Recognizing the signs of a dog dying of heart failure and knowing how to comfort a dog with congestive heart failure are important, especially if your dog has been diagnosed with heart disease. To help guide you on this journey, integrative veterinarian Dr. Julie Buzby invites her friend, end-of-life care veterinarian Dr. Dawnetta Woodruff to share some words of wisdom. Dr. Woodruff explains what to expect if your dog has congestive heart failure, how to care for your dog, and when it may be time to say goodbye.
When your beloved canine companion has been diagnosed with heart problems, the possibilities and uncertainties are often overwhelming. Your veterinarian may have given you a brief overview of heart failure. Or he or she may have gone over things in great detail. Either way, a new diagnosis of canine heart disease means that you have a lot of information to consider. And you likely have many questions.
Two of the biggest concerns are often, “How can I keep my dog comfortable through the final stages of congestive heart failure?” and “Will I be able to recognize the signs my dog is dying of heart failure and know when it is time to say goodbye?”
Understandably, you want your dog to be with you for as long as possible. But you also want to prioritize his or her comfort and quality of life. So what does this look like when your dog has congestive heart failure (CHF)?
Heart failure basics
To really grasp the complexities of these questions, we need to start with a basic understanding of heart failure. The canine heart is like the human heart—it has four chambers, a smaller right and left atrium and a larger right and left ventricle.
These chambers are made up of strong muscle that contracts in a specific rhythm to move blood throughout the body. As blood moves through the heart and into its associated blood vessels, there are heart valves in place to prevent blood “backflow” and to ensure blood is pushed forward to its next destination.
If the ability of the heart to pump blood to the lungs and body changes, the heart’s function decreases. And eventually the end result may be congestive heart failure (CHF). In other words, fluid accumulates in the body or lungs due to the heart’s inability to adequately do its job.
Sometimes heart failure is due to leaking of the valves, such as occurs in mitral valve disease in dogs. Other times, a condition such as dilated cardiomyopathy (DCM) in dogs weakens the heart muscle itself, leading to heart failure. Or potentially the dog could have heartworm disease in dogs, a congenital heart defect, or other heart problems.
Regardless of the cause, when the heart muscle can’t pump effectively, or when the valves do not prevent backflow, this disrupts proper blood flow through the heart and vessels. As a result, blood backs up in the vessels, pushing fluid out into the lungs or abdomen. At that point, the dog is in congestive heart failure in dogs. Depending on which side of the heart fails, heart failure can be left-sided, right-sided, or both.
Diagnosis of heart failure in dogs
If the vet catches heart disease in dogs early, there may be no outward signs of heart failure. The only clue may be that your vet hears a heart murmur in dogs during a physical exam. But in other situations, you may see more obvious symptoms such as coughing, trouble breathing, or being a lethargic dog.
In either case, your vet may recommend chest X-rays as a diagnostic starting point. X-rays are a good way to evaluate the size and shape of the heart and to look for fluid accumulation in the lungs (i.e. pulmonary edema).
Additionally, your vet may refer you to a veterinary specialist near you, such as a veterinary cardiologist for further diagnostics. This may include an echocardiogram (i.e. heart ultrasound). The echo lets the vet see inside the heart while it is beating to give a full picture of what is causing your dog’s heart disease. And it helps your dog’s medical team know what medications will be most beneficial.
Treatment and monitoring of heart failure
Once your vet has diagnosed your dog with one of the types of heart disease, it is important to give your dog his or her medications on time and not miss doses. The various heart medications help your dog’s heart beat stronger, decrease abnormal heart rhythms, or help keep fluid from accumulating in the lungs or body. Thus, it is critical to carefully follow your vet’s instructions regarding these medications.
Additionally, you should bring your dog back to the vet for regular checkups. That way he or she can track the progression of your dog’s heart disease and modify the treatment plan as needed.
How do you recognize worsening heart failure?
It is also important for you to be on the lookout for signs the heart failure is progressing, including:
- Exercise intolerance—Your dog may tire quickly on walks or have no interest in play. Or your dog may only be able to catch the ball a few times or often need to “catch his or her breath” during play sessions.
- Increased fatigue—Dogs with heart failure may sleep many more hours a day than they used to.
- Muscle wasting—You might notice your dog looking thin and losing lean muscle mass.
- Coughing—Initially, you might hear your dog coughing and gagging in times of activity or excitement. But he or she may progress to coughing even at rest.
- Elevated heart rate—Your dog may have a “pounding” heart that can be felt or even seen.
- Restlessness—Dogs with congestive heart failure can’t get comfortable in any one position. Or they may only sleep for a few minutes before moving.
- Panting—Even when at rest or when the ambient temperature isn’t overly warm, your dog may still be panting.
