Severe Congestive Heart Failure Research Articles

Respiratory syncytial virus-associated illness in adults with advanced chronic obstructive pulmonary disease and/or congestive heart failure.

BackgroundRespiratory syncytial virus (RSV) is recognized as a serious pathogen in people with chronic cardiopulmonary conditions. Immunoprophylaxis might be considered for adults at high‐risk for frequent and severe RSV infection. Thus, we studied the incidence of RSV‐related medically attended acute respiratory illness (MARI) in adults with severe chronic obstructive pulmonary disease (COPD) and/or congestive heart failure (CHF).MethodsSubjects ≥50 years of age with Gold Class III/IV COPD and/or American Heart Association class III/IV CHF and exposure to children ≥once per month were recruited. Subjects were evaluated over 1.5 to 2.5 years for RSV‐associated MARI, defined as polymerase chain reaction (PCR) and/or seroresponse.ResultsFour hundred forty‐five subjects were enrolled between October 2011 and May 2012. Overall, 99 RSV infections were documented by PCR or serology for a cumulative incidence of 22.2%. Of these, 42 (9.4%) subjects had protocol‐specified RSV‐MARI for an incidence of 4.68/100 patient‐seasons. All‐cause MARI was common (63.85/100 patient‐seasons) with rhinovirus most commonly identified.ConclusionRSV infection was common in adults with severe COPD and/or advanced CHF. Given the severity of underlying cardiopulmonary diseases in the study population, most illnesses were surprisingly mild. Thus, active immunization rather than passive immunoprophylaxis with monoclonal antibodies may be a more cost‐effective strategy.

Weight Supported Treadmill Ambulation in a Patient with Severe Congestive Heart Failure: A Case Report

Weight Supported Treadmill Ambulation in a Patient with Severe Congestive Heart Failure: A Case Report

CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed.

CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed.

A rare case of acromegaly with normal IGF-1, severe chronic congestive heart failure, and impaired glucose tolerance

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis.

In aortic valve stenosis (AS), congestive heart failure (CHF) is a well-established symptom that indicates the need for surgical aortic valve replacement (SAVR). However, it is difficult to judge whether CHF symptoms such as dyspnea are caused by severe AS or other conditions, especially in elderly persons with restricted mobility or other organ complications. It is important to identify objective and noninvasive parameters associated with severe CHF symptoms in severe AS. One hundred ninety-eight patients with severe AS without left ventricular (LV) dysfunction were retrospectively studied. CHF symptoms were classified by New York Heart Association (NYHA) functional class. Echo parameters were compared between NYHA I-III and NYHA IV. Patients with NYHA IV (n=40; 20%) were older (86±6 vs 82±8years; P=.001) and had a larger LV mass index (LVMI) (157±43 vs 114±34g/m2 , P<.001), a higher transmitral flow velocity ratio (E/A) (1.31±0.62 vs 0.93±0.42; P=.001), a shorter deceleration time (DT) (202±72 vs 286±98ms; P<.001), and a higher systolic pulmonary arterial pressure (SPAP) (44±13 vs 35±13mmHg; P<.001) than patients with NYHA I-III. On multivariable analysis, LVMI and DT were independently associated with NYHA IV. Receiver operating characteristic curve analysis identified LVMI≥142g/m2 and DT≤194ms as the cutoff values associated with NYHA IV in patients with severe AS. Left ventricular mass index and DT were independently associated with severe heart failure (NYHA IV). These echo parameters could be helpful to judge whether CHF symptoms are caused by severe AS.

Efficacy of Transhepatic Anterior Approach to the Inferior Vena Cava for Malignant Pheochromocytoma Invading Right Posterior Lobe of the Liver: A Case Report

Introduction: The anterior approach to the inferior vena cava (IVC) by the liver hanging maneuver is effective in resecting large retrohepatic tumors without mobilizing the right lobe. Case presentation: A 50-year-old man was referred to our hospital with a diagnosis of pheochromocytoma. He had severe congestive heart failure and cardiac ejection fraction was 15%. Abdominal magnetic resonance imaging (MRI) and ultrasonography (US) showed an adrenal mass about 80 mm in diameter. The tumor-infiltrated posterior segment of the right hepatic lobe and tumor were widely attached to the IVC. After treatment of congestive heart failure with conservative therapy, surgery was planned. Right adrenectomy and right hepatectomy were performed, the latter using the liver hanging maneuver to avoid mobilizing the right lobe, and we were able to minimize blood pressure fluctuations and perform the operation safely. The histopathologic diagnosis was malignant pheochromocytoma. Conclusions: We performed right hepatectomy without mobilizing the right lobe by the liver hanging maneuver and minimized stimulation of the tumor. We could perform the operation safely using the liver hanging maneuver, which seems effective in such cases.

