How to interpret feline EKG results?
May 18, 2016 11:54 AM   Subscribe

We took our 14 year-old cat went in for what was supposed to be a routine dental procedure yesterday, but a pre-surgery EKG detected a heart anomaly, so she referred us to a cardiologist for an echo cardiogram. The cardiologist estimated it would cost "between $500-$800", which is a lot of money to spend if this turns out to be nothing. You're not my vet, but how would you assess the risks in this situation to make an informed decision?

Our vet told us the anomaly from the EGK is a "left axis deviation", and said we could still go ahead with the procedure, but that there was some risk involved -- she couldn't quantify how much. Googling hasn't shed much light on the subject of what exactly a left axis deviation indicates. We did ask around to another animal hospital and the estimate for the same test was similar, $500-$600, so I guess this is just what these tests cost. The problem is I don't really know what we're paying for, and I don't know if we'll have a good idea of how much risk is involved in doing the dental surgery even if we do pay for the expensive test.

We're not even sure the tooth he went in for surgery is bothering him that much --we just know it looks red and irritated around the gum line, so the vet recommended taking it out. Maybe we could just try brushing harder? He's already on dental food. He's had dental surgery one other time and it went fine, but that was 5+ years ago.

We just spent over $1500 on our other cat to treat his kidney failure before he died, and as much as we want to say it's never a matter of money for our loved one, we do have to spend wisely now and make sure we're not wasting money that could be used to pay for his care later on. Our vet basically said she understands we're in a tough spot but didn't give any indication either way which was the right way to go here.

I don't expect any concrete answers here -- I know there are a lot of variables in this question, everyone has different levels of financial resources, etc, but I was hoping for some insight as to what exactly this EKG result could be suggestive of, whether this is a reasonable cost for a single diagnostic test in animals, and any other information that can help us as we decide what to do.
posted by tonycpsu to Pets & Animals (9 answers total) 2 users marked this as a favorite
I mean, for me it would come down to how you'd proceed following the echocardiogram. If the outcomes are (a) "Something wrong, easy fix like antibiotics" versus (b) "Something wrong, needs something drastic like a heart transplant" versus (c) "Something wrong, nothing that can be done" versus (d) "Nothing wrong, do nothing", make a decision based on that.

Is the echocardiogram only to see if doing the tooth extraction is safe? Then yeah, why not skip both. He's an old cat; even barring the abnormal EKG general anesthesia isn't risk free. I'd really only do it if there was a high chance of option (a), uncovering an easily-fixed problem incidental to the dental procedure.
posted by supercres at 12:07 PM on May 18, 2016 [5 favorites]

My cat had a mild heart murmur and also cancer, and before both his surgeries they had to do an EKG to be sure his heart was still in good working order to make it through the sedation, which is not awesome for cats generally and not-awesome-er for older cats. They don't want to put your cat under if the anesthesia is going to kill him, and this is one of the ways they minimize that risk.

I was already paying for fucking cancer, so I wasn't too fussed about $500 to be sure I didn't get the cat killed with anesthesia. If your tooth issue isn't pressing then the surgery can maybe be put off and you can skip it, but I would not put a cat under with a possible heart issue without this attempt at verification.
posted by Medieval Maven at 12:18 PM on May 18, 2016 [1 favorite]

We faced a very similar situation with our 16 year old big grey boy who has a bad tooth last summer and I said, "Nope. No cardiologist for a geriatric cat who is in no immediate danger from his heart issue and no aesthetic risk for him because his apparently bad tooth is not affecting his eating." Like supercres' questions suggest, we based our decision a lot upon whether diagnosis from the cardiologist was necessary to maintain his health or just to clear him for dental surgery.

Our vet is very good about explaining risks and benefits and she was unable to quantify the exact risk from his heart condition if he's anesthetized. She believed that the cardiologist would be better able to do so, but only to a certain point, but did not feel the EKG was necessary to care for him generally. Flat out, neither the heart issue nor the tooth is going to kill him (or even really cause him pain that can't be managed) but the anesthesia might. I'm not going to kill him for a dental procedure, basically--I don't have enough time left with him as it is.

Our vet also sees this cat every six months. We've discussed pain management, if the tooth starts to interfere with his eating, but for now, we're just worrying about his other geriatric issues.
posted by crush-onastick at 12:19 PM on May 18, 2016 [6 favorites]

I agree with supercres - the key is what the results would tell you, and what (if anything) you would do based on them. btw when I had a somewhat similar (but not super-similar) situation re cat cardiology the vets could not give me any sort of quantification of the odds or % risk either.
posted by 2 cats in the yard at 12:28 PM on May 18, 2016

Chiming in to say I'm a cat owner, and I always provide a "forever home" so over the years I've dealt with many cats in their twilight years. It's totally okay to pass on tests like this as your cat gets older. It's totally okay to decide that the stress and pain involved with vet visits, sedation, testing, etc. is not worth what it might gain your cat in terms of extra time. Your cats happiness -- while subjective -- is a factor that should be included in making these decisions, not just its objective "health."
posted by BlahLaLa at 1:36 PM on May 18, 2016 [7 favorites]

I am spendy on our animals, but I might not do this test for a 14 year old cat, because I am not clear on how knowing more would extend your cat's life expectancy.

