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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com HearT Failure in dogs: 6 PracTical TiPs From cardiologisTs Peer reviewed 28 Abnormalities that support CHF include: • Left atrial enlargement • Pulmonary venous enlargement • Perihilar interstitial-to-alveolar pattern from pulmonary edema. During initial presentation for coughing or decreased exercise tolerance, radiographs are the best way to confrm presence of venous congestion and pulmonary edema. Radiographs can also indicate bronchial compression due to an enlarged left atrium and rule out alternate diagnoses, such as pneumonia or pulmonary neoplasia. When CHF is suspected, diuretic therapy can be initiated before thoracic radiography if the patient is dyspneic. Periodic biochemistry monitoring is important in dogs receiving diuretics and ACE inhibitors or those with comorbid conditions, such as kidney disease. Adjustments in diuretic dosing can be based on clinical signs, radiographic fndings, and kidney values to achieve the lowest effective dose. Echocardiography is a powerful tool; know when to perform it: Echocardiography can establish the type of heart disease and identify complicating factors, such as pulmonary hypertension, systolic ventricular dysfunction, high left-sided flling pressures, intracardiac shunts, atrial tears, and pericardial effusion. Echocardiography can also identify anatomic abnormalities and assess function, but it cannot specifcally diagnose the presence of CHF. Echocardiography is not typically necessary until a dog is clinically stable; however, it can provide useful information to guide treatment protocols and is especially helpful when response to heart failure therapy does not meet expectations and additional treatment may be indicated. A more detailed study requires an experienced sonographer to identify complex issues and characterize congenital defects (see Tip 6). 4. When Recommending Therapy, Consider Comorbidities and Drug Interactions and Adverse Effects For the 2 most common acquired heart diseases in the dog—DMVD and DCM—recommended heart failure therapy includes multiple medications, typically furosemide, pimobendan, and an ACE inhibitor. Adult dogs are more likely to have concurrent systemic diseases—kidney disease, protein-losing diseases, hyperadrenocorticism, and arthritis—that are important to consider when making treatment recommendations. It is also essential to consider the patient's medical history, current drug therapy, potential adverse effects of cardiac medications, and drug interactions. • Decreased glomerular filtration rate in a dog with kidney disease may be a concern when ACE inhibitors, diuretic therapy, and nonsteroidal anti- inflammatory drugs are being administered. • Electrolyte concentrations are affected by ACE inhibitors and diuretics. • Pulmonary hypertension can develop in dogs with DMVD, protein-losing diseases, and hyperadrenocorticism. 5. Make Recommendations for Home Care That Considers the Pet's and Care Taker's Quality of Life Involve owners in monitoring their dogs' heart disease: Set up a recheck schedule to monitor disease progression, potential adverse effects of medications, patient quality of life, and any challenges faced by the owner. Recheck evaluations for a dog in heart failure are often recommended every 2 to 4 months, or sooner, if medications are adjusted or clinical decompensation occurs. Educate owners about clinical signs that indicate their dogs need medical attention, including cough (new or worsening), breathing diffculty, anorexia or vomiting, and lethargy or collapse. Encourage owners to record resting or sleeping breathing rates at home. Many dogs have a resting breathing rate of less than 35 breaths/minute, often in the mid-teens to mid-twenties. An elevated breathing rate that is repeatable within the hour, especially if the dog has breathing diffculty or a decrease in appetite or activity level, should prompt medical attention. Additional points to consider: • Ensure the dog is eating and taking its medications. Make recommendations for a palatable diet and advise the owner to avoid high- salt foods and treats when possible. • Set activity level expectations, which varies for each dog. Light activity is acceptable and encouraged, especially if it enhances quality of life, but strenuous activity needs to be avoided. • Consider the owner's lifestyle when making treatment recommendations. For instance, therapy given more than twice daily may be difficult for some owners.