Analysis of volatile organic compounds: an innovative approach to heart failure characterization in older patients

Background: Analysis of exhaled volatile organic compounds (VOCs) may be applied for diagnostic purposes in some chronic diseases, but there are no data on their role for discriminating people with congestive heart failure (CHF), particularly in older patients where natriuretic peptides have lower accuracy. We evaluated whether VOCs analysis can discriminate patients with or without CHF, stratify CHF severity and predict the response to therapy of decompensated CHF. Methods and Results: We recruited 89 subjects admitted to an acute care ward with acutely decompensated CHF, 117 healthy controls and 103 chronic obstructive pulmonary disease (COPD) controls. CHF patients performed echocardiography. VOCs were collected using the Pneumopipe® and analyzed with the BIONOTE electronic nose. Partial least square analysis was used to evaluate the discriminative capacity of VOCs. Accuracy in discrimination of CHF versus healthy and COPD controls was 81% and 69%, respectively; accuracy did not decrease in a sensitivity analysis excluding subjects younger than 65 and older than 80 years. In CHF patients VOCs pattern could predict with fair precision ejection fraction and systolic pulmonary arterial pressure, but not changes in weight due to therapy. Conclusions: VOCs pattern is able to discriminate older CHF patients from healthy people and COPD patients and correlates with cardiac function markers.

Windkessel model of hemodynamic state supported by a pulsatile ventricular assist device in premature ventricle contraction

BackgroundCounter-pulsation control (CPC) by ventricular assist devices (VADs) is believed to reduce cardiac load and increase coronary perfusion. However, patients with VADs have a higher risk of arrhythmia, which may cause the CPC to fail. Consequently, CPC has not been applied by VADs in clinical practice. The phase-locked loop (PLL) algorithm for CPC is readily implemented in VADs; however, it requires a normal, consistent heartbeat for adequate performance. When an arrhythmia occurs, the algorithm maintains a constant pumping rate despite the unstable heartbeat. Therefore, to apply the PLL algorithm to CPC, the hemodynamic effects of abnormal heartbeats must be analyzed.ObjectivesThis study sought to predict the hemodynamic effects in patients undergoing CPC using VADs, based on electrocardiogram (ECG) data, including a wide range of heart rate (HR) changes caused by premature ventricular contraction (PVC) or other reasons.MethodsA four-element Windkessel hemodynamic model was used to reproduce the patient’s aortic blood pressure in this study. ECG data from 15 patients with severe congestive heart failure were used to assess the effect of the CPC on the patients’ hemodynamic state. The input and output flow characteristics of the pulsatile VAD (LibraHeart I, Cervika, Korea) were measured using an ultrasound blood flow meter (TS410, Transonic, USA), with the aortic pressure maintained at 80–120 mmHg. All other patient conditions were also reproduced.ResultsIn patients with PVCs or normal heartbeats, CPC controlled by a VAD reduced the cardiac load by 20 and 40%, respectively. When the HR was greater for other reasons, such as sinus tachycardia, simultaneous ejection from the heart and VAD was observed; however, the cardiac load was not increased by rapid cardiac contractions resulting from decreased left ventricle volume. These data suggest that the PLL algorithm reduces the cardiac load and maintains consistent hemodynamic changes.

Mortality Prediction in Severe Congestive Heart Failure Patients with Multifractal Point-Process Modeling of Heartbeat Dynamics.

Multifractal analysis of human heartbeat dynamics has been demonstrated to provide promising markers of Congestive Heart Failure (CHF). Yet, it crucially builds on the interpolation of RR intervals series, which has been generically performed with limited links to CHF pathophysiology. We devise a novel methodology estimating multifractal autonomic dynamics from heartbeat-derived series defined in the continuous time. We hypothesize that markers estimated from our novel framework are also effective for mortality prediction in severe CHF. We merge multifractal analysis within a methodological framework based on inhomogeneous point process models of heartbeat dynamics. Specifically, wavelet coefficients and wavelet leaders are computed over measures extracted from instantaneous statistics of probability density functions characterizing and predicting the time until the next heartbeat event occurs. The proposed approach is tested on data from 94 CHF patients, aiming at predicting survivor and non-survivor individuals as determined after a 4 years follow up. Instantaneous markers of vagal and sympatho-vagal dynamics display power-law scaling for a large range of scales, from s to s. Using standard SVM algorithms, the proposed inhomogeneous point-process representation based multifractal analysis achieved the best CHF mortality prediction accuracy of 79.11 % (sensitivity 90.48%, specificity 67.74%). Our results suggest that heartbeat scaling and multifractal properties in CHF patients are not generated at the sinus-node level, but rather by the intrinsic action of vagal short-term control and of sympatho-vagal fluctuations associated with circadian cardiovascular control, especially within the VLF band. These markers might provide critical information in devising a clinical tool for individualized prediction of survivor and non-survivor CHF patients.

