Sleeping and resting respiratory rates in dogs and cats with medically-controlled left-sided congestive heart failure
Introduction
In dogs and cats, left-sided congestive heart failure (L-CHF) is characterized by development of pulmonary oedema or pleural effusion secondary to severe left heart disease (Kittleson, 2010). Clinical signs of L-CHF include dyspnoea and/or varying degrees of tachypnoea (Kittleson, 2010). These can be subtle and difficult to detect early in the course of developing L-CHF, but can progress to more noticeable signs. Although L-CHF is ultimately a clinical diagnosis, the clinician often relies on results from several tests, including radiographic demonstration of cardiomegaly accompanied by an interstitial or alveolar pattern indicative of cardiogenic pulmonary oedema (Haggstrom et al, 2008, Ferasin et al, 2013), or by pleural effusion in cats (Johns et al., 2012).
In hospitalized dogs with L-CHF, resting respiratory rate (RRR) proved the most sensitive and specific single test for identifying L-CHF as a cause of respiratory signs and independently predicted L-CHF in multivariable regression analysis (Schober et al., 2010). A further study demonstrated that resolution of the L-CHF resulted in respiratory rates returning to pre-CHF ranges (Schober et al., 2011). We recently showed that healthy dogs have average sleeping respiratory rates (SRR) <25 breaths/min in the home environment and that dogs with subclinical left-sided heart disease have average SRR that rarely exceed 30 breaths/min (Rishniw et al, 2012, Ohad et al, 2013). Similarly, we have shown that most healthy cats and cats with subclinical heart disease have average SRR <30 breaths/min and rarely exceed 40 breaths/min in the home environment (Ljungvall et al., 2014b). However, whether successful therapy of L-CHF in dogs and cats results in average SRR measurements that are similar to those of healthy or subclinically affected animals in the home environment remains unknown.
We hypothesized that dogs and cats with stable, well-controlled L-CHF would have average SRR at home similar to those of dogs and cats with subclinical heart disease. Therefore, we examined the SRR and RRR of dogs and cats in the home environment with previously diagnosed L-CHF that had been satisfactorily controlled with standard medical therapy.
Section snippets
Data acquisition
In this prospective study, we recruited veterinary cardiologists and veterinarians with clinical expertise in cardiology to request their clients to collect SRR and RRR data in the home environment from dogs and cats seen in the course of their clinical work, using a standardized data collection form. Clients returned completed forms to participating clinicians who then provided additional medical information for each patient. Data collection began in March 2012 and ended in December 2014.
Results
Twenty-one participants (14 veterinary cardiologists, 4 residents and 3 clinicians involved in veterinary cardiology) from eight countries in three different continents provided data for 51 dogs and 22 cats with clinically stable CHF that met our inclusion criteria. Most dogs (40/51) and 10/22 cats had thoracic radiography at the time of CHF diagnosis. The 10 dogs that did not undergo thoracic radiography had marked cardiomegaly identified echocardiographically and a positive and sustained
Discussion
The results of our study suggest that dogs and cats with L-CHF generally achieve SRR similar to those of healthy and subclinically affected dogs and cats, when managed with sufficient diuretics (and adjunct therapies) to stabilize their clinical signs to the satisfaction of the owner and the clinician (Ohad et al, 2013, Ljungvall et al, 2014b). Dogs and cats rarely had SRRmean >30 breaths/min when L-CHF was stable and well-controlled. In most cases, SRRmean < RRRmean in both dogs and cats.
Conclusions
Our study demonstrates that most dogs and cats with stable, medically controlled CHF have SRRmean <30 breaths/min and relatively small day-to-day changes in SRR in the home environment. These findings provide reasonable targets for clinicians to strive for when attempting to manage cases of CHF, with the caveat that other factors (such as renal disease) should be considered when managing CHF. In such circumstances, achieving SRR <30 breaths/min might not be feasible or desirable. In animals
Conflict of interest statement
None of the authors has any financial or personal relationships that could inappropriately influence or bias the content of the paper.
