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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

Heart Disease in Pets: It's Not Always Heart Breaking

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July 18, 2012 / (7) comments


Researchers at Tufts University’s school of veterinary medicine have developed two quality of life surveys for dogs and cats suffering from heart disease. Known as "FETCH" (Functional Evaluation of Cardiac Health) and "CATCH" (Cats’ Assessment Tool for Cardiac Health), the surveys ask owners to rank aspects of their dog’s or cat’s health on a scale of 0 to 5. Veterinarians are then able to assess the animal’s quality of life, which may inform decisions about treatment, nutrition, or even euthanasia.

 

If you have a dog or cat that has been diagnosed with heart disease, your veterinarian can contact the veterinarians at Tufts for a copy of the survey and information about how to interpret the results. In the meantime, here is some basic information about heart disease in pets.

 

What is heart disease?

 

Heart disease in animals is either congenital (they are born with it) or acquired (not present at birth but developing at a later date). Congenital disease is usually seen in younger animals, whereas acquired heart disease is generally diagnosed in older dogs and cats. Small breed dogs often develop leaky heart valves due to degenerative changes. Cats and large breed dogs are more likely to develop heart muscle dysfunction. Heart disease is often diagnosed with X-rays, an electrocardiogram (ECG), and an echocardiogram (ultrasound of the heart).

Congestive heart failure, a consequence of many types of heart disease, is usually a result of the heart’s inability to pump blood forward in a normal manner. Stress is placed on the heart muscle and valves and a back-up of blood may occur in the lungs and/or liver resulting in abnormal fluid accumulations in the chest or abdomen.

 

How is heart disease treated?

 

There are many treatments available for heart disease, each one focusing on the underlying cause of the disease. Medications, surgery, and other therapies (e.g., pacemakers) may be directed at correcting an irregular heartbeat, increasing the amount of blood pumped by the heart with each beat, or decreasing the amount of fluid retained in the lungs and abdomen. A diet low in salt can also be an important component of therapy for congestive heart failure, as it helps minimize fluid retention in the body.

 

What symptoms can present as heart disease progresses?

 

Early Stages

 

  • reduced activity/lethargy
  • increased sleeping
  • exercise intolerance
  • coughing — especially at night or early morning
  • weight loss
  • diarrhea
  • possible fainting spells

 

Late Stages

 

  • persistent early stages
  • severe weight loss
  • distended abdomen
  • vomiting/diarrhea
  • blue-gray colored gums
  • leg swelling
  • difficulty swallowing
  • difficulty breathing
  • fluid lung sounds
  • unable to rest
  • unable to rise

 

Crisis — Immediate veterinary assistance needed regardless of the disease

 

  • Difficulty breathing
  • Prolonged seizures
  • Uncontrollable vomiting/diarrhea
  • Sudden collapse
  • Profuse bleeding — internal or external
  • Crying/whining from pain*

 

*It should be noted that most animals will instinctually hide their pain. Vocalization of any sort that is out of the ordinary for your pet may indicate that his pain and anxiety has become too much for him to bear. If your pet vocalizes due to pain or anxiety, please consult with your tending veterinarian immediately.

 

What is the prognosis for heart disease?

 

If caught early enough, pets with heart disease can be treated and often will live for many years after their diagnosis. There are times, however, that the disease is so severe and function is so compromised that a pet’s quality of life is no longer satisfactory. A personalized treatment plan is important to slow the progression of heart disease. Talk to your veterinarian regarding the best treatment protocol for your pet.

© 2011 Home to Heaven, P.C. Content may not be reproduced without written consent from Home to Heaven, P.C.

 

 

Dr. Jennifer Coates

 



Image: Tired Dog by Alex94tay / via Flickr

 

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COMMENTS (7)
1
Heart Problems
by TheOldBroad on 07/18/2012 07:11am

Darlene was being treated for several problems, including sub-q fluids for CRF (Chronic Renal Failure). She went into congestive heart failure and was treated with diuretics to get her past the initial problem. The veterinary cardiologist didn't find any heart problems, so the thought was that she was retaining too much fluid.

Balancing fluids and diuretics was a real challenge!

She eventually succumbed to her many problems.