- Decreased appetite—Dogs with heart failure may not eat well or may need to pause while eating to catch their breath.
If your dog is is experiencing any of these signs of worsening heart failure, it is important to see your veterinarian or schedule a recheck with your cardiologist right away. He or she may add additional medications or adjust the medication dosages to try to get the heart failure under control again.
Consequences of fluid accumulation
As part of advanced heart failure, your sweet pup will have fluid that accumulates within their abdomen (in right-sided congestive heart failure), or within their lungs (in left-sided congestive heart failure). And you might notice your dog’s paws or legs look swollen from fluid building up there as well.
Regardless of where the fluid builds up, it is evidence that your dog’s heart failure is progressing from stable or “compensated” heart failure to unstable or “decompensated” heart failure. And it means your dog is becoming at risk for a respiratory crisis.
As a dog’s heart failure progresses to its end stages, he or she will have more and more difficulty breathing. Your dog’s gums might look either muddy brown or bluish-grey due to lack of oxygen. And you might notice your dog breathing fast, extending the neck and holding the head at an odd angle, using the belly muscles to breathe, or moving the whole body with each breath. These are signs of respiratory distress.
Air hunger
A dog who is in respiratory distress experiences “air hunger.” This is similar to the way a person feels when they have a severe asthma attack. The body can’t get enough oxygen, and trying to get enough oxygen causes a lot of physical and mental stress. Air hunger has been compared to “drowning from the inside.” As you can imagine, it is a very difficult thing to experience. And it can be very stressful to watch your cherished friend going through such a traumatic time.
Seek help ASAP if you suspect your dog is in advanced heart failure
Should your dog be showing these symptoms of respiratory distress, look “bug-eyed” or stressed while sitting still, or you are otherwise worried about your dog, you need to make an emergency vet visit right away. Additionally, if you notice your pup has a “pot-belled dog” appearance from fluid in the abdomen, it is important to seek care quickly.
How can you help comfort your dog with congestive heart failure?
A respiratory crisis can strike at any time. So it is important to understand how best to help your dog before and during a crisis.
Have an emergency plan
If your dog has CHF, it is important to have an emergency plan before a crisis hits. Know if your vet provides after-hours emergency services and where the nearest emergency room or urgent care is located. And review the signs of advanced congestive heart failure so you can recognize them.
If your vet gives you certain medications (such as furosemide) to administer during a crisis, know where they are so you can find them in an emergency situation. But also be prepared to get to the vet as fast as possible.
Know how to keep your dog comfortable on the way to the vet
When dogs are experiencing respiratory difficulty, you can do a few things in the car on the way to the vet or at home to help them be more comfortable.
- Prop their chin up on a pillow to help extend their neck. This may make it easier for them to get enough air
- Have a fan nearby to move air past their nose to increase comfort.
- Consider purchasing an emergency supply of pet oxygen that you can administer during a crisis (e.g. Pawprint Oxygen). This supply will not last long (typically 15-30min). But it may help you and your dog feel better on the way to the veterinary ER.
Understand what an emergency visit for CHF may entail
Once you arrive at the ER or veterinary clinic, the veterinary team will jump into action to stabilize your dog. When your dog is in an advanced heart failure crisis, he or she may need oxygen, IV medications, or even a chest tap (i.e. thoracocentesis) or an abdominal tap (i.e. abdominocentesis). And the vet may recommend hospitalizing your dog to further stabilize the heart failure before sending him or her home.
Promptly making an urgent care or an ER visit can potentially save your dog’s life when he or she is experiencing a respiratory emergency secondary to heart failure. Best case scenario, your dog responds well to the medications, and their heart can once again compensate. This gives him or her some “bonus time” to spend with you.
However, a stable patient who has recently been through an emergency situation may not stay stable for long. At some point, your dog’s disease will become so advanced that even the best medicine and the best medical team won’t be able to stop the respiratory crisis. The most challenging thing with heart failure is that we never know if the next crisis may be the one that doesn’t respond to therapy.
Take steps to reduce the chances of a respiratory crisis
Since a respiratory crisis is traumatic for all involved, dog parents may understandably also want to avoid it if possible. Sometimes, the signs of worsening heart disease are very subtle. And we may not notice them until the crisis is about to happen.
However, keeping a journal of your dog’s activity levels can help you to notice trends that could point to worsening heart failure. And monitoring your dogs resting respiratory rate (RRR) can also help you detect problems quickly. Typically, RRR for a normal dog should be 15-30 breaths per minute. For dogs with heart disease, an elevation in this number can be one of the first signs of respiratory compromise.
To monitor your dog’s RRR:
- Choose a time of day that you will consistently take the reading.
- Make sure your pup is truly resting, and hasn’t just had a lot of activity.
