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A number of diagnostic procedures need to be taken into account when diagnosing heart failure.
A number of diagnostic procedures need to be taken into account when diagnosing heart failure.
Coughing, dyspnea, tachypnea, orthopnea, exercise intolerance, syncope, lethargy, peripheral oedma, ascites, mucous membrane colour and weight loss are all clinical signs that may be caused by heart disease, but may also have other causes. There may also be a capillary refill time of less than 3 seconds, which is normal. Over 3 seconds is abnormal. Pale mucous membranes suggest poor peripheral circulation due to vasoconstriction, decreased hemoglobin in the blood ([[anaemia]]), or [[shock]]. Cyanosis suggests adequate hemoglobin, but inadequate oxygenation. This can be seen with pleural effusion/pulmonary oedema - right to left shunt within the circulation causing deoxygenated blood to mix with oxygenated blood.
Coughing, dyspnea, tachypnea, orthopnea, exercise intolerance, syncope, lethargy, peripheral oedma, ascites, mucous membrane colour and weight loss are all clinical signs that may be caused by heart disease, but may also have other causes. There may also be a capillary refill time of less than 3 seconds, which is normal. Over 3 seconds is abnormal. Pale mucous membranes suggest poor peripheral circulation due to vasoconstriction, decreased hemoglobin in the blood ([[anaemia]]), or [[shock]]. Cyanosis suggests adequate hemoglobin, but inadequate oxygenation. This can be seen with pleural effusion/pulmonary oedema - right to left shunt within the circulation causing deoxygenated blood to mix with oxygenated blood.
Signs of heart failure are directly related to [[Hear Failure, Pathophysiology|which side is affected]]. The above signs are characteristic of cardiac problems, but can also be the signs of other diseases involving different body systems therefore a good physical exam including signalment, history, observation, palpation, percussion, and auscultation are necessary to identify true cardiac problems.
Signs of heart failure are directly related to [[Heart Failure - Pathophysiology|which side is affected]]. The above signs are characteristic of cardiac problems, but can also be the signs of other diseases involving different body systems therefore a good physical exam including signalment, history, observation, palpation, percussion, and auscultation are necessary to identify true cardiac problems.
== Physical Exam ==
== Physical Exam ==
Felines often present acutely with no history of heart disease. They commonly throw blood clots to the aorta which lodge in the bifurcation just before entering the rear limbs. The presence of no palpable femoral pulses and cold limbs along with pulmonary edema and/or pleural effusion is strongly supportive of heart failure.
=== Observation ===
=== Observation ===
'''Heart Murmurs '''are abnormal heart sounds due to turbulent blood flow. Heart murmurs are characterized based on their timing, location, intensity, radiation, pitch, and shape.
'''Heart Murmurs '''are abnormal heart sounds due to turbulent blood flow. Heart murmurs are characterized based on their timing, location, intensity, radiation, pitch, and shape.
'''Pulmonary edema''' will have crackles present in the lungs.
'''Pleural effusion''' will have dull lungs songs, more so ventrally.
=== Electrocardiography (ECG) ===
=== Electrocardiography (ECG) ===
=== Radiology ===
=== Radiology ===
Will show cardiac enlargement +/- '''[[Hear Failure, Right-Sided|right-sided heart failure]] '''signs, which are ascites, hepatomegaly and pleural effusion and [[Hear Failure, Left-Sided|'''left sided heart failure ''']]signs which are pulmonary oedema and pulmonary venous distension.
Will show cardiac enlargement +/- '''[[Heart Failure, Right-Sided|right-sided heart failure]] '''signs, which are ascites, hepatomegaly and pleural effusion and [[Heart Failure, Left-Sided|'''left sided heart failure ''']]signs which are pulmonary oedema and pulmonary venous distension.
=== Echocardiography ===
=== Echocardiography ===
Can be used to determine the cause of heart failure, such as structural deformities etc.
Can be used to determine the cause of heart failure, such as structural deformities etc. Right parasternal short axis view (mushroom view) can provide quick insight into general volume status as well as ventricle thickness and ratio giving even a novice observer some idea as to cardiac vs non cardiac disease.
'''Pericardial effusion''' can also be ruled out
'''Blood clots''' can be seen in the left atrium sometimes.
=== Ultrasound ===
[[TFAST]] and [[VetBLUE]] can be used to quickly determine if edema is present in the lungs or effusion is present in the pleural cavity, thus differentiating it from "dry" lung diseases such as asthma. Presence of nodules is indicative of fungal or neoplastic disease. If the lungs are dry, there is no left sided congestive heart failure present by definition.
The vena cava can be evaluated as it crosses the diaphragm. Distension is diagnostic for volume overload or right sided heart failure.
=== Cardiac Markers ===
NT-pro BNP levels can be measured in house or sent out to lab to measure heart muscle stretch. This cane be applied as a screening test for at risk breeds or as a diagnostic tool in emergencies or when other tests do not provide a clear answer.
{{Chapter}}
{{Mansonchapter
|chapterlink = http://www.mansonpublishing.co.uk/book-images/9781840761856_sample.pdf
|chaptername = Congestive Heart Failure in the Dog (part of Congestive Heart Failure in the Cat)
|book = Small Animal Emergency and Critical Care Medicine
|author = Elizabeth Rozanski, John Rush
|isbn = 9781840761856
}}
== References ==
== References ==
{{review}}
{{OpenPages}}
[[Category:Heart_Failure]] [[Category:Expoert_Review]]
[[Category:Heart_Failure]] [[Category:Expert_Review]]
[[Category:Cardiology Section]]