Owen's HOCM (hypertrophic obstructive cardiomyopathy) was found very early by our very astute vet when his blood pressure went from very high to very low in a matter of moments. Coupled with a heart murmur, a trip to the cardiologist was suggested. The cardiologist diagnosed HOCM and prescribed daily Atenolol and Enalapril.

Owen is still doing great. He gets a full checkup at the regular vet once every 5 months and a cardiology checkup every 9 to 12 months.

2
My experience
by Grevillia on 07/18/2012 12:14pm

I had an 11 1/2yo golden retriever diagnosed with pericarditis last year. For a while before Ghillie's diagnosis he'd seemed not quite himself; we noticed that he wasn't playing with our younger dog so much, he didn't cope with his walks quite so well & getting up was a bit more of a struggle. At his senior wellness check his bloods all came back within normal levels & everything else checked out well. However, he also had arthritis & poor hips so as he otherwise seemed well, we were looking at pain management options for him.

Then in mid-October he didn't eat all of his dinner one night & the next morning wouldn't eat his breakfast. For a boy who'd never refused a meal in the 8 1/2 years he'd lived with us this was worrying behaviour so I took him straight down to see my vet. He took bloods & noted that his breathing was laboured (he looked as if he'd swallowed a set of bellows) so took more blood & arranged for him to have x-rays the following Monday (of course all this happened on a weekend - doesn't it always?)

I really thought we would lose him over the weekend - he wouldn't eat, had very laboured breathing the whole time & was thoroughly miserable. The night before his x-rays I sat up all night with him as I didn't think he'd make it through the night. I sat with him & told him that I'd do whatever I could for him but if he'd had enough it was OK for him to let go. I hated seeing my boy so obviously unwell.

He got through the night & his x-rays the next day showed that his chest cavity was full of fluid - over 1 1/2 litres was drained. My vet suggested he go for an ultrasound the next day so we could get a better idea of what was happening. This was done & they drained more fluid from his chest. They also diagnosed the pericarditis & said that the drainage should make a big difference but that if necessary there was the option of him having a pericardectomy - removal of a portion of the lining around the heart. It was thought unlikely that he'd need it though, at least for quite a while. It was suggested that the likely cause was mesothelioma.

When Ghillie was no better the next day my vet was concerned & said he'd like the ultrasound to be repeated as in his words Ghillie should have been "jumping around like a 3yo" afterthe fluid drainage. Instead I had a very subdued boy who still wouldn't eat & didn't want to move around or do anything very much.

After a 2nd ultrasound we were given the grim news that Ghillie needed surgery the very next day - a Thursday before we had a public holiday on the Friday. It was felt he wouldn't survive to have the surgery after the long weekend. Even so the surgeon was guarded about his prognosis; she warned us that if we agreed to him having surgery, she suspected she might find cancer all through his chest & if that was the case, it would be her recommendation that he wasn't woken from the anaesthetic. After spending the night weighing up the options & shedding many tears we decided that we'd give him the chance. Ghillie had pet insurance & surely this was why we'd taken it out for him? Fortunately the insurance company, after a discussion with the surgeon, pre-approved his claim & a dear friend agreed to pay the account up-front to give us time to talk to our bank about extending our mortgage since we didn't have the $8000+ sitting around just waiting to be spent. The surgery went ahead that afternoon with my husband & I waiting in the reception of the hospital, ready to say our goodbyes if our worst fears were realised & Ghillie was in fact riddled with cancer.

After about 45 minutes a message came from the surgeon "it's looking good - I'm continuing with the surgery" & after a further 45 minutes or so another message "we're closing the chest wall up - I should be out to talk to you soon". When she came out to speak to us she said that when she cut into the pericardium she could almost see Ghillie's heart heave a sigh of relief & say "thank heavens, I feel so much better now"! She was happy with everything; she didn't spot anything that looked clearly like a cancer but that she was sending the tissue away regardless for testing as she still felt there would be some early signs of cancer found. We couldn't see our boy that night but could come in over the weekend & if all went well, we would be taking Ghillie home after the weekend.

The next day Ghillie was subdued & groggy (he was pretty heavily medicated) but when I visited on the Saturday & Sunday I found a bright-eyed, bushy-tailed boy sitting up with a look on his face that said "the room service in this hotel is TERRIBLE! I'm completely starving & they're hardly feeding me anything at all"! He ate the BBQ chicken meat I took in, took keen interest in what was going on around him & played with a squeaky toy that I took in for him. When I took him outside to stretch his legs & take a potty break he caught sight of our car & was pretty keen to get in it & go home.