To Evaluate the Efficacy of Heart Failure Reversal Therapy Using NT-Probnp Levels in Patients with Chronic Heart Failure

Heart failure is considered as a life-threatening epidemic disorder affecting about 26 million world's population and associated with considerable morbidity, mortality and healthcare expenses. Despite the availability of a range of advanced treatments and sophisticated therapies the prevalence of heart failure represents a herculean challenge. To address the challenge, the current investigation was conducted by evaluating the efficacy of Heart Failure Reversal Therapy (HFRT) in reducing left ventricular distress by assessing N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in congestive heart failure (CHF) patients. Total 76 CHF patients with NYHA Class II and III were screened from March to May 2017 and 15 CHF patients with NT-proBNP = 300-1500 pg/ml were selected for the study. NT-proBNP is measured as a marker, the value of which increases with an increase in severity of CHF. The study therapy, HFRT comprises of traditional procedure of panchkarma that includes snehana (external oleation), swedana (passive heat therapy), hrudaydhara (concoction dripping treatment) and basti (medicated enema) was administered twice daily for 7 days. Post-HFRT, ARJ kadha was administered for next 12 weeks follow-up. NT-proBNP levels were measured after a follow-up period of 90 days along with some other parameters like BMI, VO 2peak (evaluated by cardiac stress test with modified Bruce protocol) and weight. The findings of the investigation revealed significant reduction in NT-proBNP levels (42.46%, p = 0.009), weight (4.82%, p = 0.0007) and BMI (3.67%, p = 0.034) at the end of the follow-up period. The study also yielded significant improvements in VO 2peak (50.96%, p = 0.004). The overall results suggest that HFRT can possibly be explored as add-on therapy or a feasible alternative for the effective management of CHF.

Development and Evaluation of press coated tablets of Carvedilol using solid dispersion prepared by spray drying technique

Carvedilol is a non-selective beta and alpha blocker which is insoluble in water. It is used in the treatment of mild to severe congestive heart failure (CHF) and high blood pressure. As the solubility is very poor the bioavailability is only 25–35%. The problem of poor solubility can be overcome using any of the physical or chemical methods of solubility enhancement. The purpose of this research was to improve the solubility of Carvedilol by spray drying technique using hydrophilic polymers β-Cyclodextrin and Plasdone-K30. Prepared solid dispersions were evaluated for drug content, saturation solubility and in-vitro drug release study. The compatibility and surface morphology was studied by Fourier Transforms Infrared spectroscopy (FTIR), Differential Scanning Calorimetry (DSC) and Scanning Electron Microscopy (SEM) respectively. The spray dried solid dispersions of Carvedilol were incorporated into press coated tablets and were subjected to various precompression and postcompression parameters. The effect of the various barrier layer compositions on the lag time was studied. This research emphasizes on the role of chronotherapy for treatment of hypertension.

