Cardiac drug uses

  1. Valvular disease
    Mild to Moderate Heart Failure
    Low dose furosemide (lowest effective dose)

    Pimobendan (probably superior to ACE-I)

    Avoid strenuous exercise

    Prognosis with  treatment <1 year from onset of CHF
  2. Valvular Disease -Asymptomatic Patient
    Don't treat - little/no effect on time of onset of CHF

    Avoid strenuous exercise? Obesity?

    Prognosis= 1-3 years before CHF
  3. Valvular disease
    Moderate to Severe heart failure
    Avoid significant exertion

    Furosemide + ACE inhibitor (e.g. enalapril)


    +/- amlodipine

    +/- β-blocker (e.g. atrial fibrillation)
  4. Valvular Disease
    Severe, refractory heart failure
    Continue ACE-I, pimobendan

    High dose frusemide hourly until improved (2-4 hours)

    • Vasodilation;
    • CRI nitroprusside (aim for below 15mmHg SAP), Nitroglycerine (applied to skin)
    • Amlodipine

    Dobutamine (if severe oedema)
  5. Endocarditis
    • Antibiotics - till lesion resolution or indefinitely
    • Initially parenteral administration

    CHF therapy

    Poor prognosis (~20% survival)
  6. Congenital Valvular Disease
    Subaortic Stenosis
    • β-1 blockers e.g. atenolol
    • - Use in moderate to severe cases
    • - Prevent arrhythmic effects of catecholamines
    • - reduce myocardial oxygen demand
    • - increase coronary perfusion by decreasing heart rate and contractility.

    Exercise restriction

    Balloon dilation often not successful
  7. Canine DCM - Asymptomatic
    Avoid strenuous repetitive exercise

    Avoid Obesity

    • Drugs (?)
    • - ACE inhibitor? β-blocker? Pimobendan?

    Taurine until proven otherwise

    L-carnitine? wont hurt.
  8. Canine DCM- mild to moderate CHF
    Avoid strenuous, repetitive exercise

    ACE inhibitor (enalapril, lisinopril, benazepril)

    Low dose furosemide

    Pimobendan vs Digoxin

    Anti-arrythmics as required

    Sodium restriction

    β-blocker (recent evidence says no)

    Taurine until proven otherwise
  9. Canine DCM - moderate to severe CHF
    avoid significant exertion

    ACE inhibitor


    Pimobendan or Digoxin if arrhythmias present

    β-blocker (recent evidence says no)

    • Consider;
    • - Amlodipine
    • - Nitrates
    • - Taurine until proven otherwise
  10. Canine DCM
    Acute, fulminant CHF
    Cage rest, oxygen

    IV high dose furosemide, q1-2 hourly

    nitrates for preload reduction

    Dobutamine if hypotensive 

    • Antiarrhytmic therapy;
    • Atrial arrhythmias -> Digoxin (esp. with atrial fib), β-blockers (low initial dose)

    Sustained ventricular arrhythmias -> lidocaine
  11. Feline HCM treatment
    Calcium channel blockers (diltiazem)

    β-blockers - Atenolol. More effective with very high HRs and LVOT obstruction.
  12. Feliner HCM asymptomatic
    Diltiazem or β-blocker

    no drug has been shown to be beneficial in these patients.
  13. Feline HCM
    Mild to Moderate CHF
    Minimise stress

    Restrict dietary sodium


    Diltiazem or β-blocker (specific)


    Antiarrythmics if indicated
  14. Feline HCM
    Advanced CHF
    Cage rest, oxygen



    Nitrate or ACE inhibitor or both
  15. Feline HCM thromboembolism
    Do not use thrombolytic therapy

    Aspirin 5mg/kg q72 hours

    Heparin 250-300U/kg q 8 hours

    Aspiring 5mg per cat- reduces long term risk of arterial thromboembolism
  16. Feline dilated cardiomyopathy
    Taurine supplementation

    • Manage CHF;
    • Furosemide
    • ACE inihibitors

Card Set
Cardiac drug uses
heart treatments