Possible HCM Dx - Opinions?

[FrostD]

Hi all,
Long time no see! Just a heck of a year personally, but all good. Mr Kitty is still in DM remission, and has not had any cabergoline in well over a year. Wild.

He's been having some issues recently - lack of appetite, PU/PD, not grooming, not very social, general apathy. Vet heard an arrhythmia. We've essentially ruled out everything else we can, and are looking at HCM and/or the unmanaged thyroid.

I'm posting this specifically in the acro forum given that HCM is fairly common in acros, and they're a bit more of a special caze than generic Feline Health. Feel free to move it if needed!

I've searched old posts, so really just looking for opinions at this point. Mr Kitty cannot undergo anesthesia, not safe for him (has had to be resuscitated twice). So ECG is out, and likely chest x ray as he is particularly spicy.

There is a possibility that the unmanaged thyroid is causing thickening of the heart walls (in which case it is possibly reversible damage), we are doing our best but he isn't tolerating the high dose oral methimazole well. Radiation and topical methimazole are not possible.

At this point I am thinking about all I can do is monitor BP? And keep an eye out for signs of worsening symptoms and possibly CHF?

@Wendy&Neko

 

[Wendy&Neko]

How is Mr. Kitty with sedation? That is not anaesthesia. Neko tended to be more spicy at her cardio vet - one time he knew she wasn't well because her spice level was down. She could not have anaesthesia, but handled some sedation OK. She got ECG and echoes done that way.

How is Mr. K's BG? Any coughing? What is his respiration rate?

 

[FrostD]

How is Mr. Kitty with sedation? That is not anaesthesia. Neko tended to be more spicy at her cardio vet - one time he knew she wasn't well because her spice level was down. She could not have anaesthesia, but handled some sedation OK. She got ECG and echoes done that way.

How is Mr. K's BG? Any coughing? What is his respiration rate?

I went back through my notes - he was technically under sedation once and anesthesia once and had to be resuscitated both of those times. Even gaba for appointments hits him hard, I suspect playing with dose/concentration (?) may help but don't want to risk it if not necessary.

BG consistently floating around 85 mg/dL. No coughing. Respiration has been on higher end of normal, but also seems a bit labored. Updated lab tab as well.

We are, essentially, at the point of trying to keep him comfortable/maintain quality of life while not doing anything too excessive for him (I truly am worried he is going to give himself a stroke at the vet one of these times, even as a gaba space cadet ). Really trying to get that thyroid under control while not making him miserable.

Our vet said that given his "lack" of symptoms and the thyroid even if we did see a cardiologist and get imaging, he expects it would just be a "wait and see, treat thyroid first" situation - but admits he's no cardio vet.

 

[Wendy&Neko]

I agree that unmanaged thyroid is a good first step. Good luck with that.

Another option is the Cardiopet proBNP test (a blood test).