Page 278 - Feline Cardiology

Chapter 19: Congestive Heart Failure 285

Table 19.1. Medical therapy and monitoring of cats with congestive heart failure

Drug Dosage Follow-up

Mild heart Furosemide 6.25 mg PO q 12–24 hr 1 week:
failure ACE inhibitor. Options include: TXR, BP, chemistry
Enalapril 0.5 mg/kg PO q 12–24 hr 3–4 months:
Benazepril 0.5 mg/kg PO q 24 hr TXR, BP, chemistry, PCV/TS (or
Ramipril 0.5 mg/kg PO q 24 hr CBC), ± UA, ± echo
Anticoagulant 1 Then every 4–6 months
Clopidogrel OR 18.75 mg PO q 24 hr
aspirin 5–81 mg PO q 3 days
+ specific treatment targeting
the functional heart disease
present

Moderate Furosemide 12.5 mg PO q 12 hr or 2–3 mg/kg PO 1 week:
heart failure ACE inhibitor q 12 hr TXR, chemistry, BP
Anticoagulant 1 1–2 months:
+ specific treatment targeting the TXR, BP, chemistry, PCV/TS (or
functional heart disease CBC), UA, ± echo
present Then every 3–4 months Congestive Heart Failure
Severe Furosemide 12.5 mg PO q 8 hr or 3–4–mg/kg PO 5–7 days:
heart failure ACE inhibitor q 8–12 hr TXR, BP, chemistry
Anticoagulant Then every 6–8 weeks to increase
Low-salt Diet to every 3–4 months if stable
+ specific treatment targeting the TXR, BP, chemistry, PCV/TS (or
functional heart disease present CBC), UA, ± echo

Acute heart Furosemide 2–4 mg/kg IV q 1–4 hr until RR Renal panel q 12–24 hours, TXR
failure decreases to <50/min and effort q 24–36 hours until clinically
improves, then 2–3 mg/kg q 6–8 hr stable & discharged
1 week: TXR, chemistry, BP
Oxygen 50–60% FiO2 for <12 hr then <50% Then every 6–8 weeks, to
increase to every 3–4 months
± Nitroglycerin 1/8–1/4 inch transdermal q6 hr x 1–2 if stable TXR, BP, chemistry,
days; or 12 hr on 12 hr off for 3 days PCV/TS (or CBC), UA, ± echo
± Dobutamine 5–15 mcg/kg/min
+ specific treatment targeting the
functional heart disease present
ACE inhibitor 2
Refractory Furosemide 4 mg/kg PO q 8 hr, may substitute or Same as severe heart failure
heart failure add 1–2 SC doses/week for PO dose
ACE inhibitor 2
Hydrochlorothiazide 1–2 mg/kg PO q 12–24 hr

± Spironolactone 1–2 mg/kg PO q 12–24 hr
Low-salt diet
+ specific treatment targeting the
functional heart disease present

1
If moderate or severe atrial dilation, spontaneous contrast, or intracardiac thrombus.
2
Once home, eating and drinking. TXR, thoracic radiograph; BP, blood pressure; chemistry, serum biochemistry profile (renal values
and electrolytes may be sufficient); CBC, complete blood count; PCV/TS, packed cell volume/total solids; UA, urinalysis; RR, respiratory
rate.