Canine Dilated Cardiomyopathy – Canine Heart Disease

This week I’d like to tackle one of the types of canine heart disease. It’s fairly common, with a few breeds particularly at risk. Before we dig in, though, I want to put up a couple of links that you might find interesting and helpful if you’re still feeling a little overwhelmed by the heart and its physiology.

This link leads to a really neat animation of the heart. It shows the flow of blood into the various chambers, the contraction of the chambers, and the flow of blood out of the chambers. Valves are shown opening and closing. There are also two graphs that show pressure in the various chambers during the contraction cycle and the EKG tracing as it relates to the various chambers.

This page is full of cardiology and respiratory cases. It’s pretty technical stuff, but it was too neat not to share. If you’ve got an interest in cardiology, it’s a great resource.

Now, onward to Canine Dilated Cardiomyopathy.
Canine dilated cardiomyopathy en

Dilated Cardiomyopathy (DCM) is a disease in which the muscle walls of the heart chambers become weak and gradually lose the strength in their contractions. When this happens, the pressure in the heart and the blood vessels of the body causes the chambers to stretch even further. The whole heart enlarges in the chest cavity. This is the exact opposite sort of change from what occurs in cats with HCM. When the heart chambers enlarge like this, the valves aren’t able to close completely, so blood flows backwards when the heart contracts. This makes a murmur occur in the heart, which we can hear through the stethoscope.

Just as with cats, the blood doesn’t flow the way it’s supposed to and pressures start to back up. In dogs with DCM, both the left and right side of the heart can fail simultaneously. Heart failure causes fluid to start building up in one or both of two places.

Dogs with DCM can have fluid build up in the abdomen because of the right sided failure. Fluid in the abdomen is called ascites. The abdomen will become distended/enlarged. Dogs may have trouble breathing because of the pressure on the diaphragm. I’ve had a few DCM patients vomit, too, or not want to eat.

DCM will also cause fluid leak into the lungs themselves because of left sided failure. This fluid buildup is called pulmonary edema. (It’s different than cats, which fill the chest cavity with fluid.) When fluid fills up the little spaces in the lungs that are supposed to have air in them, dogs can’t get oxygen into their blood. This causes very severe problems, and is often the cause of death in dogs with DCM. Dogs suffering from pulmonary edema will cough, breathe heavily, or even have their lips/tongue turn a bluish color.

The radiograph below shows a normal dog’s chest from the side. (Sorry about the gray labels – I don’t know why they weren’t in color like they should have been! ) Take note of the angle between the two lines labeled “spine” and “trachea.” Those lines should get closer together toward the front of the dog, where the arrowheads point. Notice also that the lungs are nice and dark, just like air should be on a radiograph. The branching white lines in there are blood vessels in the lungs.

Feb03 227565 latsm

The next radiograph shows a dog with DCM. Notice how big and round the heart looks. Also, notice the two lines for spine and trachea — they’re much closer to being parallel instead of coming together. This means that the heart has enlarged and has pushed the trachea up from underneath. The lung fields have lots of white fluffy looking stuff in them. That white fluffiness is fluid in the lungs themselves — pulmonary edema. The lungs are being flooded because of pressure backup in the heart and blood vessels in the lungs.

Finnigan DCM CHF July2011 Lat sml copy

The next couple of radiographs show you a side and top-bottom view of a dogs’s chest that has DCM. The heart is HUGE and round. This dog does NOT have pulmonary edema, so the lungs still look pretty clear. No white fluffy stuff.
Finnigan DCM CHF FollowUp Lat

Finnigan DCM CHF FollowUp DV

The breeds that are prone to this type of heart disease include Doberman Pinschers, Boxers, Irish Wolfhounds, Great danes, St. Bernards, and Cocker Spaniels.

Some of the signs that owners may notice are: not able to exercise like as much as before (exercise intolerance), coughing, weight loss, lethargy, abdominal distention, fainting, weakness, not eating, shock, and sudden death.

Radiographs of the chest can give an initial diagnosis, but an ultrasound of the heart is essential to see how much muscle function is left, and later to see if treatments are helping at all.

If DCM is discovered before it’s too severe, there are medications that can be given to help the heart contract better and to help prevent failure from building fluid up in the lungs/abdomen. Patients can also develop abnormalities in the way the heart contracts (arrhythmias) that are dangerous and sometimes difficult to manage.