Acknowledgements
This study was presented as an abstract at the 31st ACVIM Forum, June 2013.
References (10)
- et al.
Sleeping respiratory rates in apparently healthy adult dogs
Research in Veterinary Science
(2012) - et al.
Risk factors for coughing in dogs with naturally acquired myxomatous mitral valve disease
Journal of Veterinary Internal Medicine
(2013) - et al.
Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: The QUEST study
Journal of Veterinary Internal Medicine
(2008) - et al.
Left atrial function in cats with left-sided cardiac disease and pleural effusion or pulmonary edema
Journal of Veterinary Internal Medicine
(2012) Chapter 9: Pathophysiology of heart failure – signs of heart failure
Cited by (22)
Predicting Development of Hypertrophic Cardiomyopathy and Disease Outcomes in Cats
2023, Veterinary Clinics of North America - Small Animal PracticeChange of Vertebral Left Atrial Size in Dogs With Preclinical Myxomatous Mitral Valve Disease Prior to the Onset of Congestive Heart Failure
2022, Journal of Veterinary CardiologyCitation Excerpt :As obtaining a respiratory rate is simple to do, cost-effective, and can be done at home, many veterinary cardiologists recommend monitoring respiratory rates to identify the development of CHF or impending CHF in dogs with subclinical MMVD. However, stress, pain, or comorbidities, including primary respiratory disease, pulmonary thromboembolism, and severe pulmonary hypertension could increase respiratory rate, so a high sleeping respiratory rate is not specific to CHF [25,26]. In contrast, serial measurements of VLAS would be useful to identify the risk of CHF in dogs with respiratory diseases or other comorbidities because it is not affected by stress, pain or other comorbidities.
Canine myxomatous mitral valve disease
2022, Small Animal Critical Care MedicineThe predictive value of clinical, radiographic, echocardiographic variables and cardiac biomarkers for assessing risk of the onset of heart failure or cardiac death in dogs with preclinical myxomatous mitral valve disease enrolled in the DELAY study
2021, Journal of Veterinary CardiologyCitation Excerpt :Early (E peak) and late A transmitral inflow velocities were assessed by spectral pulsed-wave Doppler from the left four-chamber apical view with the Doppler gate positioned at the tip of the mitral valve leaflets. The endpoint was the time to cardiac death or first occurrence of HF defined by the presence of either dyspnea and/or tachypnea (≥36 breaths/min at rest) that could not be explained by another disease based on clinical judgment by the investigator [18]. Radiographs were performed at the last visit if the dog was presented at the investigator clinic and if its health condition allowed it.
Characteristics and outcomes of cats with and without pacemaker placement for high-grade atrioventricular block
2021, Journal of Veterinary CardiologyCitation Excerpt :From the presenting physical examination, heart rates (via auscultation) and presence or absence of tachypnea or dyspnea were recorded. Tachypnea was defined as recorded respiratory rates of >30 breaths per minute in hospital [12]. The presence or absence of a heart murmur or third heart sound on auscultation at presentation, ECG and Holter recording diagnoses, atropine response test results, presence or absence of cardiomegaly, CHF, or non-cardiac pulmonary abnormalities based on radiologic assessment at the time of presentation, echocardiogram findings, and complete blood cell count, serum biochemistry panel, and total thyroxine level results were recorded.
DELay of Appearance of sYmptoms of Canine Degenerative Mitral Valve Disease Treated with Spironolactone and Benazepril: the DELAY Study
2020, Journal of Veterinary CardiologyCitation Excerpt :Quality of life was assessed by using a scoring system based on the following parameters: body weight, appetite, cough, exercise intolerance, and syncope (Table 2). The primary end point was the time to cardiac death or onset of first occurrence of HF defined by the presence of either dyspnea and/or tachypnea (≥36 breaths/min at rest) that could not be explained by another disease based on clinical judgment by the investigator [20]. Radiographs were performed at the last visit if the dog was presented at the investigator clinic and if its health condition allowed it.