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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 27371
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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I have a cat who seemed fine yesterday and this morning, but

Customer Question

I have a cat who seemed fine yesterday and this morning, but this evening he suddenly had very labored, rapid breathing. (It has been between 50 and 80 breaths a minute). We took him to the vet on an emergency basis. The vet took x-rays and did blood work. He said that a middle lobe of his lungs is collapsed. He did not see any excess fluid in the chest cavity. He did not indicate any evidence of asthma. He said that the blood work showed there is no anemia. He also said that this evening, he heard a heart murmur of about 4 or 5 on a scale of 1 to 6. He thinks that the murmur is a result of the collapsed lung because he did not see fluid in the chest, and he did not hear a murmur previously. We had the cat in to the vet about a month or two ago to have a blood glucose curve done because the cat is diabetic. (Tonight his glucose was 219 when I tested it...before he would have gotten his evening insulin...but I haven't given him his insulin since we have other issues going on.) There has not been any weight loss since then, and the cat has been doing well generally. No specific issues were noted a month or two ago. The cat was eating fairly well tonight, but does not like to get down to walk to the dish. The vet said that the cat's gums looks nice and pink, and he thought that he is perfusing well and is getting enough oxygen. He said that he isn't sure what might have caused this. He said that he sees this sometimes in dogs but can't remember the last time he saw this in a cat. The vet gave the cat some sub-Q fluids and sent us home. He said that he would call the state veterinary clinic in the morning. Our cat seems to have more trouble breathing since we got home than before we took him to the vet. Our vet said to call back if our cat started doing open mouth breathing (which he isn't yet), but the fact that he looks worse is worrying me. Since our vet was not sure how to deal with the situation, I'm not sure what to do at this point. Do you have any better information for me?. He is about 15. What are the chances he will be able to recover? Should I let him rest tonight? Should I take him back to the local vet with some additional information? Should I drive over an hour to the next nearest emergency vet clinic?
Submitted: 1 year ago.
Category: Cat Veterinary
Customer: replied 1 year ago.
Oh, yes...One more piece of information in case it is helpful...his blood pressure was taken several times and pretty consistently read around 85 over about 60.
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry that your question wasn't answered in a timely manner. Please let me know if you still need help. A collapsed lung lobe can't cause a heart murmur. The diagnostic of choice at this time is an echocardiogram (ultrasound of Patrick O'Malley's heart) in order to identify the reason for the murmur. I would suspect cardiomyopathy (heart muscle disease) in a 15 year old with such a murmur. A collapsed lung lobe isn't indicative of any one specific disorder but, instead, will appear secondary to pneumothorax (collection of air in the thoracic cavity), lung lobe abscess, neoplasia, or idiopathic (unknown cause) spontaneous rupture of a weakened spot in the lung lobe. Please give me an update on your cat. He does sound as if he would benefit from supplemental oxygen at an ER.