Unfortunately, DCM is a progressive disease that we lose the fight with. The life expectancy is as little as 6 months or as long as 24 months. Dobermans tend to do worse and often live 6 months or less.

There’s some debate in the veterinary community about whether we have ways to detect DCM before it’s actual heart failure and the dog is in severe trouble. Different breeds go about DCM differently enough that one single method won’t catch all dogs of all breeds who have DCM. Anything from a 24-hour EKG to an annual ultrasound has been suggested, but it really comes down to two things: Will the screening help the patients live better quality lives for a longer period of time, and can the owner afford the diagnostics? Cost is obviously up to the owner. Whether we can help these patients remains uncertain. In some cases, we may not make any difference at all. In others, I believe we can help these patients have much better quality of life for the time they have remaining. No matter what, it’s well worth trying to treat as long as the patient can be returned to a reasonable quality of life.

Thanks for reading!

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99 Comments

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99 responses to “Canine Dilated Cardiomyopathy – Canine Heart Disease

  1. sarahb

    I am actually surprised how long my dog has lived after the massive enlargement of her heart……….her heart is so huge and round, it takes up most of her chest. she has actually been on enalipril and Lasix for approximately 6 years………she had a tooth extraction a few months ago and required 80 mg of Lasix iv (a tremendous amount of this medication for a 23 pound dog) and nitroglycerin……….I still walk her a few days a week for approximatedly one mile (I let her “walk’ me)………this little girl refuses to die! she is so happy……….her quality of life is still fantastic and I am so happy of how well she is doing!!!

  2. Aisling

    I just found out my 4 year old Lab has DCM. It has been a huge shock for me. I noticed his abdomen looked swollen and he was breathing heavy so i brought jim for a check up. I hope my little guy will be with me for a good while longer. He is on lots of medication so fingers crossed they keep him in better health. This post is hugely informative and I really appreciate it.

  3. I’m very happy that the post was helpful for you! Best of luck with your Lab!

  4. charles

    You should probaly say that there are plenty of dogs living well past the life expectancy for someone who knows dogs do you understand the bond between the two best friends or is it your just being empty on the factual side with little to no sympathy? On another point your not exactly very understanding that the majority of viewers do not look upon this to see the darker half but yet the brightside along with the thorns that come with it. Pending your canines size and and point of detection DCM can be brung almost to a halt with the right treatment and of course precautions. By the way you forgot a few closing facts about proper solutions and the length of time that can possibly be added for instance I have seen a dog survive dcm for up to an extra 7 YEARS!

  5. Thanks for commenting on the post. I’ll try to address your concerns individually.

    DCM is a very tough topic, and it can be difficult when trying to teach to retain the empathy and emotional support that owners deserve if their dog is diagnosed with DCM.

    The blog is here to help educate owners about some of the diseases and problems that our pets are affected by. The way I have to go about teaching is VERY different from how I handle this conversation in the exam room with the owners. Here on the blog, it’s a lot more clinical and fact-based. It’s vitally important that I provide accurate information.

    The data that we have available to us from published studies is the only responsibly scientific way to present the diagnosis, treatment, and longterm prognosis for diseases. It would be irresponsible and reprehensible to give owners a false sense of hope, only to have it crushed if their pet is one of the ones that does NOT live as long as I say.

    There will always be outliers on the bell curve. Some patients will live far less after diagnosis; others far longer. A dog surviving 7 years does not fit within the range that the vast majority of patient survival times. Can it happen? Of course! Is it what most clients will experience? No.

    I always hope for a longer survival time, but in good conscience I have to prepare owners for the shorter. I discuss *both* when I am with a client. In the exam room, it’s patient- and client-focused, and I believe that the majority of my clients feel that they have the empathy and support they need.

    For pet owners that aren’t my clients, and happen upon this post with a web search or another link, I can understand why that empathy doesn’t come through the text and the screen. That’s something I will try to address from here forward. I appreciate the feedback you offered.

    I absolutely do understand the human-animal bond. I’ve had pets for my whole life — 36 years, now — so it’s not a foreign concept for me to have experienced severe problems with a pet that I love deeply.

