Heart disease in cats can be divided into congenital and acquired conditions. In this article, we will focus primarily on cardiomyopathies, which are among the most common heart diseases in domestic cats. These are serious, progressive and incurable conditions that may ultimately lead to death. After leaving the veterinary practice with medications, recommendations and a date for the next check-up, you officially become the owner of a cat with heart disease. This raises an important question – what happens next?
What will you learn from this article?
• We will list and briefly describe the most common heart diseases in cats.
• We will discuss diagnostic methods.
• You will learn how to feed a cat with heart disease.
• We will explain what everyday life with a cat with heart disease may look like.
• We will also address the emotional challenges faced by owners and offer some words of support.
The most common heart diseases in cats
The most common acquired heart diseases in cats include:
• Hypertrophic cardiomyopathy (HCM)
HCM is one of the most commonly diagnosed heart diseases in cats. Its prevalence is estimated at approximately 15%, while up to 3% of adult cats may have an occult form of the disease. The statistics are concerning: data from multiple studies involving cats presenting with signs of aortic thromboembolism indicate that fewer than 35% had previously been identified as being at risk of developing the condition, and only 8–12% had been diagnosed with myocardial disease before signs of thromboembolism occurred.
What characterises hypertrophic cardiomyopathy?
Hypertrophic cardiomyopathy is characterised by concentric hypertrophy and fibrosis of the left ventricular myocardium. This leads to increased stiffness of the ventricular walls, preventing normal relaxation and adequate ventricular filling during diastole.
Breed predispositions: Maine Coon, Ragdoll, British Shorthair, American Shorthair, Persian, Devon Rex and Cornish Rex.
• Dilated cardiomyopathy (DCM)
DCM is characterised by dilation of the cardiac chambers combined with thin ventricular walls and impaired systolic function. The condition was considerably more common in the past, before the association between dilated cardiomyopathy and inadequate dietary taurine intake was identified.
Breed predispositions: Abyssinian, Burmese and Siamese cats.
• Restrictive cardiomyopathy (RCM)
Like hypertrophic cardiomyopathy, RCM causes impaired diastolic function. The disease is characterised by focal fibrosis of the left ventricular myocardium, which increases ventricular wall stiffness and limits passive ventricular filling during diastole. Unlike HCM, however, restrictive cardiomyopathy does not cause thickening of the left ventricular wall.
Cardiomyopathies account for a large proportion of heart disease diagnoses in cats, but other conditions may also occur, including:
• myocarditis
• arterial thromboembolism
• degenerative mitral valve disease
• endocarditis
• cardiac neoplasia
• congenital heart disease, including atrioventricular valve dysplasia, ventricular or atrial septal defects and patent ductus arteriosus
Prognosis and treatment in cats with heart disease
We will not focus on statistics or specific treatment options here, as these should always be discussed with the attending vet. Prognosis varies considerably and depends on the stage of the disease and the individual cat’s response to treatment.
In general, the more advanced the disease, the poorer the prognosis. As the condition progresses, it may ultimately lead to heart failure and death.
Diagnostics
Echocardiography
Echocardiography, also known as a cardiac ultrasound or heart scan, allows the heart to be visualised and its structure, function and efficiency to be assessed. It can also help identify potential abnormalities and diseases.
The examination is completely painless and non-invasive. It is usually performed with the cat lying on its side, although it can also be carried out with the patient standing. It typically takes around 30 minutes, and the owner may usually remain with the cat throughout the procedure.
Electrocardiography
An electrocardiogram, or ECG, assesses the electrical activity of the heart. It provides information about heart rhythm and potential abnormalities.
Although ECG is an important diagnostic tool, its sensitivity is limited and cardiac diagnostics should therefore not rely on it alone. Like echocardiography, it is non-invasive and does not require any special preparation of the animal.
Thoracic radiography
Chest X-rays can help assess the size, structure and shape of the heart, as well as the condition of the lungs, which are closely linked to cardiovascular function. When evaluating radiographs, the vet will also look for abnormalities such as fluid accumulation or masses.
Blood pressure measurement
Blood pressure measurement is another non-invasive examination that can provide valuable information about a cat’s health. Hypertension may indicate another underlying condition, particularly kidney disease, heart disease or thyroid disease.
Untreated hypertension can have a harmful effect on the cardiovascular system and lead to a range of complications.
Blood tests
Blood testing will most commonly include a complete blood count and biochemical profile, with particular attention paid to electrolytes. Routine blood tests are worth performing regularly, not only after a serious diagnosis has been made.
