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Congestive heart failure patient - a cardiologist's view (CROSBI ID 659410)

Prilog sa skupa u zborniku | kratko priopćenje | međunarodna recenzija

Torti, M. Congestive heart failure patient - a cardiologist's view // 7th International Congress "Veterinary Science and Profession" Book of Abstracts / Brkljača-Bottegaro, N. ; Zdolec, N. ; Vrbanac, Z (ur.). Zagreb, 2017. str. 39-40

Podaci o odgovornosti

Torti, M.

engleski

Congestive heart failure patient - a cardiologist's view

Emergency veterinarians commonly care for canine and feline patients with congestive heart failure (CHF). Depending on the primary cause and severity of the cardiac disease, clinical signs can vary from patient to patient and are not pathognomonic for cardiovascular disease. Clinical signs in patients with CHF may include weakness and exercise intolerance, cough, lethargy, inappetence, vomiting, tachypnea, respiratory distress, syncope, or collapse. CHF is often presumptively diagnosed based on a patient's primary presenting complaints, signalment, a thorough history, and physical examination findings. In dogs the most common cause of CHF are acquired heart diseases, in the majority of cases degenerative mitral valve disease and dilated cardiomyopathy. One must not forget that congenital heart diseases, most often patent ductus arteriosus, as well as bacterial endocarditis and myocarditis can lead to the development of CHF. Also, severe cardiopulmonary dirofilariasis or cardiac tamponade can also potentially lead to the development of CHF. Chronic valvular disease (CVD) represents the most common, clinically significant acquired heart disease in older miniature and small breed dogs. The degenerative process can affect any of the four valves, but clinical disease is most apparent affecting the mitral valve (chronic degenerative mitral valve disease or myxomatous mitral valve degeneration or mitral valve enocardiosis). CVD is estimated to be the cause of canine cardiac disease in approximately 75% cases. Studies suggest that CVD is a heritable trait, as is the case Cavalier King Charles spaniels. CVD is characterized by loss of normal function and integrity of the affected valve, with resulting regurgitation causing a functional inefficiency of the left or right side of the heart (depending on the valve affected by the process). Mitral valve endocardiosis leads to left-sided CHF with development of pulmonary edema, while tricuspid valve endocardiosis leads to right- sided CHF and resultant accumulation of fluid in systemic veins and body cavities (ascites and pleural effusion). In comparison to CVD, dilated cardiomyopathy (DCM) is the most commonly acquired heart disease in medium, large and giant breed dogs. The most commonly affected breed with DCM in both European and North American studies is the Doberman Pinscher. DCM has been described in other breeds, such as Boxer, Newfoundlands, Great Danes, Irish Wolfhounds etc. DCM progresses through three stages. Stage I is characterized by morphologically and functionally normal hearts ; there is no evidence/clinical signs of heart disease. Stage II is known as the “occult” or “silent” stage of DCM. The morphological changes consist of left ventricular enlargement and/or arrhythmias. Terms “occult” or “silent” refer to owner’s perspective, since the dog appears normal. Finally, stage III of DCM is characterized by clinical signs of CHF, and is referred to as the “overt” or “clinical” stage of DCM. Compared to stages I and II, which can last for years, stage III is of short duration (several months). Cardiomyopathies are the far most common cause of CHF in cats. The most common form of feline cardiomyopathy is hypertrophic cardiomyopathy, followed by restrictive/unclassified cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy, the rarest form of feline cardiomyopathies. Other possible causes of CHF in cats include hyperthyroidism, myocarditis/endocarditis, and congenital heart diseases. One can suspect cardiac decompensation and CHF in cats with respiratory distress and history of recent intravenous fluid administration, recent anaesthesia or administration of long-acting glucocorticoids. Hypertrophic cardiomyopathy (HCM), the most common form of feline heart disease, is characterized by concentric or asymmetric left ventricular hypertrophy without identifiable cause. The most common pathomechanism by which HCM leads to development of CHF is diastolic dysfunction with elevation of filling pressures. In the emergency setting, the most useful tests are emergency ultrasound and the NT-proBNP (N-terminal pro-B-type natriuretic peptide) test. Thoracic radiography is still the gold standard for diagnosis of cardiogenic pulmonary edema, but is often contraindicated in patients with respiratory distress, since it can worsen the patient’s status and lead to death. Generally speaking, the key elements of successful CHF patient stabilization include avoidance of stressful situations, rest, oxygen supplementation, intensive diuresis and/or paracentesis. Other possible interventions include heart rate control (usage of antiarrhythmic drugs), positive inotropic support, and antithrombotic therapy. Fluid therapy is almost never a therapeutic option in CHF patient, the only exception being severely dehydrated patient where fluids are used extremely judiciously. Emergency stabilisation is directed toward management of congestion, and often includes oxygen therapy, minimisation of stress, and aggressive diuretic therapy. Cats in congestive heart failure often present with pleural effusion, so in cases of moderate to large volumes of pleural effusion thoracentesis is indicated. The goal of thoracentesis should not be complete removal of effusion but to relieve signs of respiratory distress. Furosemide is probably the most important drug for the management of acute CHF and currently is the diuretic of choice for management of severe pulmonary oedema in dogs and cats. In animals with acute severe CHF, high doses of furosemide are often required, given as intravenous bolus or continuous rate infusion. The definitive dose of furosemide required by an individual animal is hard to define, but for dog doses of up to 4 mg/kg, and cat 3 mg/kg every 1-2 hours are required. Continued use of furosemide commonly causes azotaemia and electrolyte depletion (hypokalaemia). In animals with CHF and low cardiac output, as is the case in DCM, positive inotropic support is indicted. Most commonly used drugs are dobutamine and pimobendan. Dobutamine, a sympathomimetic and ß1 receptor agonist, is most commonly given as a continuous rate infusion, because of dobutamine’s short half-life. In dogs, the infusion rate is adjusted upward from 2.5 µg/kg/min (at 2.5 µg/kg increments) until signs of improved cardiac function are apparent (e. g. increased systemic blood pressure, warm limbs, normal CRT duration). Increases in heart rate greater than 20% above baseline or heart rates >190 bpm or occurrence of arrhythmia dictates dose reduction. Pimobendan is a calcium sensitizing drug and phosphodiesterase 3 inhibitor possessing positive inotropic and vasodilating effects. It has been studied in dogs with chronic valvular disease and dogs with dilated cardiomyopathy, where its use results in significant clinical improvement. Pimobendan is also available as solution for injection (Vetmedin®, solution for injection, 0, 75 mg/ml, Boehringer Ingelheim), and as such can be administered in emergency patients. The dosage of Vetmedin® solution is 0.15 mg/kg intravenously. It should be administered only once, and therapy should be continued with peroral administration of pimobendan. In certain cases, mechanical ventilation is desirable in order to avoid respiratory muscle fatigue, and initiate positive end-expiratory pressure to help mobilize oedema while other therapies take effects. Most animals with CHF markedly improve within 24 to 48 hours after initiation of stabilization. Hence, if improvement is not detected, both the diagnosis and current therapeutic plan should be reconsidered.

ongestive heart failure, dog, cat, stabilization, treatment

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Podaci o prilogu

39-40.

2017.

objavljeno

Podaci o matičnoj publikaciji

7th International Congress "Veterinary Science and Profession" Book of Abstracts

Brkljača-Bottegaro, N. ; Zdolec, N. ; Vrbanac, Z

Zagreb:

978-953-8006-13-5

Podaci o skupu

7th International Congress Veterinary Science and Profession.

pozvano predavanje

05.10.2017-07.10.2017

Zagreb, Hrvatska

Povezanost rada

Veterinarska medicina