Felis ISSN 2398-2950

Heart: congestive heart failure

Contributor(s): Yolanda Martinez Pereira, Mark Oyama, Mark Rishniw

Introduction

  • Cause: underlying heart disease:
    • Primary:
      • Poor diastolic function (compliance failure).
      • Poor systolic function (myocardial or pump failure), rare.
      • Congenital heart disease.
    • Secondary:
      • Hyperthyroidism.
      • Systemic hypertension.
      • Taurine deficiency.
    • Arrhythmias.
  • Signs: respiratory difficulty, poor appetite, activity intolerance.
  • Treatment: control fluid retention, counter adverse neuroendocrine activation, correction of arrhythmia, improving systolic or diastolic function.
  • Prognosis: guarded.

Pathogenesis

Etiology

Pathophysiology

  • Cardiac injury    →    activation of sympathetic nervous system, renin-angiotensin-aldosterone and arginine-vasopressin systems to maintain blood pressure   →   detrimental in chronic cases   →   decreased cardiac function   →   progressive vicious cycle.
  • Decreased cardiac output   →   decreased blood pressure activates baroreceptors   →   reflex increased sympathetic activity/decreased vagal activity   →   increased heart rate, increased contractility and vasoconstriction   →   maintain blood pressure.
  • Sympathetic activation and poor renal perfusion   →   activates renin-angiotensin-aldosterone system (RAAS)   →   further vasoconstriction, sodium and water retention   →   increased sympathetic outflow and release of vasopressin (antidiuretic hormone)   →   further vasoconstriction and water retention   →   increased venous pressures and eventually capillary pressures   →   extravasation of fluid into lungs and pleura (left-sided heart failure) or liver and abdomen (right-sided heart failure).
    Pleural effusions are very common in cats with both left and right sided cardiac failure.
  • See Pathophysiology of CHF for more detail Heart: pathophysiology of CHF.

Timecourse

  • Weeks to months depending on underlying heart disease.

Diagnosis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prevention

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • MacGregor J M, Rush J E, Laste N J et al (2011) Use of pimobendan in 170 cats (2006-2012). J Vet Cardiol 13 (4), 251-260 PubMed
  • MacDonald K A, Kittleson M D, Kass P H et al (2008) Effect of spironolactone on diastolic function and left ventricular mass in Maine Coon cats with familial hypertrophic cardiomyopathy. JVIM 22 (2), 335-341 PubMed.
  • Ishikawa Y, Uechi M, Hori Y et al (2007) Effects of enalapril in cats with pressure overload-induced left ventricular hypertrophy. J Feline Med Surg (1), 29-35 PubMed.
  • Wall M, Calvert C A, Sanderson S L et al (2005) Evaluation of extended-released diltiazem once daily for cats with hypertrophic cardiomyopathy. JAAHA 41 (2), 98-103 PubMed.
  • Fox P (2003) Prospective, double-blinded, multicentre evaluation of chronic therapies for feline diastolic heart failure: interim analysis. JVIM 17, 938.
  • Boswood A (1999) Rationale for the use of drugs in treatment of cardiovascular disease 3. positive inotropes. In Practice 21, 253-259 InPractice.
  • Packer M (1998) Neurohormonal interactions and adaptations in congestive heart failure. Circulation 77 (4), 721-730 PubMed.
  • Rush J E, Freeman L M, Brown D J (1998) The use of Enalapril in the treatment of feline hypertrophic cardiomyopathy. JAAHA 34 (1), 38-41 PubMed.
  • The COVE Study Group (1995) Controlled clinical evaluation of enalapril in dogs with heart failure - results of the Cooperative Veterinary Enalapril Study Group. JVIM (4), 243-252 PubMed.
  • The IMPROVE Study Group (1995) Acute and short-term hemodynamic, echocardiographic and clinical effects of enalapril maleate in dogs with naturally acquired heart failure - results of the Invasive, Multicenter, Prospective Veterinary evaluation of Enalapril study. JVIM (4), 234-242 PubMed.
  • Pedersen H D, Koch J, Poulsen K et al (1995) Activation of the renin-angiotensin system in dogs with mildly asymptomatic mitral valvular insufficiency. JVIM (5), 328-331 PubMed.
  • Francis G S & Chu C (1994) Compensatory and maladaptive responses to cardiac dysfunction. Current Opinion in Cardiology (3), 280-288 PubMed.
  • Roudebush P, Allen T A, Kuehn N F et al (1994) The effect of combined therapy with captopril, furosemide and a sodium-restricted diet on serum electrolyte concentrations and renal function in normal dogs and dogs with congestive heart failure. J Vet Intern Med (5), 337-342 PubMed.
  • Schlesinger D P & Rubin S I (1994) Potential adverse effects of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure. Comp Cont Educ Pract Vet 16 (3), 275-283 VetMedResource.
  • Dahlström U & Karlsson E (1993) Captopril and spironolactone therapy for refractory congestive heart failure. Am J Cardiol 71 (3), 29A-33A PubMed.
  • Riegger G A J (1993) ACE inhibitors in early stages of heart failure. Circulation 87 (5 Suppl) IV117-119 PubMed.
  • Zannad F (1993) Angiotensin-converting enzyme inhibitor and spironolactone combination therapy. New objectives in congestive heart failure management. Am J Cardiol 71 (3), 34A-39A PubMed.
  • Bright J M, Golden A L, Gompf R E, Walker M A, Toal R L ( 1991) Evaluation of the calcium channel blocking agents diltiazem and verapamil for treatment of feline hypertrophic cardiomyopathy. JVIM (5), 272-282 PubMed.

