Veterinary Clinical Medicine-I (General and Systemic)

Congestive heart failure - Clinical presentation

CONGESTIVE HEART FAILURE

Etiology

• Valuvular disease
  • Endocarditis
  • Congential valvular detects
  • Valve or chordae tendinae rupture
• Myocardial disease
  • Myocarditis
  • Myocardial degeneration
  • Cardiomyopathy, congenital, hereditary
• Pericardial disease
  • Pericarditis
  • Cardiac tamponade
• Blood pressure increase
  • Pulmonary hypertension, e.g. high altitude disease, cor pulmonale
• Congenital shunts, constriction
  • Septal defects
  • Fibro-elastrosis
  • Aorta coaretation
  • Patent ductus arteriosus

Clinical findings

• Left side failure
  • Resting respiratory rate, depth increased
  • Cough
  • Moist crackles at lung base
  • Dull percussion note over ventral lungs
  • Dyspnea, cynaosis at rest
  • Possibly murmur referable to left AV or aortic valves
• Right side failure
  • Listlessness depression
  • Reluctant to walk
  • Shuffling, staggery under, eventual recumbency
  • Anasarca ventrally under the jaw, down the neck and under the abdomen
  • Ascites
  • Hydrothorax
  • Possibly palpable enlargement of liver beyond right costal arch
  • Urine volume small, concentrated, minor albuminuria
  • Profuse diarrhea terminally
  • Anroexia
  • Condition lost, weight may increase due to edema
  • Jugglar vein distension (other veins also)
  • Abnormally high and visible jugular pulse
  • Epistaxis in some horses
  • Hydropericardium
• Progenosis
  • Horses with rhythm defects capable of surviving
  • Rarely survive; survival is with permanently reduced cardiac reseve

Clinical pathology

• Increased venous pressure
• Paracentesis from all body cavities; fluid is edema transudate but has high protein content due to anoxic damage to capillary walls
• Proteinuria

Dignosis

• Resembles
  • Peritonitis
  • Bladder rupture
  • Liver fibrosis
  • Hypoproteinenmia
  • Urine accumulation is ventral abdominal wall due to urethral perforation
  • Edema of late pregnancy in mares and cows involving perineum udder edema, ventral abdominal wall
  • Pulmonary edema occurs also in
    • Acute bovine pulmonary emphysema and edema
  • Organophosphorous compound poisoning
  • Jugular engorgement also caused by space occupying thoracic lesions, e.g. thymus lymphosarcoma

Treatment

• Limited value in cattle because lesions not reparable. Impractical in all species because rest-of-life treatment not eminently practicable
  • Digoxin orally or intravenously in horses; intravenously only in cattle. Not intramuscular in any species.
  • Horse: I/V loading dose 1.0-1.5 mg/100 kg then maintenance dose every 24 hours at half the dose. Oral loading dose; 7 mg /100 kg, plus daily maintenance oral doses at hall the rate.
  • Cattle and sheep: I/V loading dose 2.2 mg/ 100 kg, then maintenance doses 0.34 mg/ 100 kg every 4 hours. Any animals under treatment, require daily potassium chloride (100g cattle, 30g horses) if not eating, with blood potassium levels being monitored
  • Furosemide (0.25-1.0 mg/kg for horses, 2.5-5.0 mg/kg for cattle) when edema a problem; also reduce salt intake
  • Stall rest