Treatment of Cardiac Disease
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3. Treatment of Cardiac Disease
It is beyond the scope of this chapter to mention the appropriate treatment for each cardiovascular disease recognized in dogs and the reader is referred to the many excellent textbooks on specific pharmacologic or surgical treatments (Kittleson & Kienle, 1998; Fox et al., 1999; Kittleson, 2000; Sisson et al., 2000a; Ware & Keene, 2000). Common cardiovascular medications include furosemide, angiotensin converting enzyme (ACE) inhibitors, digoxin, positive inotropes, beta-blockers, antiarrhythmic drugs, and additional diuretics such as thiazide diuretics and aldosterone receptor blockers (e.g., spironolactone). Medications used in an individual patient can impact appropriate diet selection (see below).
In general, dietary management of dogs with cardiac disease depends upon the clinical signs and stage of heart failure, rather than the underlying disorder. Therefore, the dietary management of a dog with CHF secondary to ventricular septal defect or bacterial endocarditis would be similar to that of a dog with CVD and CHF. When selecting a diet for a dog with cardiac disease, clinicians should take into consideration a number of factors including clinical signs and laboratory parameters. Another important issue to consider is the dog's stage of disease. In the face of acute CHF, the initial goal should be to titrate medication doses and to get the dog stabilized. In a dog with pulmonary edema or pleural effusion, the only diet change routinely advised during the initial period or even when first discharging the dog is to limit intake of very high sodium diets or high sodium treats. Once the dog is home and stabilized on medications, a gradual change to a new diet can be made - usually at the time of the first recheck 7 - 10 days after discharge. Forced dietary changes when the animal is sick or starting new medications may induce food aversions.
Failure to respond to pharmacologic and nutritional therapies can be the result of advanced or progressive disease, drug side effects, or incorrect diagnosis. Common pitfalls in the treatment of dogs with cardiac disease are shown in Table 4.
Table 4. Common Pitfalls in the Treatment of Dogs with Cardiac Disease | |||
Older small breed dogs with a cardiac murmur often have concurrent respiratory disease and it can be difficult to determine whether the clinical signs result from respiratory or cardiac disease Thoracic radiographs should always be obtained prior to initiation of diuretics and other cardiac medications. | Large breed dogs with acquired cardiac disease often have either dilated cardiomyopathy or pericardial disease Since both of these diseases can occur without significant abnormalities on cardiac auscultation, there may be a delay in accurate diagnosis unless one maintains a high degree of suspicion for these diseases. | Failure to accept a new diet Causes can include abrupt change, particularly if the diet is introduced at the same time that drug interventions are being introduced or adjusted. | Anorexia Both congestive heart failure and drug side effects can lead to anorexia. Failure to eat a cardiac diet is too often attributed to lack of palatability for the diet rather than consideration of the many other factors that might impact appetite. |
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1,2Cummings School of Veterinary Medicine, Tufts University, MA, USA.
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