For congestive heart failure due to mitral valve disease, outline a common medication regimen.

• A. Diuretic (furosemide) to reduce preload, ACE inhibitor (enalapril) to reduce afterload, and pimobendan as a positive inotrope in appropriate cases.
• B. Vasopressor therapy with dopamine, ACE inhibitor, and digoxin.
• C. Calcium channel blocker, diuretic, and aspirin.
• D. Beta-blocker alone.

Answer: (A)

Managing congestive heart failure from mitral valve disease in dogs focuses on three goals: reduce fluid buildup (preload), ease the heart’s workload (afterload), and support the heart’s pumping ability when appropriate. A common regimen includes a diuretic such as furosemide to lessen preload and pulmonary edema, an ACE inhibitor like enalapril to dilate blood vessels, lower afterload, and help prevent adverse remodeling, and pimobendan in suitable cases to improve contractility while also providing some vasodilation to further reduce afterload. Pimobendan is added in symptomatic DMVD with CHF when the dog can tolerate it and there are no contraindications, with careful monitoring of kidney function, blood pressure, and hydration. This approach targets the main problems in this disease—fluid overload, increased pressure the heart must work against, and decreased heart output—whereas other options like vasopressors, certain calcium-channel blockers, or aspirin do not address these issues and can worsen the condition or offer little benefit.