- Use a clock or a stopwatch to count how many times your dog breathes in 15 seconds (one rise and fall of the chest equals 1 breath).
- Multiply this number by four to get the RRR in breaths per minute (bpm).
You may want to use a blank calendar sheet, an excel spreadsheet, or even a shared Google Doc to track the RRR. That way everyone in the family can watch for trends and your vet can look at the data too.
If your dog’s RRR is gradually climbing, if it rises above 35-40 bpm, or if it makes a big jump (more than a 25% increase from the typical baseline value), report this to your veterinary care team. They may want to make medication adjustments or schedule a recheck based on your observations.
How long can a dog live with congestive heart failure?
Sometimes, with medical therapy and careful monitoring, a dog may live for several years with controlled (or compensated) heart disease. It may take a long time for the disease to progress. And the dog can have a good quality of life for much of that time.
However, in other situations, the heart disease changes rapidly within just a few days or months. The dog may go downhill quickly and have a much shorter window of time with a good quality of life.
For example, in a study of 54 dogs with advanced CHF due to mitral valve disease, the average time between onset of congestive heart failure symptoms and onset of advanced heart failure was 163 days. But it ranged from 10 to 743 days. And the average survival time was 281 days after the diagnosis of advanced heart failure. However, some dogs in the study were euthanized within a few days of being diagnosed with advanced heart failure. And others lived for about two more years.
Thinking through when to put down your dog with heart failure
This whole discussion about heart failure and the potential for a respiratory crisis may sound a bit daunting. And it is. After all, taking care of dogs with CHF is not an easy task. You must give them their medications on time and they may require a special diet. Plus, making sure they are stable requires a lot of diligence and a bit of luck. It can be exhausting for the patient, and sometimes caring for a sick pet becomes too much for you too.
You may be wondering how to know when it is time to put down a dog with congestive heart failure. Should you make that decision before they ever have a crisis? After the first crisis? Or should you allow them to pass with a medically unassisted death? There is no one right answer for every dog. In fact, if you have two dogs with heart failure, you may make a different decision for each of them.
Questions to help make the decision clearer
Asking yourself these questions can be helpful:
- Does your dog take medications well? Or does every medication dose cause stress for you and your pup?
- How severe was your dog’s heart failure when it was first diagnosed? How quickly has it progressed?
- Is your dog healthy other than his or her heart disease? Or does he or she have several other chronic health concerns?
- Does your schedule allow you to keep the medications on a good schedule? How long must your dog stay home alone with no human around?
The answer to all of these questions can help you to see the bigger picture. If your dog takes pills well, heart disease is their only ailment, and you work from home, you will likely be able to help your dog stay stable longer. But if pill time every day is stressful and causes breathing issues, your dog also has osteoarthritis in dogs and kidney failure in dogs, and you spend nine hours a day away from home, it may be kinder to make an earlier decision for euthanasia.
There is no “one right day” to make the decision. Rather there is a window of time where euthanasia is a very appropriate decision to make. In some cases, we need to make the decision earlier in the window, and in other cases, we can wait longer while still being kind to your dog.
Take air hunger into account
One thing to consider specifically with CHF in dogs is the topic of air hunger that was mentioned earlier. Some families prefer for their dog to pass naturally, if possible. When that is the family’s wishes, they are often hoping for their dog to peacefully pass away in his or her sleep.
This can sometimes happen. However, with congestive heart failure, an unmedicated passing is more likely to be painful and difficult for your dog. Air hunger is a very traumatic thing to experience. And at the natural end of CHF, a dog has air hunger to the point of dying while drowning in their own fluids. Dying in this way is distressing for your dog. And is also a difficult final memory for all who love him or her.
For this reason, many veterinarians will encourage families to make a decision sooner with CHF than with other diseases such as mobility problems or kidney failure. If your dog’s congestive heart failure is worsening, his or her breathing is becoming more labored, your dog is in a respiratory crisis that can’t be resolved with therapy, or you are seeing other signs of a dog dying from heart failure, the kindest thing may be to help him or her skip over the hardest parts that are still to come.
Words of comfort for saying goodbye
The decision to euthanize a dog with congestive heart failure never feels like something we are ready for. Our mind can logically come to terms with the decision as a kind and merciful option. However our hearts are not logical, and they will never feel ready.
Even still, when we watch our precious canine friend struggling, and we know that we cannot fix the disease, we come to a point where watching them continue on is harder than allowing them to be at peace. This is when we know we are as ready as we can ever be.
Dogs are very good at sensing a person’s intentions, and they are very intuitive. I believe if they could talk to us, that they would tell us they understand that we are making the decision to say goodbye on a good day, before every moment of joy is gone.
Have you lost a dog to congestive heart failure?
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