HCM is the most common heart disease in cats. Hypertrophy refers to the enlargement of an organ, in this case the thickening of the heart muscle. Cardiomyopathy refers to a heart muscle disease. As a result of the thickening of the heart muscle, the heart can no longer fill itself sufficiently with blood and cannot pump enough blood into the body's circulation. This leads to a backflow of blood into the pulmonary circulation, which in advanced stages can lead to water retention and shortness of breath.
A distinction is made between primary and secondary HCM. In primary HCM, the heart muscle itself is diseased. In some cat breeds (Maine Coon, Ragdoll), a genetic defect has already been identified as the cause of the heart muscle disease. However, the severity of HCM is determined by many other factors. In secondary HCM, the heart muscle thickens due to other underlying diseases, such as hyperthyroidism (overactive thyroid), kidney disease, or diabetes mellitus.
Due to the initially very inconspicuous symptoms and the fact that cats in their current living conditions are not usually observed under stress (e.g. when hunting), the disease often remains undetected for a long time. It is not uncommon for some cats to suffer sudden cardiac death without any prior signs of illness.
If the disease progresses slowly, relatively sudden symptoms such as loss of appetite, fatigue, decreased playfulness, bluish mucous membranes, and, above all, shortness of breath may occur. Unlike in humans and dogs, coughing is very rare in cats as a result of heart disease.
In the course of HCM, thromboembolism (the passage of a blood clot) can occur relatively frequently in cats due to blood clots being washed out of the left atrium. Sudden paralysis of one or both hind legs or one front leg with the cat showing clear signs of pain can be a typical symptom of aortic thrombosis (a blood clot blocking the aorta). A thromboembolism is an acute emergency that requires immediate treatment.
Nowadays, veterinary medicine is also divided into many specialist areas. If you suspect that your cat has heart problems, it is advisable to take them to a vet who specializes in heart disease, known as a cardiologist. You can, of course, visit your regular vet first and ask them to refer you to a specialist. In most cases, the specialist practice or clinic will have all the necessary examination methods and equipment.
The cardiologist will, of course, perform a general examination, but also a special heart examination. They will listen to the heart and lungs with a stethoscope. This will allow them to make some initial findings, although many cats with HCM do not show any abnormalities. Conversely, some healthy cats have a heart murmur without suffering from any disease. An electrocardiogram (a recording of the heart's electrical activity) also does not usually provide clear evidence.
A blood test can be used to determine heart-specific values, the levels of which provide information about the likelihood of HCM. An X-ray examination can determine the size and shape of the heart and lungs and detect any fluid accumulation in the lungs (pulmonary edema) and chest cavity (pleural effusion).
However, the only reliable method of detection remains an ultrasound examination of the heart, which can show and determine the exact thickness of the heart muscle, the function of the heart valves, and the blood flow. Blood clots can also be detected at an early stage using ultrasound, allowing treatment to be started promptly to prevent thrombosis.
The treatment depends on when the disease is diagnosed and how far it has progressed. If HCM is diagnosed early and there are no symptoms, the vet will decide on a case-by-case basis whether and how to start medication. This depends on the heart rate and the ultrasound findings.
If HCM is only detected at an advanced stage with existing pulmonary edema or chest cavity effusion, the patient must be treated to prevent the symptoms from worsening. Depending on the severity, diuretics, circulation-stabilizing or heart-strengthening medications are used. In life-threatening conditions, the affected cats must be treated in a clinic.
The prognosis for HCM depends on the breed, the time of diagnosis, the severity of the disease, and the response to possible treatment. Some breeds, such as Maine Coons, develop HCM earlier and more severely and have a higher risk of sudden cardiac death than other breeds. The occurrence of thromboembolism (blood clots) significantly worsens the prognosis, as relapses are possible even after successful treatment. If HCM is diagnosed at an early stage, the prognosis for the affected cats is good.
The occurrence of heart muscle disease cannot be completely prevented in cats. However, regular heart ultrasound checks by a veterinary cardiologist can ensure that changes are detected and treated at an early stage, especially in breeds at risk. Some of the affected breeding associations already require such examinations before breeding.
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