Feline CHF

Question 1

What are cage side ways to distinguish cardiac v non cardiac causes of resp distress?

Answer 1

heart disease is unlikely if VHS<8.0, is likely if VHS>9.3, and the likelihood is indeterminate if VHS = 8.1–9.2)12 and circulating NT-proBNP and/or cardiac troponin-I concentrations can be measured cageside
Can do T-POCUS

Question 2

What is the mainstay of CHF treatement in cats?

Answer 2

Frusemide always
Once acute stage is over, consider adding ACEi
Possibly pimobendan
Possibly spironolactone - esp when there is concurrent hypokalaemia

Question 3

What are the risks of using spironolactone?

Answer 3

Can see severe dermatological effects, only really in maine coons

Question 4

Why can torosemide be useful?

Answer 4

There seems to be less of a tolerance build up when using torosemide cf frusemide

Question 5

When can hydrochlorothiazide be added?

Answer 5

when a maximal dosage of furosemide (eg, 3 mg/kg by mouth every 8 hours) is being administered reliably and evidence of lack of efficacy, such as persistent CHF despite normal or minimally increased blood urea nitrogen and creatinine concentrations, is evident.

Question 6

When may digoxin be of use?

Answer 6

A cat with heart disease causing both ventricular systolic dysfunction and a persistent, rapid supraventricular arrhythmia would be a candidate for digoxin treatment; such cases are uncommon.

Question 7

How should you manage diet?

Answer 7

Acute ingestions of sodium (eg, canned tuna, commercial cat treat) must then be avoided because a salt-avid state exists and such excesses can quickly trigger recurrent pulmonary edema or pleural effusion. Ultimately, a low-sodium diet that is eaten willingly by the patient means a lower dosage of diuretic can be administered while the patient remains free of edema and effusions.

Question 8

What should occur in first re-check after hospitalisation?

Answer 8

Recheck 7 to 10 days after discharge from hospitalization for acute CHF. Such a recheck typically consists of a history (eg, appetite, demeanor, respiratory effort, at home), physical examination (mentation, respiratory effort, new onset of arrhythmia and/or gallop sound; a change in heart murmur intensity is rarely significant), renal profile (an elevation in blood urea nitrogen with a normal creatinine concentration is expected; hypokalemia, if present, may warrant potassium supplementation, or initiation of spironolactone), and possibly thoracic radiographs if respiratory effort appears abnormal or ambiguous.