Hypertrophic cardiomyopathy – small cat, big heart

Hypertrophic cardiomyopathy (HCM) is the most common heart condition in cats. Maine Coons and Ragdolls have a genetic predisposition to this condition. If diagnosed late, it can be life-threatening.

INHALT
Definition and Origin Causes Symptoms Diagnosis Treatment Forecast Prevention
Definition and Origin

Hypertrophy refers to the enlargement of an organ; in this case, it refers to the thickening of the heart muscle. Cardiomyopathy is a disease of the heart muscle.

As a result of the thickening of the heart muscle, the heart can no longer fill sufficiently with blood and can no longer pump enough blood into the systemic circulation. This leads to a backflow of blood into the pulmonary circulation, which in advanced stages can result in fluid retention and shortness of breath.

Causes

A distinction is made between primary and secondary HCM.

In primary HCM, the heart muscle itself is diseased. In some cat breeds, such as Maine Coons or Ragdolls, it has already been proven that a genetic defect is responsible for the disease of the heart muscle. However, the severity of HCM is determined by many other factors.

In the case of secondary HCM, the heart muscle thickens due to other underlying conditions, such as hyperthyroidism, kidney disease, or diabetes mellitus (see the corresponding article).

Symptoms

Because the symptoms are initially very subtle and because cats in modern households are rarely observed under physical stress—such as while hunting—the disease often goes undiagnosed 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, symptoms such as loss of appetite, fatigue, decreased interest in play, bluish mucous membranes, and, above all, shortness of breath may appear relatively suddenly. Unlike in humans and dogs, coughing occurs very rarely in cats as a result of heart disease.

In the course of HCM, thromboembolism (i.e., blockage of a blood vessel by a blood clot) occurs relatively frequently in cats due to blood clots being dislodged from the left atrium. Sudden paralysis of one or both hind legs or one front leg, accompanied by obvious signs of pain in the cat, can be a typical symptom of aortic thrombosis (a blood clot blocking the aorta). A thromboembolism is a medical emergency that requires immediate treatment.

Minka with heart problems
Diagnosis

Veterinary medicine is also divided into many specialized fields these days. If you suspect that your cat is suffering from heart problems, it makes sense to take them to a veterinarian who specializes in heart disease—a so-called cardiologist. Of course, you can also start by visiting your regular veterinarian and asking them to refer you to a specialist. In most cases, the specialized practice or clinic has all the necessary examination methods and equipment.

The cardiologist will, of course, perform a general examination, but also a specific cardiac examination. They will listen to the heart and lungs with a stethoscope. This allows them to gather initial findings, although many cats with HCM show no abnormalities at all. Conversely, some healthy cats also have a heart murmur without suffering from any disease. An electrocardiogram (ECG, a recording of the heart’s electrical activity; see the corresponding article) usually does not provide clear indications either.

A blood test can 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 (known as pulmonary edema) and in the chest cavity (known as pleural effusion).

The only reliable diagnostic method remains echocardiography (= ultrasound examination of the heart, see relevant article), which allows the exact thickness of the heart muscle, the function of the heart valves, and blood flow to be visualized and determined. Blood clots can also be detected by ultrasound even in the early stages, allowing for prompt initiation of treatment to prevent thrombosis.

Chest X-ray of a cat
An X-ray can be used to visualize the size and shape of the heart
Treatment

Treatment depends on the timing of the diagnosis and the stage of the disease. In cases of HCM diagnosed early on without symptoms, the veterinarian will decide on a case-by-case basis whether and how to initiate drug therapy. This depends on the heart rate and the corresponding ultrasound findings.

If HCM is not detected until an advanced stage with existing pulmonary edema or pleural effusion, the affected cat must be treated to prevent the symptoms from worsening. Depending on the severity, diuretics, circulatory stabilizers, or cardiac stimulants may be administered. In life-threatening conditions, these cats must be hospitalized for treatment.

Forecast

The prognosis for HCM depends on the breed, the timing of the diagnosis, the severity of the disease, and the response to treatment. Some breeds, such as the Maine Coon, develop HCM earlier and more severely and are at a higher risk of sudden cardiac death than other breeds. The occurrence of thromboembolism significantly worsens the prognosis, as relapses are possible even after successful treatment. If HCM is diagnosed in its early stages, the prognosis for the affected cats’ future quality of life is good.

Prevention

It is not possible to completely prevent heart disease in cats. However, especially in high-risk breeds, regular cardiac ultrasound examinations performed by a veterinary cardiologist can ensure that changes are detected and treated early. Some of the affected breeding associations already require such examinations before a cat is used for breeding.