Congestive heart failure

Blenheim Cavalier King Charles SpanielCongestive heart failure is the end stage of many different heart diseases.  It occurs when the heart can no longer beat effectively.  This leads to a back-log of blood in the organs and tissues before the heart, leading to an increase in pressure within the veins and fluid leaking out of the vessels into the surrounding tissues.

This fluid leaking causes the main signs of congestive heart failure.  The most common effect of this is pulmonary oedema, where the fluid leaks into the lung tissue, causing difficulty breathing.  If the right side of the heart is failing as well as the left, fluid can build up in other areas, such as the abdomen, causing distension known as ascites which causes a pot-bellied appearance.

Heart failure is unfortunately not curable but can be managed for a period of time.  The length of survival will be variable depending on the underlying cause of the heart failure, and the response to medication.  Treatment will involve many different aspects and can be quite expensive as many of the important medications do not come cheap and they will need to be given for life.

Signs of a dog developing congestive heart failure include:

  • tiring more when walking
  • coughing
  • laboured and faster breathing than normal
  • difficulty settling down in the evening
  • swollen belly
  • weight loss
  • bluish tinge to the tongue and gums (in very severe cases)
  • collapse

Regular check ups are important for any dog with heart disease but if your dog develops any of the above signs, whether or not you know that they have an existing heart problem, an appointment should be sought urgently.  If your dog is having difficulty breathing or has collapsed, call your vet and explain that you have an emergency.

Close up of doctor with stethoscopeTreatment of congestive heart failure will include:

  • oxygen therapy in the severe, acute stage
  • medication to improve the heart function (e.g. pimobendan).  This may be given intravenously initially if the heart failure is severe and then will be given as tablets thereafter.  Pimobendan should be given on an empty stomach, 1 hour before food.
  • medication to reduce fluid build-up (e.g. furosemide, spironolactone, torasemide).  This may be given intravenously initially and quite frequently until the dog is stable, and then will be given orally afterwards.  The dose may need to be adjusted frequently.
  • medication to reduce blood pressure (e.g. benezepril, enalapril)
  • direct treatment of the underlying condition.  Some conditions can be treated more directly, for example some congenital heart defects (defects at birth) or conditions requiring a pacemaker.

Other things you can do to help your dog are:

  • regular gentle exercise – keeping active is important but it is also important not to over-stress the heart so not walking in the heat of the day and not doing any intense exercise (e.g. avoiding ball throwing etc.)
  • diet change – diets for heart disease are low in salt and phosphorus, have low levels but high quality protein to support kidney function, which can be affected by the heart disease and also the diuretics used to treat it, and have ingredients such as taurine and L-carnitine to support the heart muscle.
  • regular monitoring of heart rate and breathing rate – this is very important to help keep your dog healthy for as long as possible.  It is best to do this when your dog is resting.  Count the number of chest movements in 15 seconds and then multiply by 4 for the breathing rate or use a designated phone app (e.g. Resting Respiratory Rate (RRR) app available on Android and iOS or Cardalis available on Android and iOS).  To measure heart rate place your hand on the left side of your dog’s chest, just behind the elbow and you should be able to feel the heart beat.  Again, count the number of beats in 10 seconds and then multiply for 4.  By doing this and recording the result once a week you can pick up early signs of deterioration and can discuss with your vet the best treatment.

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