Early Cardiac










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SUMMARY: ROYAL CANIN Veterinary Diet^TM/MC canine EARLY CARDIAC EC 22^TM/MC is a highly palatable, highly digestible, complete, and balanced diet for adult dogs which has been formulated to aid in the dietary management of Class I-II cardiac disease.

INDICATIONS:

CONTRAINDICATIONS:

--	Asymptomatic dogs with heart murmurs or cardiomegaly (with or without concurrent cardiac medications)	--	Healthy growing puppies (i.e. no evidence of cardiac disease)
--	Dogs with mild signs of congestive heart failure (clinical signs of coughing or dyspnea)	--	Pregnant or lactating bitches
--	Puppies diagnosed with heart disease
--	Adult dog breeds at risk for cardiac disease

RATIONALE:
Canine heart disease is relatively common being present in approximately 11% of dogs in North America. Cardiac problems are more common in breeds with a genetic predisposition, overweight dogs, and older dogs. Heart disease is defined as any cardiac finding outside of normal limits. Heart failure is defined as an inability of the heart to deliver an adequate blood supply to the tissues. Most dogs with heart disease do not have heart failure at the time of diagnosis. The majority will eventually develop heart failure. The classification of canine heart disease is based on symptom severity. The various classes of heart disease are correlated with life expectancy. Dogs with class I heart disease generally have a life expectancy of 2 to 4 years. Dogs with class II to IV heart disease have an average life expectancy of only a few months.

CLASSIFICATION OF CANINE HEART DISEASE
Class I	No limitations of physical activity: activity does not cause symptoms
Class II	Slight limitation of physical activity: ordinary activity causes symptoms
Class III	Marked limitation of physical activity: symptoms occur with less than ordinary activity
Class IV	Extreme limitation of physical activity: symptoms present at rest.

Until recently, the only diets available for dogs with cardiac disease were designed for dogs with class III or IV heart disease. Diets designed for Class III-IV heart disease are inappropriate for Class I-II cardiac patients for the following reasons:

1.	Diets appropriate for end-stage heart disease are highly restricted in sodium and significantly restricted in protein. These restrictions are not appropriate for the management of Class I-II heart disease.
2.	Many diets designed for end-stage heart disease are not compatible with other aspects of medical therapy. For example, ACE inhibitors, which are frequently prescribed in heart disease, may cause hyperkalemia, yet many diets for dogs with end stage heart disease contain high potassium levels. High dietary potassium supplementation is not appropriate for the management of Class I-II heart disease.
3.	End-stage heart disease diets are designed primarily to provide symptomatic therapy. Dogs with Class I-II heart disease should benefit more from a diet specifically designed to slow disease progression, delay the occurrence of congestive heart failure, and postpone end-stage disease.

Nutritional Goals:
The goals of dietary management of dogs with Class I-II cardiac disease differ significantly from those of end-stage heart disease. These goals are to provide:

1.	Nutrients that may benefit dogs with Class I-II heart disease, including arginine, carnitine, and taurine.
2.	Appropriate sodium levels to avoid both excessive sodium intake but also to avoid too severe a restriction.
3.	Appropriate potassium levels to avoid adverse drug-nutrient interactions, such as that seen with ACE inhibitors.
4.	Appropriate protein and energy levels to maintain optimal body weight and preserve lean muscle mass.
5.	Supplementation with omega-3 fatty acids to help support healthy cardiac function.

ACT with SPEED:
Class I cardiac disease is difficult to diagnosis or the significance of subtle indications is often overlooked. Furthermore, the majority of dogs diagnosed in the initial stage of heart disease are not being treated for their disease. ACT with SPEED is an appropriate acronym for cardiac patients. It represents the nutrients important for the dietary management, and is a reminder of the importance of timely diagnosis, proactive intervention, active management, and the need to ACT with SPEED to provide appropriate support for dogs with Class I-II cardiac disease.