ЭХОКАРДИОГРАФИЧЕСКАЯ ДИАГНОСТИКА НЕКОМПАКТНОГО МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА

The clinical cases of rare, genetically heterogeneous cardiomyopathy are described - the left ventricular noncompaction (LVNC) cardiomyopathy for four children (three boys and one girl) in age from two months to 6 years. Description of echocardiography signs is presented in accordance with modern diagnostic criteria. Noncompaction of the left ventricle is recognized in three patients, of the left and right ventricle - in one. In three patients out of four, LVNC was a separate disease, and yet in one it was associated with neurofibromatosis type 1, in combination with dilatation of coronary arteries and pericardial effusion. Three of four patients were admitted with congestive heart failure (CHF) of New York Heart Association (NYHA) functional class 3-4 (FC), and one - with CHF 2 FC. The echocardiograms are brought with description of characteristic features of LVNC (hypertrabecularity, spongy myocardium on the apex of the left ventricle, typical correlation of incompact and compact layer from 2.0 to 2.6). All four patients received treatment for CHF (diuretics, beta-blockers, captopril, in one case - digoxin); two out of four got antithrombotic therapy (aspirin, warfarin). Results of follow-up observation of the patients are described with the estimation of echocardiography signs, including dilatation of coronary arteries. Left ventricular ejection fraction - both by Simpson and Teicholz - increased in two patients, with therapy of chronic heart failure at a follow-up visits over > 5 years simultaneously with the decline of severity of CHF. Another two patients have been examined from 2 months to 5 years and have had CHF 3 FC; their left ventricular ejection fraction increased too, but cardiomegaly and right ventricular heart failure preserved.

O27-2 - A Case of Recovery from Anthracycline-induced Cardiomyopathy with Biventricular Assist and Mitral Valve Repair

We report the clinical course of a 43-year-old woman in remission from diffuse large B-cell lymphoma after the combination chemotherapy including hydroxydaunorubicin (anthracycline), who presented in severe congestive heart failure due to anthracycline-induced cardiomyopathy 8 months after the end of chemotherapy. She was initially treated with intra-aortic balloon pumping, followed by conversion to left ventricular assist with an Abiomed AB5000 and right ventricular assist with a centrifugal pump and a membrane oxygenator due to sharp deterioration of her heart and lung functions. With intensive medical treatments during biventricular support, her cardiac and respiratory functions gradually improved, although moderate mitral regurgitation had not been spontaneously corrected with left ventricular unloading. On the 64th day on biventricular support, the patient underwent mitral valve annuloplasty to correct regurgitation using cardiopulmonary support. As an expected result, she was weaned from biventricular assist successfully 8 days after mitral surgery (on the 72nd day on the biventricular support). The patient discharged uneventfully from our hospital and survives currently at home 4 months after weaning from the ventricular assist devices. As demonstrated in this report, aggressive biventricular support and requisite valve repairs are significantly useful for recovery from severe anthracycline-induced cardiomyopathy of the patient with cancer in the last 5 years, who cannot be a recipient for heart transplantation.

175P - OHERA: A real world study of cardiac events in > 3700 patients with her2-positive early breast cancer treated with trastuzumab: Final analysis

Background: As of Sept 2016, > 2.2 million breast cancer (BC) patients (pts) have received trastuzumab (Herceptin®; H) in clinical trial or real world settings. Risk of cardiac failure in pts treated with H in real world practice may differ from that observed in a clinical trial setting. Methods: OHERA (NCT01152606) is a non-interventional post-approval safety study that investigated incidence of symptomatic congestive heart failure (CHF) and cardiac death in pts with HER2-positive early BC (EBC) receiving adjuvant intravenous H (H IV) in routine clinical practice, per the EU Summary of Product Characteristics (SmPC). Pts with HER2-positive EBC (stage I–IIIb) considered for treatment with H IV per the EU SmPC were enrolled, treated and monitored per local practice. Primary endpoints were incidence of symptomatic CHF (New York Heart Association [NYHA] class II–IV) and incidence of cardiac death. Secondary endpoints included time to onset of CHF. The final analysis included pt data collected for up to 5 years or until death, loss to follow-up or consent withdrawal. Results: Pts were enrolled Aug 2007–Nov 2010 at 199 sites across 9 countries. The safety population included 3733 pts with EBC treated with H IV. Median treatment duration was 11.8 months; median follow-up was 60.1 months. Incidence of symptomatic CHF was 2.8% (n = 106); including severe symptomatic CHF (NYHA class III–IV) in 1.0% (n = 38) pts. Median time to onset of symptomatic CHF was 5.7 months (95% CI 5.3–6.5) and 77 (72.6%) pts achieved CHF resolution. Incidence of cardiac death was 0.2% (n = 6). 251 pts had a left ventricular ejection fraction (LVEF) drop of ≥ 10% from baseline to < 50% and 169/251 (67.3%) achieved LVEF drop resolution. Incidence of CHF was higher in pts with baseline risk factors such as pre-existing cardiac conditions, age ≥65 years or baseline LVEF ≤55%. Pts who had left-side radiotherapy at baseline did not have higher CHF incidence. Conclusions: OHERA is the largest study investigating the cardiac safety of adjuvant H IV in a real world setting to date. Final analysis results were consistent with cardiac safety results from previous adjuvant H IV clinical trials in EBC, and the baseline risk factors for CHF reported in the H IV EU SmPC. Clinical trial identification: Protocol number: BO20652/RO 45-2317 ClinicalTrials.gov NCT01152606 Legal entity responsible for the study: F Hoffmann-La Roche Ltd Funding: F. Hoffmann-La Roche Ltd., Basel, Switzerland Disclosure: A. Bouhlel, M. Liste Hermoso: Employee of F Hoffmann-La Roche Ltd. S. Lauer: Contract work for Hoffmann-La Roche Ltd. E. Nüesch: Stock ownership: Roche. Employee of F. Hoffmann-La Roche Ltd. M. Shing: Previous employee of Genentech Inc. & current collaboration with Genentech Inc. V. Misra: Membership of an advisory board: Amgen, Eisai, Roche. All other authors have declared no conflicts of interest.