Nutrition for cats with heart disease
What are the two main nutritional goals for a cardiac patient?
- maintaining comfort
- preserving muscle mass
One of the challenges faced by many owners of cats with heart disease is cardiac cachexia. This is a syndrome associated with severe heart failure in which impaired blood flow contributes to systemic dysfunction and progressive wasting.
How can cardiac cachexia be prevented?
First and foremost, an adequate dietary protein intake should be provided. Protein should never be restricted without a clear clinical indication. An appropriate amount of protein, adjusted to the patient’s condition, is particularly important because it helps slow the loss of body tissue and supports the maintenance of normal muscle mass.
Weight loss in cardiac patients differs from weight loss in healthy cats. In a healthy cat consuming fewer calories than required, adipose tissue will primarily be used as an energy source. In cats with heart disease, amino acids from muscle tissue may increasingly be used for energy, contributing to muscle wasting. Premature protein restriction may therefore have a number of negative consequences for the cat’s health.
The basic principles of nutrition for a cardiac patient include:
Both healthy cats and cats with heart disease should primarily receive a high-quality wet diet or a properly balanced BARF diet rather than dry food.
- Protein – an appropriately adjusted amount of highly digestible protein can support the patient and help prevent premature cardiac cachexia.
- Fat – there are no specific universal recommendations regarding dietary fat content, but very high-fat diets should generally be avoided. A moderate fat content is preferable.
- Carbohydrates – choose carbohydrate sources with a low glycaemic index.
- Sodium – the diet should contain a reduced amount of sodium.
- Phosphorus – heart disease is often accompanied by other conditions, such as chronic kidney disease. It is therefore worth paying attention to phosphorus intake from the outset and eliminating inorganic phosphorus additives from the diet.
- Omega-3 fatty acids – their inclusion in the diet is important and may provide a range of benefits, including supporting the regulation of inflammatory processes.
As with other diseases, appropriate energy intake is also important, as both excess weight and being underweight can place additional strain on the cardiovascular system.
And what matters most from the cat’s perspective?
The food needs to taste good and make the cat feel well. Nutrition is extremely important and the goal should always be to tailor the diet as closely as possible to the individual cat’s needs. However, advanced disease is not the time for major dietary upheaval.
The priority should be the cat’s comfort and willingness to eat. Even the best diet in the world cannot fulfil its purpose if it makes the cat feel unwell or refuses to eat it.
Everyday life with a cat with heart disease – what advice can we give owners?
There are many articles about specific heart diseases, their diagnosis and treatment.
After a veterinary appointment, an owner may leave with what feels like a complete cardiac care package: current test results, recommendations and medications. For many people, however, one question quickly arises: what happens next?
Here are a few practical suggestions that may make everyday life with a cat with heart disease easier.
1. Organise medications and recommendations.
Consider keeping all of your cat’s medications and supplements in a dedicated basket or drawer. Write down the treatment schedule clearly in a table and keep it somewhere visible, such as on the fridge.
2. Use a pill organiser.
A pill organiser can make daily treatment much easier to manage. Once a week, you can prepare your cat’s medications in advance so that everything is ready when needed.
3.Keep a folder for medical records.
Keep your cat’s medical documentation organised. Store all discharge notes, test results and recommendations in one place and take them with you to veterinary appointments.
4. Prepare for emergencies.
Agree on an emergency plan with your vet for situations such as pulmonary oedema or thromboembolism. A rapid response can be critical, so it is worth knowing exactly what to do in advance. Write the plan down clearly and keep it somewhere easily accessible at home.
5. Plan ahead when travelling.
Make sure anyone caring for your cat fully understands their health condition. Explain how and when medications should be given and what to do in different situations. Ideally, write everything down and leave the instructions somewhere visible.
Provide the contact details of your cat’s veterinary practice and make sure funds are available in case an urgent appointment is required.
6. Consider a pet camera.
A camera can allow you to check on your cat during the day. For many owners, this provides an additional sense of reassurance and helps them keep an eye on their pet when they are away from home.
7. Have a trusted neighbour or family member as a backup.
If you have someone you trust, consider giving them a spare set of keys. In an emergency, you may not always be able to reach your cat quickly, so having a backup plan can be extremely helpful. Simply knowing that someone else can step in may also provide peace of mind.
8. Oxygen concentrator.
Some owners choose to rent or purchase an oxygen concentrator, particularly as the disease progresses and reaches a more advanced stage. Others use one temporarily, for example during hot summer weather or when travelling for longer periods and leaving the cat in someone else’s care.
