Case study: Toby’s deadly secret

Updated November 29, 2020

One month ago Toby came to us for what he may have thought would be his routine annual check up. “Just an unwelcome poke and a jab and I’ll be back on the lounge where I should be.” He was wrong.  His story is a common one and illustrates how owners who are diligent can turn ‘just a vaccination’ into a life-saving moment.

Toby came to us with no sign that he wasn’t a routine patient. He’s an old cat, and old cats spend most of the day sleeping don’t they? He had been eating well, and seemed in good health. In he came in response to his reminder that his annual check up and vaccinations were due.

One thing often overlooked about vaccinations is that they are never given without a full physical exam. It’s debatable which is the more important, but for older patients it’s almost certainly the checkup. A vet probably shouldn’t admit this but the checkup is a bit like a challenge; can you find the problem before it finds us. Sadly, when pets don’t receive annual vaccinations, they usually miss out on the check up too. We’re not very good at educating pet owners about health checks as we are about vaccination, but we should be. Here’s one example why…

Once Toby is settled on the examination table, we begin. Eyes, ears, oral cavity, throat, lymph glands, abdominal organs, coat, genitourinary systems all seem normal. It’s interesting that his weight has dropped, but only a little. A good thing? Then we stop talking and enter the realm of cardio thoracic auscultation. We’re listening for any unusual respiratory or cardiac noise or rhythm. And his heart immediately seems odd. We hunch down and listen harder. Sometimes it sounds normal, and there is no murmur, but if you follow the rhythm, every ten or twenty beats there is a brief silence where a beat is missing. It’s just like the heart beat has been written by a mad composer who randomly inserts rests into the musical score.

So we look at the rest of the cardiovascular system. Pulse pressure seems very low, but it’s an unreliable finding at best. Capillary refill seems OK. So what do we need to do?

This is where science comes to the rescue. Two or three years ago a new laboratory test was launched called the Cardiopet proBNP. It measures a peptide released into the bloodstream during times of cardiac muscle stress. It can add an extra piece of evidence for patients with suspected cardiac disease and is priced to be available to all patients. Before this test it was devilishly hard to diagnose feline heart disease without cardiac ultrasound or medication trials.

It takes no effort to convince the owners to run a blood test. Three nervous days pass and the results are in. They confirm that Toby’s heart muscle is showing signs of stress. Toby is almost certainly in cardiac failure. Why then does he have an arrhythmia? It’s like a cry for help from a failing heart; the heart muscle is stressed, running out of fuel and oxygen in its frantic battle to keep the blood pressure up. So it starts missing beats and Toby is only a short hop from a fatal cardiac arrest or pleural effusion (fluid on the lungs).

So what can we do? We can’t fix the underlying problem but we can make it a lot easier for the heart to pump blood. The drug of choice is an ACE inhibitor, one of the marvels of modern medicine.

Toby starts the medication straight away and something not wholly unexpected happens. The cat who spent all day of the couch starts getting up and follows his owners into the garden. He’s an active cat again. His weight goes back up and his heart rate goes down as his heart relaxes and pumps efficiently again. And the arrhythmia is completely gone.

He’s out of danger now and should live many happy years, touch wood. But why should it be so hard to see a problem so serious? Because animals have no reason to complain; they know something is wrong but learn to live with it. This could be a story about 1001 different ailments, all united by the fact that our pets hide disease and discomfort.

Read our related articles about detecting pain in pets and all about heart problems in dogs and cats.

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By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.