I'd like to say that Ghillie's story ended happily. Sadly when I arrived on the Monday, expecting to be told I could take my boy home, I was instead given the news that he had an infection & had stopped eating again. I spent several hours with him; stroking & talking to him & trying, unsuccessfully, to persuade him to eat. Over the next 36 hours, despite aggressive antibiotic therapy, his condition worsened. One of his lungs collapsed & he required constant oxygen. The fear was that he had contracted a drug resistant infection of some kind. After lengthy discussions with the surgeon, we agreed we would wait on the lab results to determine exactly what infection he had & if it was a "superbug" we would let him go as his body was struggling so much. As fast as he produced white blood cells they were overcome by the infection. We agreed he'd remain on constant oxygen so he was comfortable & in no pain. We were warned he likely require surgery to repair his lung, which was a concern when he was so sick. We left to go home that night to await the lab results the next morning & would make a decsion once they were received.

Unable to sleep during the night, I rang to check up on Ghillie & was told that he was vomiting blood - his blood had stopped clotting & it was a sign that he was going into multiple organ failure. We agreed that it was time to let him go & so we made the sad journey to be with him as he took his final, long walk. We spent time with him; telling him how much we loved him, how brave he'd been & how he would always remain in our hearts before letting him slip peacefully & gently away.

Since Ghillie's death I have been questioned by some as to why I would put an "old" dog through so much? Despite the outcome, I feel no regrets about giving the opportunity to live. For that one precious weekend I saw the happy, goofy, waggy-tailed boy that I loved so much - albeit a somewhat skinny & semi-bald version of him. Some hours after his death the lab results were returned & they confirmed that Ghillie had contracted pseudomonas - a drug resistant infection. Apparently the bacteria lurks in many (human & animal) just waiting for a chance to rise up when the host is weakened. Poor Ghillie's body was just too tired to fight the battle after all he'd been through. The tests on the tissue that was removed from around his heart were also better than we had expected - although the lab wouldn't say that Ghillie DIDN'T have cancer, they also couldn't say that he DID have it. So I feel vindicated that, without the pseudomonas, the likelihood was that Ghillie would have had good quality of life for a reasonable period of time once he'd recovered from his surgery. In the same situation, I would go ahead with the surgery without hesitation.

If you've made it this far - I apologise for writing such an essay! Thank you though for reading my Ghillie's story. If ever you're faced with a similar situation I hope you get the result that we hoped that Ghillie would get.

by CP on 07/18/2012 04:43pm

I'm so sorry for your loss! You did everything you could for your precious pet. You know your pet better than anyone so other's opionions don't mean much. Grevillia died knowing absolute love and devotion.

by CP on 07/18/2012 04:44pm

Sorry about the incorrect name! Ghillie is at peace.

by Grevillia on 07/19/2012 08:19am

Thanks CP. Thankfully I'm still alive & kicking!

3
Vetmedin early?
by CVICU RN on 07/19/2012 09:30am

A question for the vet - My regular vet told me last week that it is now thought to be better to start Vetmedin early rather than later. Everything I've seen in the past says it isn't for early heart disease. My 8 year old, 5 lb Maltese has a grade 1 heart murmur and it hasn't worsened over the last 2 years.
I just lost my precious 15 1/2 year old tzu boy to heart failure 2 days ago so my heart is aching horribly. I'm certainly willing to start the meds early if it is truly helpful. Thank you.

by Dr. Jennifer Coates on 07/19/2012 11:23am

The current recommendation is to start Vetmedin, and ACE inhibitor (e.g., enalapril), and lasix at the first sign of congestive heart failure - in other words when a dog has clinical signs of the disease (a cough and/or rapid breathing are most typical)and pulmonary edema that is visible on x-rays.

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About fully vetted

Jennifer Coates, DVM

Photo of Dr Coates

Image credit: Jim Piraino

...graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado. She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-Speak Deciphered for the Non-Veterinarian. Dr. Coates also writes short stories that focus on the strength and importance of the human-animal bond, and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and various species of pets.

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