9. Monitor respiratory rate.
Measure your cat’s resting respiratory rate every day. Regular monitoring can help identify concerning changes early. Record the measurements on paper or use one of the available apps designed for owners of animals with heart disease.
10. Take care of your cat’s teeth.
This may seem less obvious, but it is important. Animals with heart disease may not be suitable candidates for general anaesthesia, or anaesthesia may involve considerable risk.
Dental disease is a common problem in cats, so maintaining good oral hygiene can help reduce the risk of your cat requiring dental procedures under anaesthesia in the future.
Do all of these measures need to be introduced?
Absolutely not. They are simply intended to help establish a routine and create a greater sense of predictability in a new situation. Every owner should adapt them to their own circumstances and their cat’s individual needs.
The owner’s emotions – how can we provide support during difficult moments?
Being told at a veterinary appointment that your cat has heart disease can be overwhelming. For the owner, this may mark the beginning of a long and difficult journey focused on maintaining their cat’s comfort and quality of life, while being constantly aware that the disease is incurable and progressive and that there is no medication capable of restoring the cat to full health.
This journey can be emotionally, physically and financially demanding. It is therefore extremely important to remind owners to care not only for their cat, but also for themselves.
After leaving the veterinary practice, owners may feel lost and overwhelmed. Many spend hours online reading hundreds of articles, often finding the same frightening message: the prognosis may be poor. There is an abundance of information about the disease itself, but often very little practical guidance on what everyday life should look like from that point onwards.
There are generally two scenarios:
- The disease does not yet require treatment, but more frequent and regular cardiology check-ups are recommended.
- The disease is more advanced and requires treatment as well as regular cardiology monitoring.
Both scenarios can be emotionally challenging.
When a cat already requires treatment and the owner leaves the practice with a long list of recommendations, a poor prognosis and a box full of medication, they may wish more than anything that their cat only required regular check-ups and had a better long-term prognosis.
But the first scenario also brings a wide range of emotions, particularly helplessness. Owners may hear that they should be grateful because “it isn’t that bad yet”, while knowing that the situation may eventually change. They may also hear so often that they should simply focus on their cat’s comfort that the word itself begins to become frustrating.
What is worth saying at moments like these?
Sometimes a short conversation is enough. Owners can be reminded that they do not have to feel grateful simply because things could be worse. They are allowed to cry and they are allowed to worry. These emotions are understandable, and although the road ahead may not be easy, they do not have to face it alone.
It can also help to remind them that their beloved cat does not know the name of the diagnosis they are living with. Fear and negative emotions should not be allowed to take over the owner’s entire life.
For the cat, what matters is the here and now: relaxing in a warm bed, playing with cardboard boxes, enjoying tasty and nutritious meals and favourite treats, and playing whenever their condition allows.
Encourage owners to appreciate each day and enjoy the good moments they still have with their cat.
Conclusion
Hypertrophic cardiomyopathy is one of the most common diagnoses made by veterinary cardiologists in cats, and it understandably causes considerable anxiety among owners. Much of the information available about HCM can be frightening: it is incurable, progressive and may lead to sudden death.
Understanding the nature of the disease and establishing a new routine can make a meaningful difference to both the cat’s comfort and the well-being of the people caring for them.
It is important not to become overwhelmed by negative information and to appreciate every good day with the cat. Ultimately, quality of life matters more than its length.
References:
- Tilley L.P., Smith Jr. F.W.K., Oyama M.A., Sleeper M.M.: Manual of Canine and Feline Cardiology. Elsevier Health Sciences, 2008, 151–175.
- Paige CF, Abbott JA, Pyle RL, Elvinger R. Prevalence of cardiomyopathy in apparently healthy cats. JAVMA. 2009;234:1398–1403.
- https://magwet.pl/wpd/38493,rozpoznawanie-chorob-miesnia-sercowego-kotow
- https://magwet.pl/wpd/34244,kardiomiopatie-kotow-postepowanie-terapeutyczne
Author:
Katarzyna Hajewska – has worked professionally with animals for six years. She began her career at the Animal Shelter in Konin and currently works as a Canine and Feline Nutritionist and Animal Physiotherapist.
Animal nutrition is her great passion, which she continues to develop by constantly expanding her knowledge. Combining nutrition and animal physiotherapy allows her to take a holistic and individual approach to every patient.
Privately, she is the owner of two wonderful cats, Matylda and Lulu.