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Heartworm disease in cats is dif cult to diagnose. Because of the challenges associated with the various forms of the disease, including Heartworm Associated Respiratory Disease (HARD), many leading researchers and professional organizations have come to the same conclusion: year-round heartworm prevention is important for all cats, even those identifi ed as "indoor only." For example, in a session at the 2013 American Heartworm Society Symposium, "Heartworm- Associated Respiratory Disease (HARD) in Cats: What We Know and Don't Know," a team from Auburn University noted that "Feline heartworm disease is unique compared to its canine counterpart. HARD is dif cult to distinguish from other conditions, such as feline asthma and other causes of respiratory diseases, including those caused by other parasites." Results of the study, which repro- duced HARD by experimental duplication of heartworm larvae death, further support the need to maintain cats on heartworm prevention. 1 The Companion Animal Parasite Council (CAPC) cites HARD clinical signs including vomiting, hematological abnormalities and sudden death, which occurs in approximately 10% to 20% of diagnosed cases. The Council also notes, "Pathogenesis is unclear, but a condition (similar to acute respiratory distress syndrome [ARDS]) caused by the release of antigenic moieties from injured or dying adult worms is suspected. Pulmonary thromboemboli (frag- ments from dead adult worms) may cause acute vascular and interstitial infl ammatory events that lead to dyspnea and death. Neurological signs may indicate aberrant migration of the worm to the brain, eye, or spinal cord." 2 Leading veterinary medical associations, including CAPC, the American Heartworm Society, the American Animal Hospital Asso- ciation in conjunction with the American Vet- erinary Medical Association and the American Association of Feline Practitioners, all recom- mend year-round heartworm preventive for cats. So, why aren't more cats on monthly medication? One challenge is that many owners don't believe that their cats are at risk. "I hear it all ONE BITE FROM AN INFECTED MOSQUITO TO SPREAD HEARTWORM DISEASE TO A PET. 5 It Only takes Heartworm Prevention Year-round THE MYTH OF THE INDOOR CAT TVP_2014-0506_Seizure Patient.indd 36 5/24/2014 10:44:52 AM