Approach to dealing with acute heart failure in cats and dogs

Background: Unfortunately, heart disease is common in both dogs and cats and may eventually result in congestive heart failure (CHF). However, the clinical signs of CHF overlap with other causes of respiratory compromise. As such, differentiating cardiac from non-cardiac causes of respiratory distress is a common diagnostic challenge in emergency veterinary practice. The general principles of heart failure management can be applied to a broad range of cardiac diseases; identifying a cardiac cause for the clinical signs is therefore more important than making a definitive diagnosis in the acute phase of heart failure. Nevertheless, there is no ‘one-size-fits-all’ recipe for treatment and the approach needs to be tailored to the individual (eg, severity of clinical signs, comorbidities, patient demeanour and so on). Although the information in this article is organised linearly, the approach to an emergency case seldom follows the structure used in more stable patients. For example, a dog or cat presenting with significant dyspnoea will typically require treatment (eg, supplementary oxygen ± light sedation) before physical examination and diagnostic testing, and some diagnostic tests may need to be postponed until the patient is stable enough to safely undergo them; therefore, the initial treatment plan is often based on a working, rather than a definitive, diagnosis.