Would Heart Medication Have Saved My Cat’s Life?


Here’s a sad question I recently received on my website.

My Casper had a heart murmur from when he was a kitten. He lived six years. I was told to give one-third of Diltiazem [30mg] tablets. I live alone and could not get the tablets down. Could I have gotten this medication in liquid form, so that perhaps he might still be alive?

Grieving in Kentucky.


Nancy, I am deeply saddened to learn of your loss. I know that nothing I say can will bring Casper back, but I do believe, strongly, that your inability to medicate him did not cause his demise.

Heart disease in cats is different from the most common type of heart disease in people. People most frequently suffer from coronary artery disease that is linked to diet and lifestyle. Cats — and I’m sure Casper was not an exception — usually suffer from a different condition called cardiomyopathy.

Cardiomyopathy is when the muscle of the heart does not function properly. There are two types of feline cardiomyopathy. The first, dilated cardiomyopathy, is linked to a dietary shortage of the amino acid taurine. Dilated cardiomyopathy has been almost eliminated in recent years through the addition of taurine to cat foods.

The second type of cardiomyopathy, hypertrophic cardiomyopathy, has no known connection to diet or lifestyle. It appears to be hereditary, with Persians and especially Maine Coons at increased susceptibility, although any cat may suffer from the condition. With this disorder, the heart muscle does not properly function and attempts to compensate by becoming thickened and enlarged (a condition called hypertrophy). However, the compensation is not effective — in fact, it is counterproductive. It has a catastrophically high fatality rate.

Cats with hypertrophic cardiomyopathy often show symptoms of congestive heart failure, in which fluid builds up in the lungs and makes breathing difficult. They also are at risk of developing blood clots that pass into the rear legs causing excruciating pain and paralysis, often with fatal consequences. For a tragically large number of cats, the first symptom of hypertrophic cardiomyopathy is sudden death.

Diltiazem is frequently recommended for treatment. The medication, which is in a class of drugs called calcium channel blockers, helps lower heart rate, helps the heart muscles to relax between contractions, and helps promote the opening of vessels that supply blood to the heart. It is purported to extend the life expectancy of cats with cardiomyopathy, but in my experience its effectiveness is limited.

Nancy, you clearly are feeling guilty. I hope that feeling passes soon, because in my opinion it is not well founded. Cardiomyopathy is a devastating disease, and you must remember that Casper passed away because of the disease, not because of a lack of medication. Many cats with the condition do not respond to diltiazem or any medication. Even when the medication is effective, it sadly only delays the inevitable.

And then there is the practical matter: You cannot expect yourself to do things that are not humanly possible. Pilling a cat is a challenge under the best of circumstances. In many situations it is impossible. Believe me, I have met many cats to whom no pill ever will be administered. A compounded liquid version of the medication may or may not have been easier to administer — even tuna flavoring does not fool many cats.

In short, I do not think there are grounds for you to feel guilty. It is clear that you loved Casper very much, and that you did everything that you could for him. He was lucky to have you, but he suffered from a terminal heart condition.

I am very sorry for your loss.

Got a question for Dr. Barchas? Ask our vet in the comments below and you might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)

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