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acute attacks related to bronchial reactivity. It should be noted that low-dose steroids are beneficial for asthmatic-like clinical signs but will not prevent the ARDS-like reaction that can occur with the death of an adult worm in the cat. Cats that present in acute, severe respiratory distress may require higher dosages of injectable steroids and oxygen therapy for stabilization. Some clinicians send owners home with an emergency dose of injectable dexamethasone to administer to the cat if needed. Finally, there is anecdotal evidence that supports the use of the antileukotriene montelukast (2mg total dose PO SID). This drug reduces the release of inflammatory leukotrienes from cells that mediate immediate hypersensitivity reactions or allergic inflammation (e.g. mast cells and eosinophils). This drug is administered chronically to heartworm infected cats. • Remove the worms. A final treatment option for cats that are heavily infected and/or in critical condition is removal of right atrial/ventricular worms. An echocardiogram allows the clinician to confirm the presence of intracardiac worms. Worms within the right atrium or right ventricle can be retrieved using a small Amplatz gooseneck snare introduced through a jugular venotomy. Risks with this procedure include hemorrhage from the venotomy site, tearing/breaking the worms and anaphylaxis (which can be fatal), and damage to the tricuspid valve. This procedure is ideally performed with the aid of fluoroscopy or transthoracic echocardiography.
the likelihood of permanent pulmonary damage. In subclinical cases, radiographs and echocardiography are still useful for a baseline comparison if cardio- respiratory signs develop. Cats should be monitored with thoracic radiography every 6 to 12 months as radiographic signs can wax and wane. Repeat
antibody and antigen testing is also recommended. A regression of radiographic signs of pulmonary vascular/interstitial disease and seroconversion of the cat’s antigen status from positive to negative may be indications that the risk of acute disease has passed; however, an ARDS-like reaction is still possible if the cat has harbored an adult male worm that ultimately dies. Much remains to be learned about the pathophysiology and treatment of heartworm disease in cats. Given the serious consequences of adult heartworm infection in cats and the safety and efficacy of heartworm preventive medications, the American Heartworm Society recommends that heartworm prevention be administered to cat in areas where heartworm disease is endemic in dogs.
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If an antigen-positive cat exhibits no overt clinical signs, it is possible that the infection has cleared, albeit with
For more information on feline heartworm disease, visit heartwormsociety.org.
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