Nutritional Management of Feline Heart Disease
A 5-year-old, castrated, male domestic shorthair was presented for acute onset of dyspnea.
This indoor cat was previously healthy and up-to-date on vaccinations. The usual food was a commercial canned food. On physical examination, the cat weighed 12 pounds (body condition score, 6/9) and heart rate was 200 beats/min, respiratory rate 54 breaths/min, and rectal temperature 99.2º F. Mucous membranes were pale, and capillary refill time was slow. No jugular vein distension was noted. A II/VI systolic murmur at the left sternal border and pulmonary crackles were noted on auscultation. The leading differential diagnosis was CHF-thus, the cat was given furosemide (12 mg IV) and placed in an oxygen cage. After 2 hours, the cat was stable enough for thoracic radiographs and blood collection.
Radiographs showed a diffuse interstitial and focal alveolar pattern, distended pulmonary vessels, and moderate cardiomegaly, all of which are consistent with cardiogenic pulmonary edema (Figures 1A and 1B). A serum biochemistry profile was within normal limits. Intravenous furosemide was continued (10 mg IV Q 12 H), and the cat was maintained in an oxygen cage. The next day, echocardiography was done and showed severe concentric left ventricular hypertrophy, small left ventricular chamber size, and moderate left atrial enlargement, consistent with hypertrophic cardiomyopathy. Blood pressure was 155/90 mm Hg. Enalapril (2.5 mg PO Q 24 H) was started at this time. The cat was removed from the oxygen cage 36 hours after admission, and the furosemide dose was reduced to 5 mg PO Q 24 H. The patient began to eat small amounts of food in the hospital and was discharged 4 days after admission.
Ask Yourself ...Which of the following should be given after discharge, when the patient has stabilized?Sodium content (mg/100 kcal)A. The cat's usual canned food 145B. Science Diet Feline Senior 7+ ocean fish (canned) 115C. Eukanuba Optimum Weight Control Feline (dry) 104D. Purina ONE Feline chicken and rice formula (dry) 62E. Purina Feline CV (canned) 40
Correct Answer: AThe cat's usual canned food
Typically, in cats with an acute episode of CHF, changes in diet should be avoided until the patient is stabilized (unless the usual food is very high in sodium). Dietary changes when the animal is sick or starting new medications may induce food aversions. Once the animal is home and stabilized on medications, a gradual change to a new food can be made. Therefore, when the cat returned for a recheck visit 7 days after discharge (at which time blood pressure was measured and a renal profile was done), a new, lower-sodium food was recommended. Since the cat had always eaten canned food, several reduced-sodium canned foods were recommended for this patient so that the owner could determine which one the cat preferred.*These foods included:• Science Diet Feline Adult (beef or turkey)• Pro Plan beef & liver entrée, ground• Friskies Senior lamb & rice• Purina CV(Note that the recommendations are specifically for these flavors; other flavors of the same brand may have significantly more sodium)
There is no single "best" food for managing cats with heart disease. It is important to match the nutritional needs of an individual patient to the food or foods that best suit those needs. Patients with heart disease vary in terms of clinical signs, laboratory variables, and food preferences, all of which affect food selection. For example, cats with asymptomatic heart disease require less severe sodium restriction than cats with CHF, such as this one. Overweight cats require a lower-calorie food than would a thin cat. Laboratory results and concurrent diseases also influence food choice; if this cat also had a history of struvite urolithiasis, it would need a sodium-restricted food with nutritional modifications to reduce risk for struvite urolith formation. The most important consideration is that the food is palatable enough for the animal to eat it willingly. Table 1 lists several commercially available, reduced-sodium cat foods. It includes those specifically designed for animals with cardiac disease, therapeutic diets for other diseases, and certain over-the-counter foods that have appropriate properties for a cat with CHF. Treats that are acceptable to the cat should be included in the diet regimen if the owner desires (Table 2), and a satisfactory method for administering medications that does not involve a high-sodium food should also be devised (Table 3).
See Aids & Resources, back page, for references, contacts, and appendices.
Take-Home Messages• There is no single "best" food for managing cats with heart disease. The food should meet the requirements of and be palatable to the individual patient.• Making dietary changes when the animal is sick or starting new medications may induce food aversions. Unless the usual food is very high in sodium, it should not be changed until the cat has been stabilized.• There are many choices of reduced-sodium commercial foods that may meet the other requirements of cats with CHF.