Treatment of high-output cardiac failure secondary to anemia in three cats

Case series summary Three cats presented for clinical signs of respiratory distress and varying etiologies of anemia. Echocardiograms revealed evidence of cardiac dilation without other significant structural or functional heart disease. Thoracic imaging via point-of-care ultrasound and/or radiographs confirmed evidence of volume overload by pleural effusion. Each cat was diagnosed with presumed high-output cardiac failure secondary to anemia. Mainstays of treatment included controlling congestion and correcting the anemia with transfusions in the short-term while addressing the underlying etiology of the anemia in the long-term. Relevance and novel information Reports, treatment and management of high-output failure in the veterinary literature are limited. Extrapolating from human medicine, cats presenting with anemia and findings consistent with volume overload will benefit from treatment of their anemia to reduce neuroendocrine activation and the associated sodium and water retention. Therefore, blood transfusion should neither be avoided nor delayed in anemic cats with changes consistent with volume overload and congestive heart failure.