Other sources of information

  • Sisson D (2012) Pathophysiology of heart failure. In: Textbook of Veterinary Internal Medicine.7th ed. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders.  Chapter 234. pp 1143-1158.
  • Côté E, MacDonald K A, Meurs K M, Sleeper M M (2011) Which drug for which disease?In: Feline Cardiology. Ed Wiley-Blackwell. pp 433-438.
  • MacDonald K (2010) Myocardial disease: feline. In: Textbook of Veterinary Internal Medicine.7th ed. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders.  Chapter 252. pp 1328-1341
  • Keene B W & Rush J E (1995) Therapy of heart failure. Chapter 92. In: Textbook of Veterinary Internal Medicine 4th edn. Eds S J Ettinger, S J & E C Feldman. Philadelphia: W B Saunders. pp 867-892 (well referenced).
  • Knight D H (1995) Pathophysiology of heart failure and clinical evaluation of cardiac function. InTextbook of Veterinary Internal Medicine4th edn. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders. pp 844-867 (good logical approach to the syndrome of CHF).
  • Miller M S & Tilley L P (1995) International Small Animal Cardiac Health Council System of Heart Failure Classification. (Appendix 1: Recommendations for the diagnosis of heart disease and treatment of heart failure in small animals.) In:Manual of Canine and Feline Cardiology2nd edn. Eds M S Miller & L P Tilley. Philadelphia: W B Saunders. pp 473 (modern method of classifying CHF in dogs).
  • The COVE Study Group (1995) Controlled clinical evaluation of enalapril in dogs with heart failure - results of the Cooperative Veterinary Enalapril Study Group. JVIM 9, 243-252 (trial with dogs in moderate or severe CHF; improved quality of life and lifespan on enalapril compared with placebo).
  • The IMPROVE Study Group (1995) Acute and short-term hemodynamic, echocardiographic and clinical effects of enalapril maleate in dogs with naturally acquired heart failure - results of the Invasive, Multicenter, Prospective Veterinary evaluation of Enalapril study. JVIM 9, 234-242 (trial showing benefit of enalapril therapy in CHF in dogs).


ADDED