, in a lot of pain, and the prognosis is grave.

Clopidogrel or aspirin can be given to reduce the chances of blood clots forming. This is usually only commenced if there is evidence of a clot formation on an echo, or a very large left atrium that makes us worry about clot formation. Starting cats on these anticoagulants without an echo can be done, but it was making me wonder if Bubble had actually had a scan yet (I wasn't sure).

I'm sorry you've received this very worrying news. I'm going to keep everything crossed that this does turn out to be one of the (albeit very rare) cases of strange 'temporary' CHF sometimes seen in cats that have suffered acute stress. That or just a nasty asthmatic episode.

Please let us know how he gets on. xxxxx


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## ALR (Apr 16, 2014)

Gosh Shoshannah that was very very comprehensive. Thank you very much for this. It's greatly appreciated. 

Bubble has had an X-ray, a scan and blood pressure taken. No blood tests though. I've seen the X-ray, his heart is slightly enlarged but not as bad as the X-ray you showed. The vet initially said he might not have pulmonary oedema because his lungs formed the right shapes. 

But after the vet did the scans he mentioned HCM and CHF (sorry I'm still getting used to the acronyms). So he must have had a better view after the scan.

The vet didn't mention the result of the blood pressure. In fact I didn't know he had done one until I was paying the bill. My car was around so I had to run but I'm going to call and ask.

I think the vet wants to do repeated scans after 10 days, 3 months and 6 months to see how his heart is coping after the meds. 

I really hope Bubble copes well with all the medication and that he can lead a normal enough life.


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## PetloverJo (Nov 4, 2011)

Wishing Bubble well and hoping that the meds work well for him.

I know nothing about CHF. But I have lost a cat to sudden heart failure at the age of 2 years old. 

I sort of know how you are feeling.


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## Tanyaswisse (Dec 27, 2013)

My cat Boo has the same problem. She has been put on a tablet from the rspca vet but I am anxious to know if there is anything else that can be done for her. i have read about amino acids, taurine etc and am going to ask the vet about it. The last couple of days she is not eating, and her breathing is very very fast. Does anyone have any ideas that we could put to the vet which might help. The rspca gave us the impression that there is not a lot that can be done for her.


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## ALR (Apr 16, 2014)

It sounds like your cat's situation is a bit serious. Can you tell us what meds he's been given?

I'd go to another vet and get a second opinion. It sounds like it's an emergency to me. When we took Bubble to the vet, he had no appetite and his breathing was increasing. By the next day, he was in heart failure so I'd advise to act fast.

Also I have now joined the feline heart forum: https://groups.yahoo.com/neo/groups/feline-heart/conversations/messages

It has helped a lot in terms of information on this condition.


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## Tanyaswisse (Dec 27, 2013)

Sadly Boo died last night and although she was with us such a short time she will be so missed. I am still thinking we did right by her to keep her with us and not return her to the RSPCA when she was diagnosed as she had four weeks in a home being spoilt and she would have been put to sleep if returned as they could not have re homed her. Also think she did not suffer until she went off her food over the last two days and she died peacefully we think in her sleep. Thanks for the help and support from the forum over both Pepsi and Boo.


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## ALR (Apr 16, 2014)

Aw I'm really sorry to hear this. When a cat has gone through heart failure, it's really a lottery if they recover. 

You did everything you could for Boo and gave her a good home where she felt loved and secure. 

Rest well little Boo.


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## slartibartfast (Dec 28, 2013)

I'm so sorry.
Run free Boo.


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## MinkyMadam (Apr 12, 2014)

So sad to hear about Boo. Rest easy at the bridge little one. X


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## PetloverJo (Nov 4, 2011)

So sorry to hear about Boo. RIP little one run free at the bridge.


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## Tanyaswisse (Dec 27, 2013)

Thank you so much. First Pepsi and now Boo. It is heartbreaking when you lose pets. When Pepsi went blind at Christmas it was thanks to a forum member that she regained her sight due to advice given then, which even the vet did not know about. We are very grateful for the advice given and support for both pets. I will probably be back on again as the house is so empty and there are so many cats out there waiting for homes hopefully next time without help problems.


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## jasmine2 (Apr 30, 2019)

ALR said:


> I just got Bubble home. It's really nice to have him back.
> They did an X-ray yesterday. From what I understand there was not a great deal if water in the lungs.
> 
> I asked about the rib but the vet said the broken rib is not near his heart and it can't be that. He doesn't seem to have an answer as to the underlying cause. I did ask how advance it is, he said he's seen worse and the cat have managed to stay stable. It's not diabolical basically.
> ...


I've seen your post and wanted to know did you found out if it really was heart failure or broken rib was causing difficulty breathing. Did you got second opinion from another vet and what were you feeding him when he was diagnosed with heart problems?


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## Charity (Apr 17, 2013)

jasmine2 said:


> I've seen your post and wanted to know did you found out if it really was heart failure or broken rib was causing difficulty breathing. Did you got second opinion from another vet and what were you feeding him when he was diagnosed with heart problems?


This is a very old thread and the OP hasn't been on for a year now so may not see your message


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