The end stages of heart failure in dogs are the hardest for dog owners to endure. When the heart fails to pump as effectively as it should, a cascading chain of events takes place. While the body can try to compensate, and medications can help reduce strain on the heart, this will be effective only up to a certain extent. As the heart is forced to work more, a point will inevitably come where the heart is no longer able to pump correctly. Veterinary care at this point is still important. Your vet can suggest you a therapeutic plan and you should follow up to report the level of success of such intervention.
When the Heart Fails
In dogs, congestive heart failure is mostly caused by two heart conditions, namely valve degeneration (more common in small dog breeds) and dilated cardiomyopathy (more common in large dog breeds).
Congestive heart failure in dogs is a chronic condition that worsens over time. Although symptoms can be managed, there is no cure, and in time, affected dogs will unfortunately reach the final stages.
When dealing with heart failure, therefore vets aren't really fixing anything, but just trying to relieve symptoms and delay the inevitable for as long as possible. Dogs with end stage heart failure are unfortunately on "borrowed time."
Owners may want to know what to expect during the end stages of heart failure in dogs as the disease progresses into its final stages. Following are some symptoms that are common during the end stages of heart failure in dogs and information on how they can be managed with the help of a trusted veterinarian or veterinary cardiologist.
End Stages of Heart Failure in Dogs
As heart failure progresses, during the end stages of heart failure in dogs, affected dogs will start worsening and may start exhibiting new symptoms that weren't present before.
Medically known as dyspnea, labored breathing in dogs can occur both when the dog is active or when the dog is at rest. In dogs with severe ascites, the accumulation of fluid in the belly, can cause trouble breathing. This shortness of breath is often a symptom that concerns dog owners and may result in a trip to the emergency vet. On top of shortness of breath, many cardiac patients develop an increased heart rate.
Since the heart no longer pumps effectively, fluid starts building up in the body. Affected dogs may have swollen legs and fluid in the dog's abdomen may accumulate, a condition medically referred to as ascites. When fluid accumulates in the lungs, the condition is known as pulmonary edema.
Coughing may have been seen in earlier stages, but in the late stages it will worsen considerably. Keeping this cough under control is important as the cough can signal accumulation of fluids in the lungs that needs addressed.
Lack of appetite in dogs with end stage heart failure is common, but not always is related to problems with the heart. With the help of the vet, underlying causes can be investigated and properly addressed.
As dogs with this condition progress, they may start becoming weaker and lethargic. Dogs may become exercise intolerant and may wish to not move around much. Some dogs may start coughing and then collapsing. Such episodes of fainting are triggered by not enough oxygen reaching the brain. Because oxygen-rich blood is no longer circulating as it should, the dog may also develop bluish gums during these episodes.
Helping Your Dog EatManaging the Shortness of Breath
Changes in Medications
In the end stages of heart failure in dogs, medications, which, before were well tolerated, may no longer work well. Managing congestive heart failure symptoms therefore takes a balancing act. For example, a dog in the earlier stages of heart failure may have tolerated well a combination of drugs such as furosemide, ACE inhibitors (enalapril, benazepril) and pimobendan, but at some point these drugs may no longer help.
Some dogs may benefit from increasing doses of certain drugs or the addition of other drugs. For instance, another diuretic drug called spironolactone may be added to help get rid of fluid out of the lungs in end stage congestive heart failure in dogs, explains veterinarian Dr. Andy.
This drug operates in a different location in the kidney compared to furosemide. Sometimes, this helps remove excess fluid when furosemide has lost some of its effectiveness, explains veterinarian Dr. Bob.
It therefore becomes necessary in the late stages of heart failure to re-evaluate existing therapies and introduce new therapies, in an effort to make symptoms less severe, explains Johnny D. Hoskins, a board-certified veterinarian specializing in internal medicine.
Report to your vet if your dog is in the end stages of heart failure and you are having trouble managing his symptoms with the medications that were previously prescribed.
