Get to the heart of congestive heart failure

King Charles spaniels are one of the breeds predisposed to heart disease. (Photo: Shutterstock.com)Heart disease is all too common in our pet population. As veterinary professionals, teaching our pet parents about heart disease and congestive heart failure in at-risk patients is an important part of our job. Why? Understanding what's happening with advancing heart disease and heart failure makes understanding the clinical signs of congestive heart failure easier. The time you spend educating clients will not only help improve the pet's life but will build a stronger veterinarian-client-patient relationship.

Lead with heart

Share general information about heart disease and the possibility of future heart failure with any pet parent who has a cat or dog with a heart murmur. It's also essential to talk to clients with predisposed breeds such as Dobermans, Cavalier King Charles spaniels and so on. Educated clients will better understand your medical recommendations and are more likely to agree to further diagnostics.

What to say

I believe it's important to convey a message that knowledge is power. Heart disease and the mention of heart failure are frightening to our pet parents. Our goal is not to scare them but to educate them. I often start with saying just that. As the pet parents, we want them to understand what's happening, know what to look for and know when they need to act.  

In my experience, the mention of heart failure has most clients believing their pet will have a heart attack-a pretty distressing idea for clients. Knowing, mentioning and addressing this concern helps allay these fears. Explain that, although serious, heart disease and congestive heart failure are treatable conditions, and they're not the same as a heart attack. This will lessen pet parents' anxiety. Knowing that early detection and intervention has the potential to slow progression of some heart diseases and minimize hospitalization with heart failure patients resonates with pet parents.

Have hardy heart conversations

I typically start by explaining that the heart is a pump, and this pump circulates blood to the lungs and throughout the body. As heart disease progresses slowly over time, the pump is no longer able to do its job properly. The heart is still doing its best, but its performance is less than ideal.

This decreased performance causes congestion, or a pressure build up. I often use the analogy of a traffic jam. If the blood-or traffic-cannot move forward as it usually does, it build ups behind the problem area. This congestion builds up in the lungs if the left heart is failing and in the body if the right heart is failing.

When the pressure builds up enough, fluid will leak out. Fluid leaks out into the lungs with left heart failure and into the abdomen with right heart failure.

In the lungs, this fluid fills the tiny sacs where normally only air should be. This fluid makes exchanging oxygen more difficult. The pet has to take more breaths to absorb the same amount of oxygen. This increases the breathing rate and effort, sometimes causing a cough.

Although simplified, this explanation works very well with pet parents. Often the proverbial “light bulb” will often go off in their heads, as they now understand why we're looking for changes in breathing when their pet has heart disease.

Discuss the clinical signs

The clinical signs of congestive heart failure in dogs and cats are an increase in breathing, excessive panting or wheezing, restlessness, decreased appetite, lethargy, weakness, collapse or fainting. Dogs may also experience a cough or increase in coughing (in cats, coughing is mostly associated with lung disease).

A word on sleeping respiratory rate

One of the most sensitive early indicators of heart failure is an elevated sleeping respiratory or breathing rate. The sleeping respiratory rate (SRR) is a wonderful tool for clients. It's easy to measure, it doesn't cost anything and the pet isn't bothered, as it's asleep. You monitor and discuss an associated number over time. There are even phone applications that let the client set reminders and automatically plot data.

A normal SRR (breathing rate) is less than 30 breaths per minute. I explain to clients that they need to count the breaths-each rise of the chest-over 15 seconds and multiply that number by four to get breaths per minute (60 seconds). In a potential heart failure patient, a SRR of more than 40 breaths per minute is reason for concern and warrants veterinary attention.  

Help! I don't have time for this

Sure, a veterinary practice is a busy place, but it's still possible to build more in-depth conversations into general practice. This is a perfect way to leverage veterinary nurses to educate pet parents about heart disease and heart failure, along with many other diseases. They can spend that extra time with concerned pet parents. Pet owners appreciate our concern for them and their pet.

Ask a cardiologist

In this age of advancing veterinary medicine, it's a good idea to refer to a board-certified cardiologist when you suspect heart disease or if congestive heart failure is a concern, if possible.

Specialists have the luxury of more time available for each pet and can continue the education you've started. We're an information resource for our community of primary care veterinarians and can shoulder the burden of complicated case management. Our goal is to work with the pet, pet parent and primary care veterinarians to treat heart disease and heart failure.

Dr. Megan King practices at the Center for Animal Referral and Emergency Services (CARES) in Langhorne, Pennsylvania.