Felis ISSN 2398-2950

Heart: congestive heart failure

Synonym(s): CHF

Contributor(s): Yolanda Martinez Pereira, Mark Oyama, Mark Rishniw, Liz Bode


  • Cause: underlying heart disease:
    • Primary:
      • Poor diastolic function (compliance failure).
      • Poor systolic function (myocardial or pump failure), rare.
      • Congenital heart disease.
    • Secondary:
      • Hyperthyroidism.
      • Systemic hypertension.
      • Taurine deficiency.
    • Arrhythmias.
  • Signs: respiratory difficulty, poor appetite, activity intolerance.
  • Treatment: control fluid retention, counter adverse neuroendocrine activation, correction of arrhythmia, improving systolic or diastolic function.
  • Prognosis: guarded.




  • Cardiac injury    →    activation of sympathetic nervous system, renin-angiotensin-aldosterone and arginine-vasopressin systems to maintain blood pressure   →   detrimental in chronic cases   →   decreased cardiac function   →   progressive vicious cycle.
  • Decreased cardiac output   →   decreased blood pressure activates baroreceptors   →   reflex increased sympathetic activity/decreased vagal activity   →   increased heart rate, increased contractility and vasoconstriction   →   maintain blood pressure.
  • Sympathetic activation and poor renal perfusion   →   activates renin-angiotensin-aldosterone system (RAAS)   →   further vasoconstriction, sodium and water retention   →   increased sympathetic outflow and release of vasopressin (antidiuretic hormone)   →   further vasoconstriction and water retention   →   increased venous pressures and eventually capillary pressures   →   extravasation of fluid into lungs and pleura (left-sided heart failure) or liver and abdomen (right-sided heart failure).
    Pleural effusions are very common in cats with both left and right sided cardiac failure.
  • See Pathophysiology of CHF for more detail Heart: pathophysiology of CHF.


  • Weeks to months depending on underlying heart disease.


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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • James R, Guillot E, Garelli-Paar C et al (2018) The SEISICAT study: a pilot study assessing efficacy and safety of spironolactone in cats with congestive heart failure secondary to cardiomyopathy. J Vet Cardiol 20 (1), 1-12 PubMed.
  • Ward J L, Lisciandro G R, Ware W A et al (2018) Evaluation of point-of-care ultrasound and NT-proBNP for the diagnosis of congestive heart failure in cats with respiratory distress. JVIM 32 (5), 1530-1540 PubMed.
  • Hogan D F, Fox, P R, Jacob K et al (2015) Secondary prevention of cardiogenic arterial thromboembolism in the cat: The double-blind, randomized, positive-controlled feline arterial thromboembolism; clopidogrel vs. aspirin trial (FAT CAT). J Vet Cardiol Supplement 1, S306-317 PubMed.
  • MacGregor J M, Rush J E, Laste N J et al (2011) Use of pimobendan in 170 cats (2006-2012). J Vet Cardiol 13 (4), 251-260 PubMed
  • MacDonald K A, Kittleson M D, Kass P H et al (2008) Effect of spironolactone on diastolic function and left ventricular mass in Maine Coon cats with familial hypertrophic cardiomyopathy. JVIM 22 (2), 335-341 PubMed.
  • Wall M, Calvert C A, Sanderson S L et al (2005) Evaluation of extended-released diltiazem once daily for cats with hypertrophic cardiomyopathy. JAAHA 41 (2), 98-103 PubMed.
  • Fox P (2003) Prospective, double-blinded, multicentre evaluation of chronic therapies for feline diastolic heart failure: interim analysis. JVIM 17, 938.
  • Packer M (1998) Neurohormonal interactions and adaptations in congestive heart failure. Circulation 77 (4), 721-730 PubMed.
  • Francis G S & Chu C (1994) Compensatory and maladaptive responses to cardiac dysfunction. Current Opinion in Cardiology (3), 280-288 PubMed.
  • Roudebush P, Allen T A, Kuehn N F et al (1994) The effect of combined therapy with captopril, furosemide and a sodium-restricted diet on serum electrolyte concentrations and renal function in normal dogs and dogs with congestive heart failure. J Vet Intern Med (5), 337-342 PubMed.
  • Dahlström U & Karlsson E (1993) Captopril and spironolactone therapy for refractory congestive heart failure. Am J Cardiol 71 (3), 29A-33A PubMed.
  • Bright J M, Golden A L, Gompf R E, Walker M A, Toal R L ( 1991) Evaluation of the calcium channel blocking agents diltiazem and verapamil for treatment of feline hypertrophic cardiomyopathy. JVIM (5), 272-282 PubMed.

Other sources of information

  • Boswood A (2017) Heart failure: Clinical Management. In: Textbook of Veterinary Internal Medicine. 8th edn. Eds S J Ettinger, S J & E C Feldman. Philadelphia: W B Saunders. Chapter 247. pp 1163-1176 (well referenced).
  • Chetboul V (2017) Feline myocardial disease. In: Textbook of Veterinary Internal Medicine. 8th ed. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders. Chapter 253. pp 1278-1304 
  • Sisson D & Scollan K F (2017) Pathophysiology of heart failure. In: Textbook of Veterinary Internal Medicine. 8th ed. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders. Chapter 246. pp 1153-1162. 
  • Côté E, MacDonald K A, Meurs K M, Sleeper M M (2011) Which drug for which disease? In: Feline Cardiology. Ed Wiley-Blackwell. pp 433-438.