    You mentioned that DCM’s progression can be nearly halted with treatment and precautions. In some cases, yes, that’s true. As I stated in the last paragraph of the post, it’s absolutely worth treating to see what kind of response we get from medications. Some patients will go a long time in very good shape.

    I didn’t cover treatment in detail in this post because the post was created to educate about the etiology and pathogenesis of DCM.

    Would you be willing to share with the rest of the readers what you feel the proper solutions, precautions, and other measures should be to treat DCM? I’m always open to new information and treatment options.

    Thank you again for taking the time to comment on the blog. The discussion always helps others that come across it later. That’s the whole goal — helping others in search of reliable, accurate info.

  6. Dr.Nirmalya Ranjan Sarkar

    I am working on cardiac parameters of those dogs suffering from Ascites. It would be very helpful if you send me Left ventricular parameters ( Echocardiographic) and ECG of dogs suffering from Ascites. I am doing my Master degree thesis on this. I want to generalize the changes that occurs due to Ascites. Science will progress if you help me with this ASAP.

  7. Dr. Sarkar,

    I’m sorry to report that I do not have any clinical data available to send you regarding the parameters you requested. Our cardiac patients have their echocardiograms performed at a specialty care hospital in the area.

    You may have some luck contacting the specialty hospitals in our area:
    Oakland Veterinary Referral Service : ovrs.com
    Michigan Veterinary Specialists: michvet.com
    Michigan State University Veterinary Teaching Hospital: cvm.msu.edu/hospital

    I wish you the best with your degree!

  8. My 10 yr old Pom was diagnosed with Trachea Collapse a year ago and treated with Hydrocodone Syrup. Recently her coughing became more severe and we returned to the vet who returned a different diagnosis. He says our dog has an enlarged heart putting pressure on her windpipe. If this would have been the original diagnosis 1 year ago our dog would have been spared alot of pain. There appears to be minimal fluid in her lungs. She is at the vet for the night with Lasix and Aminophylline injections and in oxygen treatment. We will pick her up tomorrow and hopefully the prognossis is not as grim as perceived.

  9. Scott,

    I’m sorry to hear that your Pom had to spend a night in the hospital. Sounds like there was a fair amount of fluid in her lungs. I hope she’s home with you today and feeling better!

    Congestive heart failure can be something of a sneaky problem, especially in toy breeds. Collapsing trachea and a cough due to the compression of an airway in the chest by an enlarged heart can sound very similar. If there’s no heart murmur, we tend to lean away from heart failure as the true cause of the cough. It gets even trickier when both things are happening, which is sometimes the case. Without knowing about the physical exam findings in her history, I can’t really offer any more useful insight there.

    The good news here is that if it’s a leaky valve or something other than true DCM, the prognosis can be much better. A fair number of my heart failure dogs go a several months, sometimes longer, before we even have to increase medication doses.

    True DCM (diagnosed with an ultrasound of the heart) has a worse prognosis longterm. However, dogs still benefit from being on the medications and can have good quality of life.

    Best wishes for a quick recovery for your pup, and don’t hesitate to ask any questions that come up!

  10. Just read you post, and thx for putting those xrays up. i hv a 4 y.o Female husky, 2 years ago she had this bloating abdomen, had no appetite but didnt vomiting, her spine and ribs were palpable, and she just lied down and quiet. we thought she got worm. so we dewormed her. but nothing changed. brought her to the vet, her AST, ALP, ALT were all up, but her albumine & her Bilirubin total was in normal range. her creatinine & urea was slighly high by 1 point. took an xrays, her heart was enlarged. the bottom of her heart appeared to be pressing against her Liver (kinda look cross over). i compared her xrays to yours, the two lines for spine and trachea are on normal position. the enlarged heart doesnt pushed the trachea up from underneath. as far as im concern, my husky didnt had a very bad/difficulties when she was breathing. but she does sometimes had this fast breathing even though she was just sitting or lying around.
    my husky didnt coughing, but she does coughing only when she drinks but it was a short coughing. the vet gave me diuretic drugs, curcuma tablets and ursofalk. for almost 3months.the bloating was still there. we feed her boilled chicken almost everyday, coz thats the only thing that she wants to eat. 1year after, the bloating is gone and her ribs was nomore palpable. her body is in a very good, thight formed. we still feed her boiled chicken mixed w/rice until now. its already 1.5 years after the bloating condition. i dont hv enough money to bring her to the vet todo the check up. i still collecting some money todo her complete ultrasound. but not at this recent months, coz i have 1 pom who got erosive ulceration and need to do endoscopy after countless of xrays and 2times barium tests (costs me alot), and 1 cat that has CRF. im wonder, can i continued to give her boiled chicken ? i also offer her many dogs food from many brands (purina, RK, hills, instinct, and wolf something, also wellness) but she wont eat it.
    Thx

