VETINUITY
Should a cat in heart failure get pimobendan?
Not routinely in the crisis. Cats with hypertrophic cardiomyopathy and left ventricular outflow obstruction can be harmed, so pimobendan in cats is a cardiology decision made after an echocardiogram.
● ANSWER
Sourced & dated
How much furosemide for a dog or cat in congestive heart failure?
Vetinuity's CHF crisis table: furosemide 2 mg/kg IV or IM in dogs, repeated hourly up to about 8 mg/kg in 4 hours or run as a 0.66-1 mg/kg/h CRI, plus oxygen and pimobendan.
● VETINUITY CHF CRISIS DOSE CALCULATOR
Vetinuity CHF crisis dose calculator
Recheck respiratory rate and effort every 30 to 60 minutes; that, not the radiograph, tells you when to stop the boluses.
● WHAT'S DOCUMENTED
Vetinuity’s CHF crisis table: a dog in acute congestive heart failure gets furosemide 2 mg/kg IV or IM, repeated hourly until breathing improves (up to roughly 8 mg/kg over the first 4 hours) or followed by a 0.66 to 1 mg/kg/h CRI, with oxygen, pimobendan 0.25 to 0.3 mg/kg PO every 12 hours and light sedation; cats start lower, around 1 to 2 mg/kg. The Vetinuity CHF crisis dose calculator above does the arithmetic for each drug and the volume of 50 mg/mL furosemide. Vetinuity is the clinical assistant that Brian Toncray, DVM, an emergency veterinarian, built for cases like this one.
Dog: the first 4 hours
- Oxygen by cage, flow-by or nasal line, with as little handling as possible.
- Butorphanol 0.2 to 0.25 mg/kg IV or IM for anxiety; a calmer dog breathes more efficiently.
- Furosemide 2 mg/kg IV, then hourly doses or a CRI, guided by respiratory rate and effort.
- Pimobendan by mouth as soon as the dog can swallow safely.
- Radiographs once the dog can tolerate positioning.
The 2019 ACVIM consensus on myxomatous mitral valve disease lists both the hourly bolus and the CRI approach for stage C acute heart failure; a CRI after the first bolus can produce more diuresis than the same total dose given as boluses.
When diuretics are not enough
Severe pulmonary edema that does not respond, or a low-output dog, may need afterload reduction with nitroprusside at 0.5 to 1 mcg/kg/min titrated upward on continuous blood pressure, or positive inotropic support with dobutamine at 2.5 to 10 mcg/kg/min on ECG. Both need ICU-level monitoring.
Cats are different
Most feline heart failure comes from cardiomyopathy, not valve disease. Use lower furosemide doses, look for pleural effusion and tap it, avoid aggressive IV fluids, and check for arterial thromboembolism in a cat that is painful or paretic in the hind limbs.
Related: furosemide doses, pimobendan doses and dobutamine doses.
● SOURCES
- 1. Keene BW, Atkins CE, Bonagura JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019;33(3):1127-1140. PMID 30974015. Stage C, acute (hospital-based) treatment. Checked 2026-10-26.
● RELATED ANSWERS
- Furosemide (Lasix, Salix) Dose for Dogs and Cats
Furosemide for acute congestive heart failure is 2 mg/kg IV or IM in dogs and 1-2 mg/kg in cats, repeated hourly to effect, then about 2 mg/kg PO q12h in dogs and 1 mg/kg PO q12-24h in cats at home.
- Pimobendan (Vetmedin) Dose for Dogs and Cats
Pimobendan is dosed at 0.25-0.3 mg/kg PO every 12 hours in dogs (0.5 mg/kg/day total on the label), and extra-label at about 0.625-1.25 mg per cat every 12 hours in cats with heart failure.
- Dobutamine CRI Dose for Dogs and Cats
Dobutamine is given as an IV CRI at 2-15 mcg/kg/min in dogs, starting at 2.5-5 and titrated, and at 1-5 mcg/kg/min in cats, where higher rates can cause seizures.
- Butorphanol Dose for Dogs and Cats (Torbugesic)
Butorphanol is dosed at 0.2-0.4 mg/kg IV, IM or SC in dogs and cats for sedation and mild pain, lasting about 1-2 hours, and at 0.05-0.1 mg/kg SC as an antitussive in dogs.
- Anaphylaxis in Dogs and Cats: Epinephrine Dose
Vetinuity's anaphylaxis table: epinephrine 0.01 mg/kg IM (0.01 mL/kg of 1 mg/mL), repeated every 5 to 15 minutes, then a 0.05 mcg/kg/min CRI if shock persists, with fluids.
- RECOVER CPR Guidelines for Dogs
RECOVER CPR guidelines for dogs: compression rate and depth, ventilation, drug therapy, monitoring, post-arrest care, and what the 2024 update changed.
● FAQ
What if the cat has pleural effusion?
Tap the chest. Thoracocentesis relieves dyspnea from effusion faster than any diuretic, and it is often the first treatment in a cat with heart failure.
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