Customer: replied 1 year ago.
Thanks for your response. I ended up staying up all night so I could take Patrick O'Malley somewhere if he started breathing through his mouth. His breathing was fast and labored all through the night, but he didn't do any open mouth breathing (that was the condition my vet told me would warrant bringing him back in the night) so we went to the vet again this morning. The opacity on the radiographs was more diffuse than the night before, and the vet told me that could indicate asthma, heart disease, or cancer, and that it was difficult to tell the difference sometimes on a radiograph. So... I took the cat to a veterinary school so that he could be seen by a cardiologist, a pulmonologist, or an oncologist...whatever he needed. The only drawback is that it was a*****..so it made me a bit crazy wondering how he would do on the trip. But we got there. They did an ultrasound of his heart and decided that he has a mitral valve prolapse...and that is why he has a murmur. They said that the left atrium is not very enlarged yet. They are giving him heart meds tonight and seeing if his breathing improves. Otherwise, they will have to see if the breathing issues are different from the heart valve problem. They also said that his kidney values are high. The BUN is something like 85 and the creatinin is about 3.9. He just had blood work done in September, and the kidney values were normal. He was also eating well up until about Sunday afternoon, and then very suddenly stopped eating (and as a matter of fact looked nauseated if I tried to tempt him with food). I think that the heart issue, the breathing issue, and the nausea/kidney problems all happened suddenly at the same time. I don't know what would have triggered the sudden issue with the heart value since there was no indication of a murmur or shortness of breath until all of a sudden. I sort of suppose that if there was a problem with the heart that the kidneys might not have perfused well enough, and so there might be a problem from that. My question tonight is... is there any chance that the kidney issue is acute, and that it will return to normal or near normal if he responds to the heart medications they are giving him? The doctors keep telling me that a heart/kidney combination is very difficult to treat, and I can understand why...I'm just wondering if treating one can help the other as well...Sorry...just looking for any hope... I lost two cats in the last 8 months, and am worried about losing a third. This is tough on me, and although I know that no vet can give me a guarantee, I'm wondering if there is any hope at all, and I'm wondering if there are any good questions I should be asking at this point of the vet.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for such a thorough update. I'm pleased to hear that he was well attended to. The urinalysis should have the clues that chronic renal insufficiency is most likely in a 15 year old. There's little question that cardiac insufficiency will worsen renal insufficiency but I don't believe that his heart was responsible for what is likely to be a long-standing decline in renal function. Remember, a cat can lose 75% of normal functioning nephrons before the BUN or creatinine elevates. A dilute specific gravity (less than 1.020) is a big clue that chronic rather than acute renal failure has developed. An elevated serum phosphorus is another clue as it takes some time to develop and then indicates secondary renal hyperparathyroidism.

Mitral prolapse also is expected to arise due to chronic rather than acute changes in the mitral valve. As the valve weakens it prolapses - slips backward loosely into the left atrium. It's difficult to prognosticate at this time. We need to see if heart drugs will suffice to clear his lungs. It's unlikely that successful treatment of the heart will reverse the kidney changes but hopefully will slow the progression of their failure. Yes, he does present a challenge but he's at the right place for the best of care.

I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience.

Customer: replied 1 year ago.
After Patrick had a cardiac ultrasound, the cardiologist determined that the heart looked normal overall, but had an abnormal pattern in the mitral valve. Because of that, she diagnosed that he has a ruptured chordae tendinae. She put him in an oxygen chamber, put him on Lasix, a vasodialator, and a medication that would both dialate the blood vessels and make the heart pump harder (I don't remember the name of it, but it is a large brown, beef flavored pill that is usually used for dogs, but is being used off label in this case.) By morning, his breathing returned to normal, even with room air, and he started eating again. She thought that he had an excellent prognosis and that we could take him home that day. However, we elected to keep him overnight one more night so that we could make sure he was still stable after he received the oral forms of the medications as opposed to the IV forms he had been given. At 3 this morning, he developed breathing issues again, and this morning, he had another caridac ultrasound. The cardiologist said that there is more movement in the mitral valve, and so she thinks he may have ruptured another chordae tendinae. She does not give us much hope at this point. Do you know anything about ruptured chordae tendinae, and do you have any other information, suggestions, experts, referrals or ideas for me to add into the mix?
Expert:  Dr. Michael Salkin replied 1 year ago.

The chewable is pimobendan. Its most important quality is its ability to increase cardiac contractility in cats. His cardiologist should be as up to date as anyone when it comes to chordae tendinae. As far as I know, atrioventricular (AV) valve disease is still considered rare in cats. In any case of AV disease, the chordae tendinae can weaken with chronicity of degeneration in those valves and then tear. This can be surgically addressed in people, rarely done in dogs, and I'm not aware of any surgical studies in cats. I'm sorry to hear of this with Patrick...it's especially cruel to hear that his prognosis was excellent one day and hopeless the next. I'll think good thoughts for him.

Please continue our conversation if you wish.