Cardiac disease

Question 1

Cardiac dz in Small to medium sized dog breeds

Answer 1

Chronic valvular disease (CVD; endocardiosis)

Question 2

Cardiac dz in large breed dogs

Answer 2

Dilated cardiomyopathy (DCM) & pericardial
disease

Question 3

Cardiac dz in cats

Answer 3

Hypertrophic & restrictive cardiomyopathy

Question 4

Clinical signs of cardiac dz

Answer 4

Coughing 
• Shortness of breath 
• Inability to sleep comfortably 
• “Seizure” (syncope) 
• Weight loss 
• Abdominal distension 
• Weakness 
• Exercise intolerance 
• Poor growth (congenital heart disease)

Question 5

Cardiac failure

Answer 5

Abnormalities of cardiac function → inadequate cardiac output (CO) to meet the body‟s needs

Question 6

Congestive heart failure (CHF), clinical syndrome

Answer 6

– Exercise intolerance
– Pulmonary and/or systemic venous congestion
– Low CO initiated by myocardial dysfunction or CF
– Retention of sodium & water - attempt to compensate for inadequate CO

Question 7

Chronic CHF & associated fluid retentive states

Answer 7

– Development of clinical signs

– Compensation for decreases in CO and BP

Question 8

Systemic hypertension

Answer 8

– Common secondary to renal disease

– Leads to vascular disease and/or ventricular hypertrophy – heart failure

Question 9

Specific nutrient deficiency-related myocardial

disease

Answer 9

– Taurine deficiency

– L-Carnitine deficiency

Question 10

Imbalance of the RAA system can lead to

Answer 10

• extracellular fluid expansion

blood volume expansion, net whole body Na and water retention

Question 11

Cardiac cachexia

Answer 11

-Syndrome of weight loss, lean tissue wasting &
anorexia
-Rule out possible cause of decreased appetite (Digoxin toxicity, azotemia secondary to ACE
inhibitors, overzealous diuretic use)
- Provide adequate calories & protein (palatable diet)
- Modulate inflammatory cytokine production
- Supplement diet with ω-3 fatty acids

Question 12

Tips to manage anorexia

Answer 12

• Change to a more palatable diet
• Warm the food
• Feed smaller, more frequent meals
• Pill administration: banana, orange, melon, peanut butter (low salt), home cooked meat w/o salt
• Add flavor enhancers (yogurt, maple syrup, cooked meat)

Question 13

Obesity

Answer 13

• Adverse effects on cardiac output, pulmonary
function, neurohumoral activation, blood pressure, heart rate
• Implement conservative weight loss program only for BCS >6/9 (‘Obesity paradox’)
• Feed feeds / foods reduced in calories & sodium
• Appropriate treats: non-starchy vegetables,
“no salt added”

Question 14

Nutritional management: NaCl

Answer 14

• Healthy animals:Excrete excess dietary Na in the urine
• RAA system activation:
– Develops prior to onset of clinical signs
– ↓ excretion of Na = worsening of clinical status
– Avoid severe Na restriction in Stage 1-2 of cardiac
disease – it can further activate RAA system &
worsen clinical signs
• High dietary Na intake is likely detrimental
• Cl restriction equally important (1.5 x higher than Na)

Question 15

Hypokalemia

Answer 15

– Potentiates arrhytmias, muscle weakness & digitalis toxicity
– Anorexia resulting in reduced K+ intake
– Loop diuretics (eg, furosemide)
– Thiazide diuretics (eg, hydrochlorothiazide)
– Therapy: Oral K+ supplementation: 3–5 mmol/kg/day

Question 16

Hyperkalemia

Answer 16

– ACE inhibitors, potassium-sparing diuretics (eg, spironolactone)
– Therapy: withdraw any K+ supplements; consider
loop or thiazide diuretic

Question 17

Hypomagnesemia

Answer 17

– Potentiates risk of arrhytmias, decreases cardiac 
contractility 
– Digoxin & loop diuretics (furosemide) 
• Diagnosis difficult 
– Serial measurements of serum Mg 
• Therapy: diet change, magnesium oxide 
supplementation

Question 18

Protein

Answer 18

• Protein restriction → cardiac cachexia
• Feed high quality protein at the level that meets
AAFCO minimums for adult maintenance requirements (Dog: 5.1 g/100 kcal, Cat: 6.5 g/100 kcal)
• If several renal dysfunction present, feed less of
high quality protein

Question 19

Taurine- cats

Answer 19

• Function:Regulates Ca & K in the cardiomyocytes
• Dietary deficiency: Feline Central Retinal Degeneration (FCRD), Platelet abnormalities, Taurine deficiency („87) - feline dilated cardiomyopathy
• Sources: Meat & organ meats
• Availability varies in feline diets:
– Dry diet: 25 mg/100 kcal
– Canned diet: 50 mg/100 kcal

Question 20

Taurine- dogs

Answer 20

• Not required in canine diets
• Certain breeds of dogs with DCM – Tau deficient: Cocker Spaniels, Golden Retrievers, Labrador Retriever, Saint Bernard, English Setter
• Tau deficiency without DCM - Newfoundlands
– Lamb meal and rice diets; brown rice; rice bran
• Doberman Pinchers and Boxers with DCM - unlikely Tau deficient
• Diagnosis: Whole blood and plasma concentration
• Treatment: 500 – 1000 mg q 8-12 hrs PO

Question 21

ω-3 fatty acids

Answer 21

• Reduce cachexia: ↓ inflammatory cytokines
• Improve food intake
• Reduce arrhytmogenesis
• Benefits of ω-3 fatty acids supplementation prior to development of CHF
• Dosage: 40 mg/kg EPA and 25 mg/kg
DHA (dogs) = 1 capsule (180 mg EPA + 120
mg DHA) per 10 lbs of BW / day

Question 22

L-Carnitine

Answer 22

• Synthesized endogenously from Lys, Met, (vit. B6, vit. C)
• Functions: Transport LCFA into the mitochondria, “Scavenges‟ mitochondrial toxins
• Dietary deficiency: Associated with DCM in the Boxer, Doberman, Cocker Spaniel
• Sources: Red meat & dairy products; Dose: 50-100 mg/kg PO q 8 hrs of L-carnitine supplement

Question 23

Antioxidants

Answer 23

• Dogs with CHF - increased biomarkers of OS and
reduced concentrations of AOX (vit. E)
• Coenzyme Q10:
– Deficiency proposed as a possible cause of DCM
– Dose: 30 – 90 mg PO BID

Question 24

What are the 3 most common cardiovascular problems of nutritional significance

Answer 24

1) chronic CHF and fluid retentive states
2) systemic hypertension and
3) specific nutrient deficiency related myocardial disease