Welcome. My name is Jessica Ward.
I'm a board certified cardiologist and assistant professor
at the Iowa State University College of Veterinary Medicine.
Today we'll be discussing several recent advancements in
the diagnosis and treatment of congestive heart failure in dogs and cats.
Management of congestive heart failure in companion animals has
advanced significantly since the days of Furosemide monotherapy.
Although thoracic radio graphs and diuretics remain important,
veterinarians today have many more tools in our toolbox to
both diagnose and treat congestive heart failure in dogs and cats.
We'll begin by discussing what we consider the current standard
of care for diagnosis and treatment of congestive heart failure.
That is, what am I using as my reference standard when I talk about recent advancements?
We also need to discuss how this standard of care was established.
In the absence of randomized, double-blinded,
placebo controlled clinical trials of each aspect of congestive heart failure management,
we generally rely on lower levels of evidence including Consensus Statements.
In 2009 the ACVIM published consensus guidelines
for the diagnosis and management of degenerative mitral valve disease in dogs,
including recommendations for congestive heart failure secondary to this disease.
In terms of congestive heart failure diagnosis,
conventional wisdom and this panel agree that the key to clinical diagnosis of
left-sided congestive heart failure is
Thoracic radio graphs demonstrating presence of cardiomegaly,
pulmonary venous distention and an interstitial to
alveolar pulmonary pattern consistent with pulmonary edema.
Echocardiography remains the gold standard for evaluation of presence and
severity of underlying structural heart disease
that can possibly lead to congestive heart failure.
Some advanced echocardiographic indices can
be used to estimate left heart filling pressures.
In terms of treatment of chronic congestive heart failure,
the consensus panel advocates a combination of loop diuretic,
ACE inhibitor and the inodilator,
Pimobendan, which some referred to as triple therapy.
There is relatively strong independent evidence for the hemodynamic and
survival benefits of both ACE inhibitors
and Pimobendan in canine congestive heart failure.
So we have an evidentiary basis in that regard.
Interestingly, there are no placebo controlled trials
establishing the efficacy of Furosemide or
other loop diuretics in congestive heart failure for any species
including humans because who would enroll patients in that placebo controlled trial?
So recommendations for loop diuretics remain rooted in clinical judgment and anecdote.
In cats, we have essentially no good clinical trials that
show a specific benefit of any drug in congestive heart failure.
Furosemide is still the linchpin of therapy in cats,
and most practitioners also use ACE inhibitors
for suppression of the renin-angiotensin-aldosterone system.
We do have good evidence in cats that clopidogrel
is superior to aspirin as an antithrombotic.
But that's about it.