Page 155 - Feline Cardiology

154 Section D: Cardiomyopathies

Table 11.1. (Continued)

Medication Argument for the Use Argument against the Use
Considerations

Owner Inexpensive Lifelong therapy commits owner to q 12h dosing; cannot
considerations Widely available abruptly stop the medication after chronic use
Proactive owners may want to feel that they Lack of perceived benefit (although no
are giving their cat every opportunity for symptomatic benefit expected in asymptomatic
positive response and/or improvement cats) may cause discouragement and
Cardiomyopathies Because cat is receiving medication, owner may
discontinuation of the medication

be reluctant to continue important follow-up
diagnostic testing such as echocardiograms or
radiographs if they may perceive there is nothing
else to be done
Intermittent “on and off” use may be dangerous
due to beta receptor up-regulation and possibility
for adverse cardiac effects with acute cessation
Sacrifice of other necessary medications for
treatment of noncardiac systemic diseases due to
inability to administer several concurrent
medications or prioritization of the cardiac
medication over other medications

Cat Well tolerated, side effects are rare May exacerbate bronchoconstriction, especially at high
considerations doses, in cats with concurrent lower airway disease
Most cats will tolerate medication
administration if the tablet is concealed in a Pilling may be difficult and emotionally traumatic
treat/food or the medication is compounded to the cat and owner, and transdermal
in a meat-flavored suspension preparations are ineffective
Development of medication aversion causing
discontinuation of the medication, may make it
challenging to medicate if/when life-saving
medications are needed later for heart failure or
thromboembolism
Difficulty medicating the cat may lead to
antagonistic experience with owner

Morbidity and No information available for asymptomatic No information available, although no clinical
mortality cats evidence of hastened deterioration in
asymptomatic cats with HCM

*Many variables influence whether an asymptomatic cat with HCM should receive medications (atenolol), which is aimed at delaying
the progression of hypertrophy and associated complications. The advantages and drawbacks of treatment help the clinician and
owner to decide whether to pursue such treatment in each individual case.

improves prognosis and is on an “empiric basis without reduce myocardial ischemia, and prolong time to devel-
controlled data to either support or contradict its poten- opment of symptoms (Spirito et al. 1997). Likewise,
tial efficacy” (Maron et al. 2003). The same situation is negative inotropic therapy with either a beta blocker or
true in cats. Asymptomatic human patients with massive calcium channel blocker is often recommended in cats
LV hypertrophy are usually treated, with expectations with moderate or severe left ventricular hypertrophy
that pharmacologic therapy will improve diastolic filling, (wall thickness >6.8–7–7.5 mm) or significant left ven-