Reverse takotsubo cardiomyopathy presenting as abdominal pain: An atypical presentation

Reverse takotsubo cardiomyopathy is the rarest variant of takotsubo cardiomyopathy. We present a case of reverse takotsubo cardiomyopathy presenting as abdominal pain likely due to non-occlusive mesenteric ischemia. A 58-year-old female presented with abdominal pain, nausea, vomiting, and diarrhea for 2 days. Upon presentation, she was normotensive but tachycardic. Her lactic acid level was 2.8 mmol/L and troponin-T was 0.62 ng/ml. The electrocardiogram showed non-specific ST changes. CT scan of abdomen revealed bowel wall thickening in transverse colon and splenic flexure. Patient was started on aggressive intravenous fluid therapy for possible infectious colitis.The next day, patient started becoming progressively more dyspneic, hypoxic, and hypotensive. A chest X-ray at that time showed signs of severe congestive heart failure. Echocardiogram revealed left ventricular ejection fraction of 20% with akinesis of proximal and mid-ventricular walls. Patient was intubated for hypoxic respiratory failure and started on milrinone infusion for acutely depressed cardiac function. Inotropes were weaned off the next day, and she was successfully extubated on day 4. Subsequently, gastrointestinal symptoms resolved. Cardiac catheterization was performed later during the hospitalization that showed normal coronary arteries. Repeat echocardiogram done 3 months later showed return of cardiac function to normal.

Higher defibrillation threshold in methamphetamine cardiomyopathy patients with implantable cardioverter-defibrillator

IntroductionIdentification of patients with an increased risk of high defibrillation thresholds (DFTs) is important in planning implantable cardioverter-defibrillator (ICD) procedures. Clinical observations have suggested that patients with methamphetamine cardiomyopathy (MACMP) have significantly elevated defibrillation thresholds. We hypothesized that MACMP patients would have higher DFT thresholds than controls and would require procedural changes during ICD implantation to accommodate higher thresholds. MethodsWe identified consecutive patients with MACMP undergoing ICD implantation at the academic center from 2003 to 2007. We then compared DFTs against age-and sex-matched controls. ResultsThe MACMP (n = 10) group showed significantly increased DFT thresholds (23.7 ± 6.7 J) compared with age and sex-matched controls (14.5 ± 4.6 J, p < 0.005). Additionally, patients with MACMP had evidence of more severe congestive heart failure, with increased B-type natrieutic protein (BNP) levels (1173 ± 784 vs 260 ± 349, p = 0.02) and decreased left ventricular ejection fraction (LVEF) (17.8 ± 9.4 vs 35.9 ± 15.2, p = 0.02). MACMP patients required high output devices than controls (50% versus 0%, p = 0.03). Differences between groups remained significant despite adjusting for LVEF. ConclusionsPlanning for ICD implantation should take into consideration a history of methamphetamine abuse, mandating DFT testing and empiric consideration of high output devices for such patients.

Multiscale properties of instantaneous parasympathetic activity in severe congestive heart failure: A survivor vs non-survivor study.

Multifractal analysis of cardiovascular variability series is an effective tool for the characterization of pathological states associated with congestive heart failure (CHF). Consequently, variations of heartbeat scaling properties have been associated with the dynamical balancing of nonlinear sympathetic/vagal activity. Nevertheless, whether vagal dynamics has multifractal properties yet alone is currently unknown. In this study, we answer this question by conducting multifractal analysis through wavelet leader-based multiscale representations of instantaneous series of vagal activity as estimated from inhomogeneous point process models. Experimental tests were performed on data gathered from 57 CHF patients, aiming to investigate the automatic recognition accuracy in predicting survivor and non-survivor patients after a 4 years follow up. Results clearly indicate that, on both CHF groups, the instantaneous vagal activity displays power-law scaling for a large range of scales, from ≃ 0.5s to ≃ 100s. Using standard SVM algorithms, this information also allows for a prediction of mortality at a single-subject level with an accuracy of 72.72%.

