Diagnosis is confirmed by showing elevation of central venous pressure or more loosely by observing a large right heart on radiographs or echocardiography. Right-sided CHF is a clinical diagnosis based on jugular distention and pulsation, presence of ascites (dogs), pleural effusion, and peripheral edema. Presence of heart failure may be suspected during physical examination. A patient may be presented with a heart murmur or gallop, and even have myocardial failure, and may not necessarily be in CHF. Heart disease is not synonymous with heart failure. A patient with dyspnea, cough or pulmonary crackles, even with abnormal heart auscultation, may have respiratory signs caused by a primary respiratory disease. Auscultatory pulmonary abnormalities during pulmonary edema are neither sensitive nor specific. Diagnosis of left-sided heart failure however, requires a chest radiograph. It is likely to be present in patients with ascites and jugular vein distention, hepatomegaly, and abnormal cardiac auscultation. Right-sided CHF is a clinical diagnosis in dogs. During right-sided failure, interference with normal absorption of nutrients in the gastrointestinal tract caused by intestinal and hepatic congestion may also contribute to cachexia.Ĭlinical signs suggestive of heart disease, not necessarily with CHF, include: diastolic, continuous or a very loud systolic murmur, arrhythmias with pulse deficit, gallop rhythms, and ascites with jugular distention and presence of hepatojugular reflux. rupture of a chordae tendineae, development of atrial fibrillation, a few Dobermans with dilated cadiomyopathy), time may not have been sufficient to cardiac cachexia to develop and the animal may show a reasonably normal body condition. In situations in which CHF develops rapidly (e.g. Obesity is usually associated with respiratory problems. It is very uncommon to an animal with overt CHF to be obese. Dogs with left-sided CHF usually have fast heart rates caused by sympathetic activation, whereas dogs with left main stem bronchus compression have normal heart rates with pronounced sinus arrhythmia due to high parasympathetic tone.Ĭardiac cachexia is a common finding during CHF it is usually more prominent during right-sided CHF and in giant breeds with dilated cardiomyopathy. Dogs coughing due to left main stem bronchus compression tend to be obese, have dry, hacking cough that is usually worse during the day. Dogs coughing from pulmonary edema are frequently thin, with severe weight loss and have a more subtle cough that tends to be worse at night, and may be accompanied by pink nasal discharge or sputum. Dogs with heart disease may cough due to left-sided CHF or due to compression of the left main stem bronchus without CHF. Cough is common sign of heart disease in dogs. The main difference between a normal fit animal, an untrained animal, and a patient with CHF, is the amount of exercise that will lead to dyspnea and fatigue. Normal animals also became dyspneic during exercise in a manner similar to the one that occurs in CHF. Biventricular failure shows a combination of left and right side signs and is often associated with accumulation of pleural fluid.ĭyspnea may be caused by pulmonary edema or pleural effusion, but it may also occur before the patient develops severe fluid retention. In dogs, ascites always precedes subcutaneous edema in patients with right side CHF. ![]() ![]() Systemic venous hypertension causes jugular distention, hepatic congestion, ascites, and subcutaneous edema. Thus, elevated pulmonary venous and capillary hydrostatic pressures lead to pulmonary edema and can be manifested as dyspnea, cough, pulmonary crackles, and exercise intolerance. These signs develop preferentially in the capillary beds drained by the failing ventricle. ![]() Sodium and water retention increases circulating volume and venous pressure leading to transudation of fluids in body cavities (effusion) or interstitium (edema). Compensatory mechanisms activated during heart failure cause sodium and water retention. ![]() Dogs with CHF are usually brought to the clinics due to cough, dyspnea, exercise intolerance, abdominal enlargement, or syncopes. What are the Clinical Manifestations of Heart Failure?Ĭlinical signs in heart failure may result from accumulation of fluids, low cardiac output, or changes in skeletal muscles (Table 1). Dyspnea may happen in patients with pulmonary edema or pleural effusion secondary to congestive heart failure (CHF) or in patients with primary respiratory disorders. For example, old dogs, particularly of small breeds, are commonly affected by chronic respiratory diseases and mitral regurgitation, both of which can result in coughing. Many clinical signs compatible with left-sided heart failure also may occur in respiratory diseases, making the distinction difficult in some cases.
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