“It is important to remember that heart failure is progressive, and medications that were historically well-tolerated may lead to, or potentiate, clinical signs at a later stage.”~Johnny D. Hoskins, DVM, PhD, DACVIM
As mentioned, many dogs in the late stages of heart failure may be unwilling to eat. This can be due to several reasons that may be worth investigation with the help of your vet. Some causes may be directly related to the heart failing, some may be concomitant or even totally unrelated.
During the end stages of heart failure in dogs, because the dog's digestive system receives less blood, affected dogs may feel nauseous or they may feel full due to the presence of ascites in dogs.
The loss of appetite at the very end may be a natural sign of the body starting to shut down and many dog owners are distressed by this because feeding is associated with care and love. Dogs with advanced heart disease may start losing weight and develop cardiac cachezia.
If your dog has loss of appetite consult with your vet, loss of appetite may also occur as a side effect of some medications (like digoxin) or your dog may have stomach ulcers.
Loss of appetite can also result from dietary indiscretion (owners feeding different foods to tempt their dogs to eat or take their medications but such foods may not agree with their stomachs). In some cases, dogs may be unwilling to eat due to teeth problems which are common in elderly dogs.
Depending on the underlying cause, your vet may suggest a few therapies. Appetite stimulants along with supportive digestive care may be suggested. A home-made salt restricted diet or a commercial diet for congestive heart disease in dogs may be helpful to increase palatability.
Managing the Cough
Coughing in dogs with end stage heart failure may be directly linked to the heart, but in some cases there may be other dynamics at play. For instance, small older dogs may be affected by concomitant collapsing trachea, a condition where their trachea weakens and causes coughing.
An enlarged heart may secondarily cause coughing by putting pressure on the dog's bronchi. Cough may also be directly related to the failing heart. The coughing in this case occurs because the heart is unable to cope with the demand of supplying oxygen to the body. Fluid at some point will start building up in the lungs (pulmonary edema).
The vet can implement a management plan using several strategies such as increasing dosage or frequency of diuretics (water pills, such as Lasix, generic name furosemide). Furosemide helps because it helps pulls any accumulating fluid out of the lungs.
Dogs already receiving maximum doses of this drug, may benefit from injections of diuretics under the skin. Ask your vet for guidance.
"Your dog may need injections of a diuretic (such as Lasix/furosemide) to quickly move the fluid out of her lungs so she can breathe more easily. Once she is stablilized, she would likely go home with Lasix in pill form so that the fluid doesn't build up again, as well as the Enalapril (which is something called an "ace inhibitor" to help the heart function more effectively). "~Dr. Fiona, veterinarian
The fastest way to help with any breathing issues is to have the vet deliver an injection of lasix so to remove excess fluid from the chest. Affected dogs may need some oxygen therapy too while waiting to see if the injection helps.
Drug dosage adjustments once the dog is stable may help. Never increase dosages on your own, always consult with your vet.
If excess fluids in the abdomen are causing trouble breathing excess fluids can be removed through a procedure known as abdominocentesis. Afterward, diuretics should be administered.
As breathing becomes difficult, dogs may engage in open-mouth breathing and may be reluctant to lie down. These dogs may be wanting to keep their head high so to keep their air passages open. These dogs can be helped by propping a pillow or two so that they can sleep with the head raised up enough to be comfortable.
Dogs in the end stages of heart failure are very fragile and stress and exercise should be kept to a minimum. As breathing becomes more and more labored, it's a sensible choice to elect for euthanasia to prevent unnecessary suffering associated with the inevitable.
- DVM360: Keys to managing end-stage heart failure
- Textbook of Veterinary Internal Medicine Expert Consult: Expert Consult, 7e(2 Volume Set) 7th Edition. by Stephen J. Ettinger DVM DACVIM (Author), Edward C. Feldman DVM DACVIM (Author).