big belly from small heart murmur (or...?)

[sweetheart9]

Hi,
I have a 9 wks old kitten that has a "small heart murmur" and the vet says that's the reason why her belly is huge. That she's not ingesting the food properly or it "flows back from her heart" (not sure i understand that one entirely). From what i'v read though, i would think heart murmur only starts creating fluids (swelling) once it's developedinto actual heart failure. Surely my kitty can't have that, sinceher murmur i only "small" and she's all hapy and playful otherwise. So what could be the cause of the big belly and what can be done about it? I have already wormed her with milbemax but no worms came out. She is eating fine, no diarrhea, no vomiting.

Thank you!

[Dr. Carol Osborne, DVM]

Hello
I would ask your vet to run a full viral blood panel to rule out the top four viruses in cats: Feline Infectious Peritonitis (FIP), Feline Leukemia (FELV), Feline Immunodeficiency Disease (FIV) and Toxoplasmosis. Heart murmurs do not cause fluid accumulation in the abdomen versus heart disease which often does cause this. Heart murmurs can be caused by many things such as the mere excitement and stress of just going to the vet. An EKG would also help detect any heart problems which to me sound doubtful.
Thank you
Dr Carol Osborne

[Brian C Hurley, D.V.M.]

Sorry I haven't commented before now.  I am on vacation this week and have not been turning my computer on all that often.  I appreciate Dr. Jim answering your previous questions.

I agree with everything said to this point.  Two tests to consider looking into would be a radiograph to evaluate the abdomen and the heart for obvious abnormalities.  Ultimately, an ultrasound of the abdomen may be a more sensitive indicator of fluid in abdomen since we are dealing with a kitten.

Again, keep us posted.

[Jim Humphries, B.S., D.V.M.]

Hi Sweetheart9:  

Please let us know what you find out.  Dr. Hurley and I are anxious to know what you discover.  

[Jim Humphries, B.S., D.V.M.]

Dr. Hurley is absolutely correct and his comments point to the absolute need for a complete physical exam and a definitive diagnosis.  On this forum we don't know the severity of the murmur and other critical points in making a correct diagnosis.  Chest X-rays would also give you some good information as to the condition of the heart / chest fluid.  

Wouldn't this be nice if the problem was a very small "functional" murmur, and an abdomen full of parasites we can treat!!  

We wish you well, and let us know how she does.  

[Brian C Hurley, D.V.M.]

I agree with the comments by Dr. Jim.  I was writing a response as he posted and thought I would offer it, in addition to his comments.  Please keep in mind I am approaching this in a slightly different light and why I chose to comment.  However, it shows the importance of a thorough physical examination and the importance of seeing your veterinarian to discuss.

Big Belly

Hi, congratulations on your 9 week old kitten.  I am glad to hear she is “healthy and happy!”  Heart murmurs can be identified in young animals.  

Heart murmurs can be benign (causing no problems) or severe (leading to heart failure).  When a heart murmur is identified in young kittens, we often think about the possibility of a congenital defect.   Congenital defects that may occur are patent ductus arteriosus, atrial and ventricular septal wall defects, mitral or tricuspid dysplasia, aortic stenosis, and pulmonic stenosis.  In kittens, the most common congenital defects are related to the mitral valve or ventricular septal defects.

When heart murmurs are severe enough to create an issue, we would often expect to see a kitten doing poorly.  They would not grow normally and be inactive.  The murmurs identified tend to be loud grading 3 or greater on a scale of 6.  Soft murmurs are seen in young, healthy and active kittens.  These murmurs are soft grading 3 or less on a scale of 6.

In young kittens, it is important to follow the heart murmur during the initial examinations that are recommended while doing the kitten’s vaccinations.  It is difficult to assess the significance of a heart murmur at an early age and often requires these repeated auscultations (listening to the heart). If the murmur stays present or increase in severity, further diagnostic tests may be warranted.

My initial thought in a kitten presenting with a bloated (big) belly would be the presence of gastrointestinal parasites (worms).  The most common internal parasite causing a big belly would be roundworms (Toxocara cati and Toxascaris leonina).  Others may include hookworms, coccidia or giardia.  

I am glad to hear that you have dewormed your kitten, but it takes repeated dosing of an oral dewormer to treat roundworms and hookworms.  Coccidia and giardia take different oral medications to treat.  It is not uncommon never to see worms passed in the stool.  I would advise you speaking with a veterinarian about your concerns.  It is important to test fecal samples to identify GI parasites.  I recommend multiple samples in young kittens because fecal samples are only approximately 80% effective in identifying the presence of internal parasites.  

An aggressive deworming protocol needs to be discussed with your veterinarian and the heart murmur needs to be followed closely.  I hope this helps you.

[Jim Humphries, B.S., D.V.M.]

I am so very sorry to hear about your new kitty's problems.  Unfortunately this sounds like a bad one.  If a heart murmur is picked up this early it usually means a congenital or inherited defect in the heart.  Usually not a "practically" correctable thing.  

