Dear Dr. Eric,
Yesterday morning was like any other morning. My cat Roland was perfectly fine and normal. A few hours later, I received one of the most devastating phone calls in my life. Roland was meowing in pain and unable to move his back legs. At the vet, we were told it was either a blood clot or an undiagnosed heart problem, commonly known as cardiomyopathy. Regardless of what we chose to do, there was no guarantee, and he was suffering. So we had to make the very difficult decision and say goodbye. My heart is broken and I am still in shock.
Did we make the right choice? He had already lost movement in his back legs and it would have cost us thousands of dollars for tests and surgeries, with no guarantee that he would be all right or have the same quality of life. He was only 2.5 years old. I came across your article on feline heart disease. Is it possible this is what he had? Did we make the right choice?
Unfortunately, your tragic story is not uncommon. Based on Roland’s age and the symptoms you described, it is very likely that Roland suffered from a condition known as aortic thromboembolism, or ATE. It is one of the most devastating things that can happen to a cat.
ATE generally occurs as a consequence of a common feline heart condition known as cardiomyopathy, which appears to be primarily hereditary. Unlike the common forms of human heart disease, cardiomyopathy does not usually occur as a consequence of lifestyle. There is very little that can be done to prevent or stop it. The condition is very hard to detect — it frequently does not lead to heart murmurs or clinical signs that are apparent on routine physicals.
Cardiomyopathy most often affects young, purebred cats. Maine Coons and Persians are among the most frequent sufferers, but it can develop in any cat. It occurs when the muscles in the heart develop and function improperly.
Symptoms of the condition can manifest in three ways. Some cats develop congestive heart failure, which leads to exercise intolerance and difficulty breathing, which can be fatal. For other cats, sudden massive heart attack and death is the first symptom.
And finally, for some cats such as Roland, ATE is the first physical manifestation of cardiomyopathy. It occurs as a result of abnormal blood flow through the heart, which leads to blood clot formations. A fragment of a clot can dislodge and pass into the great artery (the aorta) and travel through the artery toward the tail until it becomes lodged, most frequently at the base of the legs. Blood flow is cut off, which leads to intense pain, massive distress, and sudden paralysis of the legs.
Treatment options are limited. Limited success has been reported using powerful pain killers and blood thinners, the purpose of which is not to dissolve the existing clot, but to prevent it from getting larger and to reduce the likelihood of additional clots. Over time, in some cats the clot dissolves and function returns. However, the potential for complications during treatment is very high. Most cats suffer intensely, and a very significant number do not recover. Cats may die from complications such as infection, sepsis, excoriation (self-mutilation), and skin or intestinal sloughing.
Finally, even those cats that do recover are at extreme risk of recurrent issues. The underlying cardiomyopathy places these cats forever at risk of another embolism (as well as congestive heart failure and sudden massive heart attack and death). A blood thinner called Plavix has been used with some success in preventing ATE, but, in the end, there is virtually nothing to prevent a cat from suffering another episode.
Steve, if you had opted for treatment for Roland, there would have been no guarantee of success. The only guarantee would have been suffering for Roland and, if he recovered, a virtual guarantee that another episode would occur. Although I certainly would have respected a decision to move forward with treatment (conditional upon sufficient aggressive pain control), I also completely respect your decision to let Roland go.
Cardiomyopathy is terrible for many reasons. It usually afflicts young cats who should have at least a decade of life ahead. It is hard to diagnose and even harder to treat. The consequences of it tend to occur suddenly and dramatically, leading to unexpected and urgent grief among those in the cat’s family. Please accept my deepest sympathies on your loss.