  11. I’m happy to hear that your husky is doing better!

    As you probably already know, chicken and rice is not a complete diet. You can try to mix the chicken and rice into regular dog food. Or you can try canned dog food.

    You can get a recipe for home-cooked food at this website:

    https://secure.balanceit.com/

    They will give you a free recipe, but you need to buy the supplement to make the diet complete. I like this website because it is run by specialists in animal nutrition.

    Huskies can be very stubborn about some things. I wish you the best of luck and good health!

  12. Brandy

    I found your page very educating and helpful. More so than most I have come across. I currently have a Rottweiler that has been diagnosed with a mild case of heartworms and cardiomyopathy. He has gone bad very suddenly and we are so devastated. I do realize the heartworms are complicating the problem and he wouldn’t tolerate treatment. My question is do you think a visit to a specialist in any way would be beneficial. He is currently on Enalapril and Lasics. I would just like to do anything in my power to help him as long as I possibly can. Please let me know your opinion on his state. Thanks!!!

  13. Thanks for writing in with your comments and questions! It’s always surprising to me which posts generate the most responses. This one is by far the leader. I’m really happy that I can help in any way whatsoever.

    I’m sorry to hear that your Rottweiler is having trouble. No matter how confident I am in my diagnosis, I always offer referral to a specialist to my clients. The reason for that is that a specialist will have the most up to date information about diagnostic and treatment options.

    If your general practice vet has done an ultrasound of the heart already (echocardiogram), the specialist may not have to repeat it. Just make sure you take the results with you. That’s one of the best things to guide treatment.

    The enalapril and lasix are great initial choices. There are additional medications that might be helpful. Which are appropriate depends upon the ultrasound/xray/bloodwork results.

    The quicker the better with the referral to the specialist if you’re going to go. Early intervention often has the best response.

    Good luck with your boy!

  14. Meghan

    Hello all, looking at adopting/rescuing a little shih tzu who has an enlarged heart…found when they did an xray to clear her urinary tract infection. They report that she is not exhibiting any symptoms, and is not on any medication as of yet. I’m wondering about the approximate cost of medication to maintain quality of life and about how long I should expect to have a dog with this condition. above comments did not sound incredibly promising and losing a dog so soon would be heart breaking –
    Weighing options…thanks for any advice or information

  15. The good and bad news is that depending on the patient, depending on the heart’s degree of failure or damage, and which type of cardiac disease is present, which meds are used, when they’re started, and some dumb luck … it could be a LONG time before there are any big problems. Unfortunately, some patients progress fairly rapidly into failure that can’t be corrected with medications.

    The recommended diagnostics at this point would be a cardiac ultrasound and bloodwork that includes kidney and liver values. In our area, the ultrasound and cardiologist consult would run about $500, and bloodwork about $100. Monthly medications would run between $30 and $60 a month (for 2-4 meds).

    I realize that this is basically a totally obtuse answer to the very reasonable questions you posed. The ultrasound should give you a lot more information and allow you to assess exactly what’s happening and how bad things are.

    Keep in mind that most small dogs don’t have DCM. They tend to have a bad valve (usually the mitral valve), and that doesn’t usually have such a rapidly worsening prognosis as DCM does.

