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CHF Staging Planner
Canine congestive heart failure stage assessment
CHF Staging Flow
A
Stage A – At Risk
No structural heart disease, no clinical signs
B
Stage B – Preclinical
Structural heart disease, no clinical signs
C
Stage C – Current CHF
Structural heart disease with current or prior clinical signs
D
Stage D – Refractory CHF
End-stage disease, clinical signs at rest despite therapy
ACVIM Cardiology Consensus
Stage A: No therapy indicated. Monitor for development of heart disease.
Stage B1: No therapy (MMVD with VHS < 10.5). Pimobendan if MMVD with VHS > 10.5 (EPIC).
Stage B2: Pimobendan, ACE inhibitor, diuretics if indicated.
Stage C: Furosemide, pimobendan, ACE inhibitor, ± spironolactone.
Stage D: Refractory - consider torsemide, hydralazine, supplemental O₂.
Stage B1: No therapy (MMVD with VHS < 10.5). Pimobendan if MMVD with VHS > 10.5 (EPIC).
Stage B2: Pimobendan, ACE inhibitor, diuretics if indicated.
Stage C: Furosemide, pimobendan, ACE inhibitor, ± spironolactone.
Stage D: Refractory - consider torsemide, hydralazine, supplemental O₂.
💡 Clinical Pearls
- Cough is not always CHF – consider pulmonary hypertension or primary airway disease
- Resting respiratory rate > 30/min at home suggests decompensation
- Monitor renal values when escalating diuretic therapy
- Pimobendan improves survival in Stage B2 (EPIC study) and Stage C (QUEST study)