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Management of Heart Failure
1
Steven Rosenthal, DVM, DACVIM (Cardiology) , and Mark A. Oyama, DVM, MSCE, DACVIM (Cardiology) 2
1 CVCA Cardiac Care for Pets, Towson, MD, USA
2 Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA

Successful management of both acute and chronic heart respiratory rate and/or exercise capacity can be useful
failure typically involves alleviation of congestion, gauges that help clinicians formulate or modify treat-
improvement in cardiac output and organ perfusion, and ment plans. In this capacity, owner education and home
maintenance of normal blood pressure and cardiac monitoring are essential components of successful ther-
rhythm. Patients with heart failure can be categorized apy. Rarely do canine or feline patient with early CHF
into those with subtle symptoms such as mild exercise cough nor do they exhibit dramatic changes in activity or
intolerance or respiratory signs versus patients with exercise. Thus, daily monitoring of their resting home
debilitating and life‐threatening clinical signs such as respiratory rate is often the most effective monitoring
severe respiratory distress, collapse, syncope, or cardio- tool to detect CHF symptoms in their early stages.
genic shock. Congestive heart failure (CHF) specifically Common oral medications for treatment of chronic heart
refers to patients with evidence of congestion in the form failure can be divided into the following five main groups:
of pleural or abdominal effusion, pulmonary edema or, diuretics, vasodilators, modulators of neurohormonal sys-
much less commonly, peripheral edema. tems, antiarrhythmic agents, and positive inotropes. Some
A variety of cardiac medications are used to restore and medications will have effects in more than one group. In
maintain adequate cardiac function, along with diet addition to these conventional therapies, nutritional sup-
changes, nutritional supplements, and body cavity centesis. plements and dietary modification are often beneficial. In
During therapy of both acute and chronic heart failure, order to limit adverse reactions to medications, close moni-
patient hydration status, electrolytes, renal function, blood toring of electrolytes, biochemical parameters, hydration
pressure, urine output, respiratory rate and effort, and body status, and blood pressure along with serial cardiac‐specific
weight are monitored. During this time, patient quality of tests (i.e., chest radiographs, electrocardiograms, echocar-
life can remain very high in the absence of significant diograms) aid the practitioner in achieving effective treat-
amounts of congestion or adverse medication side‐effects. ment. Each patient responds to medications differently and
As heart disease progresses, doses and number of cardiac therapy is individualized to each cardiac patient.
drugs are increased along with increasing risk of adverse Treatment of chronic heart failure depends almost
effects. In this chapter, the therapy of chronic, acute, and entirely on medical therapy. Exceptions would include
refractory heart failure will be presented. CHF due to bradycardia that is treated with artificial pac-
ing, or CHF due to congenital heart defects such as patent
ductus arteriosus that are treated using surgery or mini-
Management of Chronic Heart Failure mally invasive catheter‐based techniques. Advancements
in the surgical management of degenerative valve disease
The major goals of treatment of CHF are to alleviate and have been made over the past few years but due to cost
prevent mild clinical signs, reduce likelihood of recur- and limited surgical centers that perform the surgery, sur-
rent episodes of acute life‐threatening heart failure, and gical valve repair or replacement is not a widely available
increase longevity. option for most pet owners. Due to the lack of controlled
Management begins with a thorough medical history clinical trial data, some of the therapy for both chronic
and physical examination. Subtle changes in the resting and acute heart failure is based on expert opinion.

Clinical Small Animal Internal Medicine Volume I, First Edition. Edited by David S. Bruyette.
© 2020 John Wiley & Sons, Inc. Published 2020 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/bruyette/clinical