  16. Lauren Walsh

    I found this article to be helpful in better understanding DCM. My 11 year old doberman mix was diagnosed with an enlarged heart, DCM/Congestive Heart Failure in March 2013. Since then, he was placed on Enalapril, Vetmedin and Lasix (as needed). He has improved with this treatment, but has lost an extreme amount of weight. He eats like crazy though so his weight loss is not due to lack of appetite. My vet told me the drastic weight loss is as a result of the heart disease. He also said he is okay with him being skinny rather than heavy due to his condition. However, within the last few weeks I’ve noticed his abdomen is distended and feels like there is fluid build up. My vet told me to start him on the Lasix again, which I did, but I do not see any signs of improvement. If anything, it looks worse. My vet then was going to add Spironolactone to his regiman (in addition to the Lasix). However, my vet’s office forgot to call in the new meds and they are going to be closing for Thanksgiving soon. Frankly, I am at a point where I want my dog seen and to have an x-ray or ultrasound done. Because my vet is on vacation now, I am taking him to another vet today for an evaluation. My parents vet has offered to look at him and I trust them 100%. I was already told back in March that dogs his age, breed and with this condition generally live one year or less. Well, right now he has made it 8 months so I am very grateful for that. I am hoping maybe they can tweek his meds a bit more to help extend his lfe. As a matter of fact, my vet has never adjusted the dosages of any of his meds this entire time. I guess I will know more by the end of the day today. I am looking at this appointment with my parents’ vet as a second opinion.

  17. It does sound like he could use some follow-up diagnostics and adjusted medications. You’re on the right track. It’s worthwhile to ultrasound these guys more often than we would other heart patients simply because of how their disease progresses. Fluid buildup in the abdomen and weight loss are both definitely signs of heart failure. I hope your parents’ vet can improve things and buy you some more time. Good luck! I’m glad the post was helpful for you. I think everyone does better when they’re well-informed.

  18. I have a 13 teen year old Minature Pincher with Cardiomyopathy . He has been sick for about one year. He is currently taking enalapril 5mg and theophylline 100mg. Lately his cough has gotten worse. He seems to wan’t to eat all the time. The theophylline seems to help his cough for his tracheal condition. But lately nothing seems to help. He seems to be confused and just lays around and very quiet. Some days he seems fine and runs around and plays with me. Do you have any suggestions.

  19. Cardiomyopathy can have an arrhythmia as a component of the disease process. Intermittent arrhythmias can cause intermittent symptoms such as weakness, lethargy, fainting. It’s worth having his heart listened to regularly to screen for this, or an EKG to check the rhythm.

    Older dogs and cats can also develop a condition similar to alzheimer’s syndrome in which their brain functions decrease. Signs of that can include some of the things you’re describing: confusion, personality changes, sleeping excessively. There is an excellent writeup on this syndrome here: http://indoorpet.osu.edu/dogs/aging_pets/cds/index.cfm If your dog’s symptoms match, speak with your veterinarian about some of the treatments available to treat the syndrome.

    Regular rechecks for pets with chronic conditions are important. I know it can be costly to see the vet frequently, but having older pets checked 3-4 times a year may be necessary to keep up with their increasing medical needs. If it’s been a while since his last checkup, I definitely recommend having him seen by your vet.

    I hope the suggestions were helpful. Don’t hesitate to follow up with additional questions!

  20. Tracey

    My gorgeous baby boy was diagnosed 23rd december with DCM. He is a 10 year old cocker spaniel whom I just love sooooooo much. I am heartbroken and have spent the last few days crying. I am told by my vet that cockers can do better than larger breed dogs and as he is still running round like a puppy he said it shows how well he is coping with the enlarged heart.He started with a cough and initially was diagnosed kennel cough but when he started getting increased respirations I was worried and took him back. He was then xrayed which showed an enlarged heart with fluid in the pericardium and we then had an emergency cardiology referal. The cardiologist said his heart is twice the size it should be. He has been started on vetmedin,frusemide, spironalactone and fortekor. I am trying to stay positive and hope he will still have many months/years ahead. I will just continue to spoil him and love him to pieces and cherish every moment. I wish everyone well with their own pets. I know my boy is so very special to me and how devastated I have been and just hope for the best outcome for my beautiful Jake.

  21. Tracey,

    I’m sorry to hear that Jake was diagnosed with DCM. It’s a devastating and difficult diagnosis, especially for owners. It sounds like the cardiologist is aggressively treating him, which is good. Hopefully, he’ll continue to feel better and good for a long time to come.

