ECG for heart murmur?

Dr. Marie replied:

Thanks for your question Paul. Sorry to hear that Yaffa had such a traumatic experience at the vet's office.

I'll give you my thoughts on your cat's situation.

I'm a little bit concerned that Yaffa has a Grade 4 heart murmur. We grade heart murmurs on a scale of 1 to 6 with 6 being the most severe. So, a grade 4 murmur is usually a sign of something significant.

The problem is that it is often hard to know whether or not we need to be really worried. Cats will often show no symptoms of having heart disease for quite some time and then suddenly become ill.

It sounds like what your vet wants to do is to monitor Yaffa regularly so that we can intervene with medications *before* anything really serious happens. But I can understand your hesitation, especially if your cat reacts poorly to his vet visits.

I may not have an answer for you here, but I'm going to give you some facts and hopefully that can help you make a decision.

The most common problem for cats to have with their heart is a condition called HCM (hypertrophic cardiomyopathy). This is a condition where the walls of the heart are too thick. Cats can live quite happily with HCM and then suddenly go into heart failure. When this happens most cats do not live for long.

Unfortunately, an ECG does not always pick up HCM. The only way to accurately diagnose it is with an ultrasound of the heart (also known as an echocardiogram). Now, sometimes people get echocardiogram and electrocardiogram (which is an ECG) mixed up. An ECG is where they attach leads to the cat and get a tracing of what the electrical activity in the heart is doing. Personally, I do not do many ECGs in cats. They can be a little controversial amongst vets. Sometimes they can tell us if there is a problem there, but often they don't tell us much.

So, personally, I'm not sure that a regular ECG would tell us much. There are other conditions that could be picked up on an ECG but they are less common than HCM.

On the other hand, if it is an echocardiogram (ultrasound) that your vet is able to do every 6 months this will tell us a lot more information. If we start seeing evidence that the heart is struggling then there are medications that can really help a lot of cats. (We don't tend to treat heart disease until we are seeing some actual changes in the heart's ability to function - a heart murmur is not enough to make me want to treat.)

One thing that I often recommend is to have my clients measure their cat's resting respiratory rate. To do this, wait until Yaffa is sleeping and then count how many breaths he has in one minute. Write this number down and then check it again once a week. If the number starts to increase then this can be an early sign that the heart is struggling. An increase in resting respiratory rate can mean that there is some fluid in the chest as a result of a failing heart.

I'm struggling a little bit with how to conclude this. The reason for this is that I rarely want to contradict a vet's advice. Your vet knows what is best for your cat and if they have recommended these regular checks then it is probably a good idea. If you are reluctant to do this, then another option is to contact your vet and ask them what the next recommendation would be if you are not willing to come in for regular rechecks. They may make an alternate plan for you.

I hope that helps and didn't add to your confusion! And I hope all goes well for Yaffa!

Dr. Marie.


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