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Re: [FH] Re: Purcy update

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  • William Draper
    sorry guys, i ve had a bad 2 weeks with exams. a few things: - heart failure is the condition where the heart can t pump enough blood to meet the body s
    Message 1 of 9 , Jul 10 1:29 PM
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      sorry guys, i've had a bad 2 weeks with exams. a few things:
      - heart failure is the condition where the heart can't pump enough blood to meet the body's metabolic demands
      - there are 2 kinds: forward (low output) and backward (congestive)
      - heart failure is a clinical syndrome, not a specific disease/diagnosis
      - CHF often presents clinically with pulmonary edema, pleural effusion, ascites, etc. depending on if it is right or left sided
      - so, from a clinical perspective, if you need to use a diuretic because the animal has fluid in it's lungs, you can probably say it has CHF
      - but you can not say it ONLY has CHF, as it is caused by a particular disease (HCM for instance)
      - mitral valve insufficiency is a common cause of CHF
      - i like that article, but i'm still not 100% sold on using beta-blockers in CHF therapy (personal preference) unless you have a concurrent HCM

      bill
      dvm in 2005
      ----- Original Message -----
      From: Susan
      To: brinkett ; feline-heart@yahoogroups.com
      Sent: Saturday, July 10, 2004 5:46 PM
      Subject: Re: [FH] Re: Purcy update


      --- brinkett <scrubbrush@...> wrote:
      > > That's what I wasn't sure about. All this time
      > I've wondered if
      > > Purcy is really in CHF or not. He was put on
      > Lasix for slight
      > > pericardial effusion due to severe mitral valve
      > regurgitation. So
      > > would that make him technically be in CHF?
      >
      > I'm not sure, that's why I asked. I'm hoping
      > someone like Bill will
      > chime in and clarify it for us. :-) I've always
      > been under the
      > impression that if a cat needs diuretics to keep
      > fluid at bay,
      > whether it be pulmonary edema/effusion or
      > pericardial effusion, it
      > means they are in CHF, but it's an impression.
      >

      I think technically asymptomatic and CHF are used
      depending on whether a diuretic such as lasix is being
      used. However there are 4 stages of CHF and there is
      also what is called refractory CHF, which means it is
      not being controlled by medications. In people a
      doctor can ask the patient how it feels to walk or
      climb stairs so the beginning of CHF may be different
      if exercise tolerance is a standard.

      The following link has a chart with the 4 NYHA classes
      of CHF.
      from:
      http://www.vetlatranquera.com.ar/pages/wild/small_animal_3.htm
      Management Of Cardiovascular Disease: New Drugs And
      New Approaches

      Susan



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    • Susan
      ... I think technically asymptomatic and CHF are used depending on whether a diuretic such as lasix is being used. However there are 4 stages of CHF and there
      Message 2 of 9 , Jul 10 1:46 PM
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        --- brinkett <scrubbrush@...> wrote:
        > > That's what I wasn't sure about. All this time
        > I've wondered if
        > > Purcy is really in CHF or not. He was put on
        > Lasix for slight
        > > pericardial effusion due to severe mitral valve
        > regurgitation. So
        > > would that make him technically be in CHF?
        >
        > I'm not sure, that's why I asked. I'm hoping
        > someone like Bill will
        > chime in and clarify it for us. :-) I've always
        > been under the
        > impression that if a cat needs diuretics to keep
        > fluid at bay,
        > whether it be pulmonary edema/effusion or
        > pericardial effusion, it
        > means they are in CHF, but it's an impression.
        >

        I think technically asymptomatic and CHF are used
        depending on whether a diuretic such as lasix is being
        used. However there are 4 stages of CHF and there is
        also what is called refractory CHF, which means it is
        not being controlled by medications. In people a
        doctor can ask the patient how it feels to walk or
        climb stairs so the beginning of CHF may be different
        if exercise tolerance is a standard.

        The following link has a chart with the 4 NYHA classes
        of CHF.
        from:
        http://www.vetlatranquera.com.ar/pages/wild/small_animal_3.htm
        Management Of Cardiovascular Disease: New Drugs And
        New Approaches

        Susan



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      • Susan
        ... And the veterinary cardiologists who have started talking about the addition of beta-blockade to an ACE-I/diuretic therapy acknowledge that it is
        Message 3 of 9 , Jul 10 2:59 PM
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          --- William Draper <wedraper@...> wrote:
          >> - so, from a clinical perspective, if you need to
          > use a diuretic because the animal has fluid in it's
          > lungs, you can probably say it has CHF
          > - but you can not say it ONLY has CHF, as it is
          > caused by a particular disease (HCM for instance)
          > - mitral valve insufficiency is a common cause of
          > CHF
          > - i like that article, but i'm still not 100% sold
          > on using beta-blockers in CHF therapy (personal
          > preference) unless you have a concurrent HCM
          >
          > bill
          > dvm in 2005

          And the veterinary cardiologists who have started
          talking about the addition of beta-blockade to an
          ACE-I/diuretic therapy acknowledge that it is
          experimental at this time because it is based on
          extensive human and animal drug trials but not drug
          trials that were conducted to benefit animals. One of
          those huge trials is called SOLVD (Study of Left
          Ventricular Disfunction). This was systolic
          disfunction rather than diastolic so I am not sure how
          that applies to felines. The rationale is based on
          the activation of the SNS in CHF as that activation is
          deleterious to the myocyte and results in further
          remodeling

          Susan




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        • brinkett
          ... Thanks for clarifying that for us, Bill. And no need to apologize - it s great that you take the time to answer our questions. Sarah.
          Message 4 of 9 , Jul 10 6:08 PM
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            > sorry guys, i've had a bad 2 weeks with exams.

            Thanks for clarifying that for us, Bill. And no need to apologize -
            it's great that you take the time to answer our questions.

            Sarah.
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