  22. Glenn

    We have a 5 year old little Chihuahua mix, who has been gagging and trying to catch her breath, sometimes at night. The gagging seems to be a dry gag or cough. We came home from shopping last week and she had the worse episode we have seen and was trying to catch her breath. I picked her up and she was actually shaking. That’s when we took her in to the vet.
    We picked her up a year ago and she weighed about 7 pounds, but now weighs 11 lbs. She lays on her back a lot, and stretches her head backward and we wondered if this was because she can ease the strain. We just took her in this week and the results are an enlarged heart and a murmur. She just started enalipril this week. She is not gagging as much, but seems a little lethargic.
    The vet wants a follow up visit in 3 weeks. I have been reading for two days, all the information I can. I read good and bad things. I tend to want to hear the hopeful information and maybe she can get this reversed or at least live with it.

  23. I’m glad that you took her in to have her checked out. The sooner a heart disease diagnosis can be made, the better. It lets us intervene before things are terrible. MANY dogs can do well for a long time with valve disease. DCM is another story, one we’re a lot more conservative about. Both conditions can lead to an enlarged heart, so without an ultrasound, it’s harder to tell which may be happening with your pup. If she had an ultrasound, the vet should be able to tell you whether her heart muscle is working normally or is weaker than normal. That’s the big, critical difference.

    I don’t mean to be rude, but it sounds like she gained quite a bit of weight. If she’s even a little overweight, work *very* hard on getting her back down to a healthy weight. That makes a HUGE difference for dogs with heart disease, lung problems, and trachea problems. It’s not easy, but it pays off in the long run.

    Stay on schedule for bloodwork and rechecks, and stay positive! She may do very well!

  24. Leslie Pinto

    We have a 12 year old Apso Terrier mixed breed male dog. He was diagnosed to have DCM with CCF in June 2012. He was treated for the failure with enlapril and lasix. Thereafter he is on 7.5 mg enalapril daily and spironolactone/frusemide as and when his cough becomes worse. He was fine on this treatment till Dec 2012. Since then he stopped responding to this medication and developed a severe dry hacking cough. The vet took an X ray and stated that the enlarged heart is pressing on the trachea and this is the cause of the cough for which nothing can be done. The cough is very severe and becoming worse. What can we do?

  25. If the lungs are clear of fluid, then the cough is probably (as your vet said) due to the pressure of the enlarged heart on the trachea and main bronchi that head to the lungs. For my patients in which the cough is severe, I will prescribe a cough suppressant to help. The danger in doing so is that the suppressant can mask signs of fluid building up in the lungs due to congestive failure. We have to be VERY careful about using a cough suppressant in this manner. It’s a good option if the coughing is affecting quality of life. Good luck with your pup!

  26. Tracey

    Thank you for your reply. It’s 3 weeks now so still early days but Jake is doing well on his medication and we are still walking daily maintaining the same level of activity as before his diagnosis.His cough has gone and his respiratory rate has settled.My vet advised to continue exercise (to maintain his quality of life) as before and if he is tired at all I will of course reduce his exercise as necessary.After reading around online I asked my vet about the significance of taurine levels in DCM and it was decided it may be beneficial to check Jake’s taurine levels. A blood test was taken. His blood taurine level result was 9 mmol/ml so significantly reduced and we have started 500mg taurine bd. We will have repeat taurine levels in 1 month. My vet says it’s not certain if this will cause improvement but some research has proven to show in some dogs it can be beneficial. I am so hoping it may help my boy.

  27. Thank you for giving me an update on how Jake is doing! I’m happy to hear that he’s doing well. Good thinking with the taurine level, too. Hopefully it’ll help him in addition to the other meds he’s on. It sounds like you’re doing everything you can! You’re a dedicated owner. 🙂

  28. Karen Lewis

    We have a 12 yr old boxer who was diagnosed with DCM 6 months ago. His heart is huge and round and he has arrythmie that is very hard to listen to. He lost alot of weight in this process but just recently, started to gain weight, especially in the abdomen. His behavior has changed so much, in that he appears confused at times, so much so that he just stares straight ahead for long periods of time while standing in place. Then he has periods of total clarity and is very alert. He continues to eat very well, drinks water well and even plays and barks at visitors. He is on benezapril and lasix and vetmedin, which im sure has helped extend his life. He has fainted several times over the last 2 months and it is very scarey when that happens. We are very blessed to have had him for 12 years, all but the last 6 months being perfectly healthy! We struggle with whether we are being selfish by not putting him down but when we see the good moments, it makes that decision so difficult.

