Congestive Heart Failure: Managing the Decompensated Patient

Dr. Rosemary Stolzer-Bolton, DVM, DVMCaninePre-RACE approval · 0.5–3 CE creditsFree Preview

When a compensated cardiac patient crashes overnight, the next 60 minutes determine survival — and the decisions made over the following months determine how much good time remains. Follow Charlie, a 10-year-old Cocker Spaniel in acute left-sided CHF, through emergency stabilization, quad therapy initiation, integrative support, and the honest conversations about Stage D and end-of-life planning that every cardiac clinician must master. Earn RACE CE credit (approval pending; hours assigned at approval).

Learning Objectives

  • 1Explain the neurohormonal cascade driving CHF decompensation — RAAS activation, sympathetic overdrive, ADH-mediated water retention, and natriuretic peptide counter-regulation — and identify the pharmacologic targets of each drug class in quad therapy
  • 2Execute the acute CHF stabilization protocol including oxygen delivery selection, IV furosemide bolus dosing (2-4 mg/kg) and CRI calculation, butorphanol sedation, and contraindicated interventions (alpha-2 agonists, IV fluids)
  • 3Construct the Stage C quad therapy protocol (furosemide, pimobendan, ACE inhibitor, spironolactone) using QUEST, BENCH, IMPROVE, and Bernay et al. trial evidence, and implement a structured furosemide escalation pathway for Stage D
  • 4Manage Stage D refractory CHF using torasemide conversion (1:10-1:20 furosemide ratio), sequential nephron blockade with hydrochlorothiazide, and secondary pulmonary hypertension with sildenafil
  • 5Apply a structured quality-of-life assessment framework, implement proactive end-of-life conversations at Stage C diagnosis, and counsel owners on home resting respiratory rate monitoring as an early decompensation detection tool

Course Syllabus

  1. 1
    Meet Charlie — When a Stable Heart CrashesPreview

    module-1-meet-charlie

    7 min
  2. 2
    The Neurohormonal Storm — Why Compensated Hearts Fail

    module-2-pathophysiology-decompensation

    9 min
  3. 3
    Acute Stabilization — The First Golden Hour

    module-3-acute-stabilization

    10 min
  4. 4
    Chronic CHF Management — The Quad Therapy That Extends Survival

    module-4-chronic-chf-management

    10 min
  5. 5
    Integrative Cardiac Support — Evidence-Based Adjuncts for the CHF Patient

    module-5-integrative-cardiac-support

    8 min
  6. 6
    Prognosis, Quality of Life, and the Honest Conversation

    module-6-case-resolution

    7 min

Final Assessment

10 questions · Passing score: 70%

Complete all course modules to unlock the assessment. Upon passing, your CE certificate will be generated automatically.