Cardiac drug uses

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Author:
VetStudent21
ID:
224339
Filename:
Cardiac drug uses
Updated:
2013-06-20 06:08:42
Tags:
cardiac
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Description:
heart treatments
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  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)

    Pimobendan

    +/- 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

    Furosemide

    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

    Furosemide

    Diltiazem or β-blocker (specific)

    Nitrates

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

    Diltiazem

    Furosemide

    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

    Digoxin

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