Management of cardiac hemochromatosis.

Iron-overload syndromes may be hereditary or acquired. Patients may be asymptomatic early in the disease. Once heart failure develops, there is rapid deterioration. Cardiac hemochromatosis is characterized by a dilated cardiomyopathy with dilated ventricles, reduced ejection fraction, and reduced fractional shortening. Deposition of iron may occur in the entire cardiac conduction system, especially the atrioventricular node. Cardiac hemochromatosis should be considered in any patient with unexplained heart failure. Screening for systemic iron overload with serum ferritin and transferin saturation should be performed. If these tests are consistent with iron overload, further noninvasive and histologic confirmation is indicated to confirm organ involvement with iron overload. Cardiac magnetic resonance imaging is superior to other diagnostic tests since it can quantitatively assess myocardial iron load. Therapeutic phlebotomy is the therapy of choice in nonanemic patients with cardiac hemochromatosis. Therapeutic phlebotomy should be started in men with serum ferritin levels of 300 μg/l or more and in women with serum ferritin levels of 200 μg/l or more. Therapeutic phlebotomy consists of removing 1 unit of blood (450 to 500 ml) weekly until the serum ferritin level is 10 to 20 μg/l and maintenance of the serum ferritin level at 50 μg/l or lower thereafter by periodic removal of blood. Phlebotomy is not a treatment option in patients with anemia (secondary iron-overload disorders) nor in patients with severe congestive heart failure. In these patients, the treatment of choice is iron chelation therapy.

Severe congestive heart failure in elderly patient with Paget’s disease

Paget’s disease of bone is characterized by focal areas of increased bone turnover, affecting one or several bones throughout the skeleton. Paget’s disease is often asymptomatic, but can be associated with bone pain and other skeletal and non-skeletal complications. We report a case of a 84-year old woman who presented a clinical condition suggesting Paget’s disease of bone complicated by congestive heart failure.

Clinical and Pathological Findings in 2 Rats (Rattus norvegicus) With Dilated Cardiomyopathy

Two 2-year-old intact female rats (Rattus norvegicus) were presented with severe dyspnea and tachypnea. In rat 1, radiographic evaluation of the thorax revealed severe pleural effusion, and cardiomegaly was suspected, suggesting a severe congestive heart failure. Echocardiography and computed tomography (CT) revealed bilateral pleural effusion, severe dilated cardiomyopathy (DCM), hepatomegaly, and mild abdominal effusion. Thoracocentesis and cytological examination revealed a chylous effusion. The patient was treated with a low-fat diet, octreotide, and medication to treat heart disease (furosemide, benazepril, pimobendan, and digoxin). However, because of worsening clinical signs, the animal was euthanized 5 days following the initiation of treatment. At necropsy, the heart was enlarged and rounded, with evident dilation of both ventricles, and the final diagnosis determined to be a DCM and myocardial fibrosis. The cardiac disease appeared to cause a chronic passive liver and lung congestion that, finally, resulted in both pleural and abdominal effusions. In rat 2, radiographic analysis of the thorax revealed pleural effusion and (conceivably) cardiomegaly, suggesting a severe congestive heart failure. Echocardiography and CT revealed pleural effusion and severe DCM of 4 chambers without effective contractility. Thoracocentesis was performed on the patient with the subsequent cytological examination of aspirated fluid being assessed as a transudate rich in macrophages and cells compatible with mastocytes. Cardiac medications were initiated, and the patient was monitored on a weekly basis. The rat died 27 days after the initial diagnosis due to respiratory failure. During the necropsy examination, it was determined that the rat’s heart was rounded, with enlargement of the left ventricle and thinning of the ventricular wall. The final disease diagnosis following the postmortem examination of rat 2 was a DCM and myocardial degeneration, which caused a chronic passive liver and lung congestion that resulted in a pleural effusion, hindering normal pulmonary activity. There is a paucity of published articles that describe DCM in rats. Recommended treatment of cardiovascular disease in this species is largely extrapolated from data obtained from cats, dogs, and ferrets. Further studies are warranted to detail the efficacy of therapeutic agents to treat cardiac disease in pet rats.