The big belly is directly related to the heart not functioning.  When a heart is not efficiently pumping blood, the venous flow back into the heart gets backed up.  This venous pressure causes fluid to seep into the abdomen (sometimes called ascites).  

Did your veterinarian give you any options?  In order to correct this it most likely would cause open heart surgery, something that in a 9 week old kitten is both impractical and very expensive.  

There are some types of congenital heart disease that are "easier" than others.  I.E. a Patent Ductus Arterosis (PDA) can be "simply" tied off.  Of course this is all open chest surgery.  Others like Atrial or Ventricular Septal Defects are practically impossible to correct.  

If the kitty is already developing a fluid filled abdomen - well the outlook is not good at all.  

I wish I had better news for you.  

The next thing to happen is her chest will also fill with fluid and she will not survive long.  

Please remember I am basing all this discussion on a "murmur" and a "big belly" in a very new kitty.  

I would like to know more from your vet's physical exam.  But again I caution you this does not sound good.  

[sweetheart9]

hi again,
just to let you know her shape has improved a lot, so i think i'll leave it with that for now. thanks for all your comments and advice. bye :)
ps - her faecal sample showed no parasites whatsoever, in case you were wondering.

[Brian C Hurley, D.V.M.]

Good Evening,

I was just looking through the posts and thought I would follow up.  I was glad to read things seem to be improving at the last post.  Have things continued to improve??

Dr. Brian

[sweetheart9]

Thanks for this,
Extremely helpful comments :)
Today as i look at her the belly seems to be going down, so maybe, just maybe, it was still worms and/or inadequate feeding by the previous owner.
I will keep you posted.

Thanks.

[sweetheart9]

Hi Dr Jim,
Thanks for the comment, it's rather helpful to know that if it's worm-related it should be gone by the time of the next check-up.
Yeah, i just wasn't sure whether it's urgent to test for FIP or not, if you say it's not (and she doesn't seem to have any other symptoms!), then i won't worry about that one.
It's very difficult for me to understand, how a heart murmur so weak could possibly be related to fluids in the abdomen. And when i told the vet that if there's already those abdominal fluids, the kitten should be dying soon, he said not at all, and that he wouldn't worry about the murmur, unless the kitten doesn't grow.

Is there any way to determine whether there is such a fluid actually present or not?
Because that's where i would start if it was up to me. I'd find out what the excessive body mass (in relation to the rest) actually consists of, or what's going on in there. I'd leave out the heart issue for now, since grade 1 doesn't sound like anything serious to me. I know that it's likely to progress and has to be checked on regularly but that's another story, isn't it?

[Jim Humphries, B.S., D.V.M.]

I see no reason not to do the test, but you may also wait for the 4 week recheck then test for FIP - certainly a possibility.  

IF your doctor feels the murmur is responsible for the abdominal fluid, then he or she (like me) believes the cardiac output is inadequate to circulate blood normally and hence the abdominal fluid.  Again if this is the case, the outlook is not good as that typically progresses.  Congenital holes in heart chambers typically to not close and actually grow with the animal.  consequently the lack of cardiac output will also continue and the heart may begin to "decompensate".  

In 4 weeks you will know more than you know today.  Because your vet does not feel this is an urgent condition, I would wait and watch for the month.  

IF the abdomen is due to worms and they have been treated, you will see that go away in one month.  

Remember a grade 1 murmur is the softest, so it is possible this is "functional", but my experience says in this young of a kitty it is congenital and those typically don't do well.  

Please keep us posted.

[sweetheart9]

He doesn't seem to think she's anywhere near dying. His only concern seems to be wheather she grows...
I find it all kind of weird though.
Would you still recommend testing for FIP without a delay or do you think it's ok to wait 4 weeks? I forgot to discuss the possibility of FIP at all with the doc. And all he suggested himself was that it could also be a problem with the liver (bloodvessel bypassing it) , or something to do with the bile... i don't remember the name of the condition. He said these tests could be done later on...

[sweetheart9]

Hi again, i talked to my vet. He said the murmur is grade 1 out of 5, like barely audible. But he still thinks that's the reason she's round in the middle. He said no point in testing for worms at the moment, as i've probably cleared them out for the time being (milbemax treats all kinds of worms) - but that yes, the worms could have contributed as well.
He said we should wait for 4-5 weeks and see how she does growth-wise. He thinks in a small kitten like her the cause of the murmur would most likely be a hole in the heart. And that a surgery would cost something like 2000 euros, which is a lot, of course. But anyhow, according to him it's too early to do further tests.
I'll check back here later to see if you have any comments.

[sweetheart9]

Thank you both, your answers were very down-to-the-point and you gave me the courage to go and ask my vet to do the necessary tests and maybe also refer me to a cardiologist.
I hope to be able to let you know how it goes!

[sweetheart9]

Oh and sorry for the typos!