Today's Veterinary Practice

MAY-JUN 2018

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33 MAY/JUNE 2018 ‚óŹ TVPJOURNAL.COM CONTINUING EDUCATION The role of dietary modification in the treatment of CHF is uncertain. Ideally, moderate sodium restriction in a calorie-dense diet seems a sensible approach, but it is important that the dog continues to eat well, as unintended weight loss (cardiac cachexia) is a feature of advancing heart failure and a poor prognostic sign. Very low sodium diets can stimulate the renin-angiotensin- aldosterone system and be counterproductive. Supplementation with omega-3 fatty acids has been shown to be beneficial in human patients with CHF, and the same is likely to be true in dogs, especially if cardiac cachexia is present. Doses of eicosapentaenoic acid (EPA) 40 mg/kg PO q24h and docosahexaenoic acid (DHA) 25 mg/kg PO q24h have been suggested. 14 Carnitine and taurine supplementation has been suggested and may be appropriate in cases with poor systolic function. However, apart from anecdotal reports, there is little evidence to support their use. Management of Recurrent Acute Signs If decompensated heart failure (ie, pulmonary edema) returns, the patient should be admitted and diuretics given intravenously to regain control. A higher dose of furosemide may be needed and is often achieved by increasing the frequency of administration to 3 times daily or more. If the dose of furosemide starts to exceed 3 to 4 mg/kg q8h, furosemide resistance may be present. At that point, options include adding another diuretic, such as a hydrochlorothiazide, to achieve sequential nephron blockade. Alternatively, the more potent loop diuretic torsemide can be prescribed. The starting dose is generally obtained by taking the total daily furosemide dose and dividing it by 10; that total daily dose of torsemide is divided to be given PO twice daily. For example, if a dog is receiving a total daily dose of 100 mg furosemide, the dose of torsemide would be 5 mg PO q12h. 15 After switching diuretics, renal parameters and electrolytes should be checked in 5 to 7 days. COMPLICATIONS The most common cause of a recurrence of acute decompensated heart failure is a ruptured chorda tendinea. An echocardiogram can confirm the presence of the new flail mitral leaflet ( FIGURE 4 ). Emergency treatment of the acute heart failure is CLIENT PARTICIPATION Owners are strongly advised to record their dog's resting respiratory rate. There are several apps available for smartphones that can help do this. Involving clients in their dog's care and treatment increases client compliance and allows them to recognize when CHF is returning, which will prompt a return to the clinic. Client compliance is extremely important, as the owners will need to medicate their pet daily for the rest of its life and be vigilant for the return of decompensation. shutterstock.com/Monkey Business Images

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