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An Urban Experience
Dogs and cats in clinical (overt) heart disease
Regular contacts with the owner by phone or email should be maintained when the animals are managed
on an out-patient basis in order to monitor therapeutic outcome and to establish a suitable maintenance dosage of diuretic. In addition, re-examinations should be scheduled.
The owner should be informed that the treatment protocol always need to be optimized for the individual cardiac patients, and that the treatment protocol used
is based on both the particular disease/disease stage affecting the animal, as well on the treatment response. Meticulous information about the various medicines should be given the owner. It is important to use appropriate dosage of diuretics to relieve clinical signs, but unnecessary high maintenance dosages should
be avoided. Overzealous use of diuretics may lead to weakness, hypotension, syncope, aggravation of pre- renal azotemia and acid-base and electrolyte imbalances. Accordingly, the lowest dosage of diuretics possible,
that can keep the animal free from clinical signs of CHF, should always be used. The maintenance dosage of diuretic in a patient that has developed CHF usually
has to gradually be increased over weeks or years to prevent clinical signs of CHF to reoccur. Reasons for increasing the dosage often include recurrent dyspnea and tachypnea caused by pulmonary edema or, less commonly, development of ascites.
Dog-owners should also be informed that the dog must be given the possibility to urinate approximately one
to two hours after oral dosages of diuretics are given. Animals with symptomatic heart disease should avoid excessive intake of sodium.
Initially, in close proximity to the acute decompensated CHF event, the dog-owner should be recommended to restrict the walking distances for the dog. Dogs that are stable on their heart failure therapy usually tolerate walks in their own pace, but strenuous exercise should be avoided. The owner should be instructed to avoid high ambient temperatures for the dog, if possible,
for example by selecting early morning hours or late evenings for longer walks.
The owner should be informed about complications
that may develop in the future, such as new signs
of decompensated left-or right sided CHF due to aggravation of congestion and edema (and accordingly a need for alteration in the treatment protocol) or syncopal episodes/collapse even at mild exercise.
Suggested reading
1. Ljungvall I, Rishniw M, Porciello F, Haggstrom J, Ohad D. Sleeping and resting respiratory rates in healthy adult cats and cats with subclinical heart disease. J Feline Med Surg. 2014;16(4):281-90.
2. Ohad DG, Rishniw M, Ljungvall I, Porciello F, Haggstrom J. Sleeping and resting respiratory rates in dogs with subclinical heart disease. J Am Vet Med Assoc. 2013;243(6):839-43.
3. Porciello F, Rishniw M, Ljungvall I, Ferasin L, Haggstrom J, Ohad DG. Sleeping and resting respiratory rates in dogs and cats with medically-controlled left-sided congestive heart failure. Vet J. 2016;207:164-8.

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