Congenital heart disease and steroid therapy

Re: Congenital heart disease and steroid therapy

Hannah Wynne Richards — Thu, 05 Feb 2015 12:18:26 GMT

You'll probably have to give a higher than normal dose of diuretic to counter the steroid. Play it by ear, but don't be afraid to add prilactone. I once had an elderly Yorkie that had Cushings, diabetes and CHF, and lived happily with all 3 for > 2 years.

What is ARVC?

Wynne

Re: Congenital heart disease and steroid therapy

David Mills — Thu, 05 Feb 2015 11:37:58 GMT

Yep, current thinking is that the fluid retention caused by steroid therapy is the main problem, and for meningitis the dose will naturally be higher with potentially more side effects and more fluid retention. Adding this to the already dilated atria may well precipitate CHF due to increasing LA (+/-RA) pressure. The myocardium tends to be less affected by the muscle-wasting of steroids as it is physiologically different to skeletal muscle. Hopefully the course of preds can be scaled back with improvement of the meningitis. Agree with comments about quantity of life likely low and prioritise the QoL - CHF is manageable with medication to a certain extent, and I think it's unlikely to become refractory just due to preds.

How dilated was the LA? And was it on steroids already? Has it got ARVC?

Re: Congenital heart disease and steroid therapy

Anthony Todd — Thu, 05 Feb 2015 11:19:57 GMT

http://circ.ahajournals.org/content/21/5/661.full.pdf

They seem to worry about fluid retention more than anything else but don't suggest it is a no-no.

In this case it would seem that the advantages, in dealing with the overriding condition, outweigh the potential disadvantages.

Re: Congenital heart disease and steroid therapy

Richard Carter — Thu, 05 Feb 2015 11:01:58 GMT

think the feeling is that long term high dose cortisone will weaken the strength of contraction due to the heart muscle fibres atrophying along with the general steroid induced decreased muscle mass and tone??

however the last cardiac case I sent to referral (agility springer spaniel super fit all her life) came back on cortisone to counter / treat the myocarditis she had somehow acquired.

Re: Congenital heart disease and steroid therapy

Braden Collins — Thu, 05 Feb 2015 10:46:42 GMT

I would think the dog's not long for the world, so the priority needs to be getting quality of life. the steroids are going to be needed for that purpose. If it affects the heart, so be it, though I don't understand how it would (if anyone knows why I'd be keen to learn).