I would get the dental work done. Red and irritated is a big indication of pain, and the vet's recommendation is something I'd weigh heavily.
posted by bearwife at 3:13 PM on May 18, 2016

IANAV but I do read EKGs. A common cause of left axis deviation is left ventricular hypertrophy, which is commonly related to heart valve issues or high blood pressure.

I don't actually think that's important, though, from my perspective, to answer the question. If the tooth isn't obviously bothering him, why would you do the procedure? Unless he's having an eating issues, I'd just forget about it. As noted above, if the benefit is near zero, why would any degree of risk (and cost) be worth it?

I could wax on about the pros and cons of pre-operative evaluation for a low risk procedure like a tooth extraction (does this even require general anesthesia? Can it not be done under procedural sedation, which carries less risk?)..... but I don't want to belabor the point because I think the bottom line is that unless the procedure is necessary, the whole thing is moot.
posted by treehorn+bunny at 5:23 PM on May 18, 2016 [2 favorites]

You have a geriatric cat, in no apparent distress, facing an expensive test in order to assess the relative risk of a minor procedure. In your shoes, I think I'd ask your vet what treatment she would recommend if the EKG counter-indicated doing the extraction now. Then follow that course.

If Kitty does not improve, the bad tooth begins to interfere with her eating, or becomes an obvious source of discomfort, you can always revisit that decision. For now, I'd take the low-risk path.
posted by peakcomm at 5:41 PM on May 18, 2016 [2 favorites]

I'm not your vet, and I haven't examined your cat, though I'm sure he's handsome.

Your question didn't mention a heart murmur or symptoms of heart failure, but that your kitty had a pre-surgery ECG that was abnormal.

"left axis deviation"

I haven't seen your cat's ECG, but this finding (left anterior fascicular (LAF) block) can be artifactual - the result of your cat's positioning during the procedure - or even normal for your cat.

But in cats, this ECG finding can also be indicative of heart disease, especially cardiomyopathy. Most commonly for cats, this involves excess thickening of the walls of the left ventricle (hypertrophic cardiomyopathy or HCM).

Symptomatically, HCM can manifest as respiratory difficulty that progresses to congestive heart failure. The other chambers of the heart may also become enlarged and allow blood clots to develop. These blood clots can break up and travel all over the body, and sometimes lodge in the arteries leading to the leg, causing intense pain and lameness.

Cats with HCM can be asymptomatic, even with severe thickening of the wall of the heart. Precipitating events that can lead to congestive heart failure in asymptomatic HCM cats include administration of fluids, anesthesia, and surgery.

All anesthetic procedures carry inherent risk. If a cat is suspected of having HCM, those risks can be considered and minimized by drug and protocol choices. So it would be nice to know if your cat has HCM before anesthesia.

HCM can only be diagnosed by an echocardiogram that shows that the walls of the heart are thickened. Because many cats with HCM are asymptomatic, it is often found incidentally during physical exam, when a murmur is heard (30-80% of cases). Other findings can include an arrhythmia (20-70% of cases), respiratory changes, or thromboembolism. Without a murmur or arrhythmia, an ECG finding of left axis deviation isn't terribly compelling.

I don't really know what we're paying for...whether this is a reasonable cost for a single diagnostic test

An echocardiogram is an ultrasound of your kitty's heart, where the chambers of the heart, the walls of the chambers, the valves between the chambers, and the relative pressure and flow between the chambers are all evaluated. An ECG is performed while the heart is observed in action, and measurements are taken and compared to established normal values. This can allow a cardiologist to provide a prognosis - if your cat has HCM, how serious is it? Should you do the dental surgery or buy small bags of cat food? Should you start medical treatment to stave off blood clots and congestive heart failure? This might be more important if your cat was symptomatic for heart disease or had a murmur or arrhythmia.

It is a non-invasive procedure, but can be very stressful for cats, because cats. The estimate of $500-800 for referral to a boarded cardiologist for consultation and echo sounds about right.

the tooth...looks red and irritated around the gum line...Maybe we could just try brushing harder?

I haven't seen your cat's teeth, but dental disease is progressive and can contribute to systemic disease. Most people report that their pets seem happier after dental work; we attribute this to the reduction in discomfort or pain the pet was experiencing before the procedure.

low risk procedure like a tooth extraction...does this even require general anesthesia? Can it not be done under procedural sedation, which carries less risk?

Yes, it requires general anesthesia in cats and dogs. Dental procedures on dogs and cats are dangerous for the patient and operator when not done under general anesthesia. There is just no chemical persuasion short of general anesthesia that will allow the practitioner safe access to do what they need to do in a pain and fear-free way.
posted by Seppaku at 8:09 PM on May 18, 2016 [3 favorites]

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