ACT with SPEED - a summary of cardiac supportive nutrients
A	arginine	Arginine is a pre-cursor for the smooth muscle relaxant nitric oxide. Arginine may help improve blood flow and exercise tolerance in dogs with heart disease.
C	carnitine	Carnitine is found in high concentrations in heart muscle tissue. Carnitine deficiency has been linked to heart disease in dogs (Boxers and possibly Cocker Spaniels). Carnitine supplementation may improve heart muscle function in dogs with heart disease.
T	taurine	Taurine has been linked to cardiomyopathy in cats. A percentage of dogs with cardiomyopathy have low blood levels of taurine. Taurine has been shown to benefit some dogs with heart disease.
W I T H
S	sodium and essential minerals	Sodium and essential minerals. Sodium should be mildly restricted in Class I-II heart disease. Cardiac diets can be severely restricted in sodium and this is not appropriate for dogs in the initial stages of the disease. Two other important minerals are potassium and magnesium. Potassium deficiency is associated with irregular heart beat and muscle weakness. Magnesium is involved in energy production in heart muscle. It is important to supply the appropriate levels of these essential nutrients.
P	protein	Protein should not be severely restricted in dogs with cardiac disease. Protein restriction may contribute to cachexia (lean muscle wasting) and exercise intolerance.
E	energy	Energy levels need to be appropriate to maintain ideal body weight. Excess energy may lead to weight gain and increased cardiac workload. Low energy diets increase the risk of cardiac cachexia.
E	eicosapentaenoic acid (EPA)	Eicosapentaenoic acid (EPA) and Docasohexaenoic (DHA) are long chain omega-3 fatty acids. Dogs with cardiac disease can have low circulating levels of these fatty acids. Supplementation with EPA and DHA may help reduce inflammation. This has been associated with a reduced risk of cachexia and arrhythmias.
D	docosahexaenoic acid (DHA)

EARLY CARDIAC EC 22^TM/MC is the first and only diet specifically designed to support cardiac health in dogs with Class I-II heart disease. It is supplemented with a unique blend of cardio-protective nutrients, including taurine, arginine, and L-carnitine. The minerals are balanced for Class I-II heart disease, with particular emphasis on sodium, potassium, and magnesium levels.

It is enriched with long chain omega 3 fatty acids (eicosapentaenoic acid, docosahexaenoic acid), B-complex vitamins, and antioxidants. The protein content is appropriate to reduce the risk of cardiac cachexia, to promote healthy heart muscle, and exercise tolerance. Finally, it contains appropriate energy to maintain optimal body weight.

REFERENCES:
Freeman LM, Rush JE, Cahalane AK, et al. Dietary patterns of dogs with cardiac disease. J Am Vet Med Assoc 2003;223(9):1301-5.

Willis R, Dukes-McEwan J, Biourge V, et al. The Role of Taurine in Dilated Cardiomyopathy in Newfoundland Dogs J Vet Intern Med 2003;17(3):438.

Freeman LM, Rush JE, Cahalane AK. Dietary patterns of dogs with cardiac disease. J Nutr 2002;132: 1632S-1633S.

Van Pottelberge D. Importance des facteurs nutritionnels dans la cardiomyopathie dilatée (CMD) chez les chiens de races géantes. Compte Rendu Congrès AFVAC-CNVSPA, 8-9 Nov 2002, Paris. (pas de résumé).

Tôrres CL, Fascetti AJ, Rogers QR. A model for the development of taurine deficiency in dogs by the use of cholestyramine. Proc. Joint Nutrition Symposium, Antwerpen Belgium August 21-25, 2002, p71.

Willis R, Desprez G, Dukes-McEwan J, et al. Six months taurine or methionine supplementation in Newfoundland dogs suffering from low whole taurine. Proc. Joint Nutrition Symposium, Antwerpen Belgium August 21-25, 2002, p70.

Biourge V, Dukes-McEwan J, Desprez G, et al. Association between low whole blood taurine and dilated cardiomyopathy (DCM) in Newfoundland dogs. Proc of 5th ESCVN Conference. Sursee, Switzerland. 2001, p60.

Dukes-McEwan J, Biourge V, Ridyard A, et al. Dilated cardiomyopathy (DCM) in Newfoundland dogs: Association with low whole blood taurine level. BSAVA Congress Scientific Proceedings, 2001, p500.

Freeman LM, Rush JE, Markwell PJ. Dietary patterns of dogs with cardiac disease. Proceedings of the WALTHAM International Symposium: 2001, p 21.

Rush JE, Freeman LM, Brown DJ, et al. Clinical, echocardiographic, and neurohormonal effects of a sodium-restricted diet in dogs with heart failure. J Vet Intern Med 2000;14:513-520.