  29. The confusion you’re describing could be due to the heart disease and whatever it is that’s leading to fainting spells. It could also be due to aging changes in the brain similar to alzheimer’s disease. It’s worth discussing with your vet as a separate issue. Officially, the syndrome is called “Cognitive Dysfunction Syndrome.” There are several other symptoms that have to be present for this diagnosis, but there are things that can be done to help. It wouldn’t be a bad idea to have frequent rechecks with his heart condition, too — every month or two if things are changing at home.

    Any pet with a severe medical condition is at a point that regular evaluations of quality of life are necessary. It really comes down to this: if there are more good days than bad days, it’s not wrong to continue. If there are more bad than good, you either have to have your vet intervene to try to improve quality of life, or decide that that is the line you don’t want to cross. It’s *VERY* hard to evaluate this sort of thing, so here is a link to help you: http://www.veterinarypracticenews.com/vet-practice-news-columns/bond-beyond/quality-of-life-scale.aspx

    There’s a good FAQ here for help in caring for senior pets: https://www.avma.org/public/petcare/pages/caring-for-an-older-pet-FAQs.aspx

    I’m always confident that owners will know the right time to stop, especially if they’re asking questions and discussing things as you are. (It’s the owners that don’t worry that upset me.) I wish you the best of luck and strength as you care for your boxer. They’re great dogs.

  30. Mary Goodling

    I have a 2 year old Leonberger female I would like to breed. My issue is 2 dogs from a previous breeding, they just turned 4, have been diagnosed with DCM in the last 6 months. The female passed in Dec, the male is responding well to meds. Is there any blood test to diagnose this prior to symptoms showing up? Has it been determined if this is a simple recessive gene or is it an X chromosome issue. I don’t want to pass on bad genes. Thanks for any information, my brain is being over loaded with everything I’m reading & unfortunately her breeder isn’t helpful & said it would be okay to breed her.

  31. Mary,
    Thank you for being patient with a reply. I’ll try to clear up a few of your questions.

    DCM has been shown to have a genetic link in Doberman Pinschers, and genetic testing is being developed (or has been) for them. Some other types of heart disease in certain breeds seem to have a genetic link, as well. Where in the genes these defects occur varies by disease/breed. So, in some cases we know which chromosome has a problem.

    In general, regular physical exams are a good screening tool. Proactive clients may choose to have chest radiographs done, or echocardiograms. There is a blood test that can be used to help identify a dog that is at risk of going into heart failure (or is already in failure). It’s called a ProBNP test. There’s a lot of strong and reasonable debate about how useful this test is and how it’s best used. I don’t think it’s likely to be particularly helpful in your situation. I tend to use it to help me monitor the status of a dog that’s already in failure (diagnosed by other means). The trouble with DCM is that by the time you get signs you can find, a dog’s already in trouble.

    If the dog you’re hoping to breed is related to the two affected dogs, I would wager that her offspring are more likely to have problems than if she were part of a bloodline that doesn’t have DCM. If she’s related to them, I wouldn’t personally recommend that you breed her.

    I’ll do a bit more digging and let you know if I find anything out.

  32. Leslie Pinto

    After going through your advise and that of our vet we started our pet on cough suppressant (corex) but it is just not working. He coughs almost non stop and it seems (to me) painful to the pet. Even his expiration during the time he is not coughing is noisy. We are heartbroken to see him like this. All his other systems seem ok.
    PS: the year in above post is 2013 NOT 2012

  33. Apologies for taking so long to reply! Let’s jump right in. I’m sorry that your dog is still coughing so much. When I checked out corex, I saw that it contains codeine, which is a pretty potent cough suppressant. If it’s not enough on its own, there are a few things that that could indicate. Rarely, dogs will have a cough as a side effect of the enalapril (ace inhibitor). For small dogs, they may also have a collapsing trachea. With each breath, the trachea squishes down and causes a cough. In some cases, the trachea is so weak that there is noise during all phases of breathing. There is also a dysfunction that can occur in the larynx that can lead to coughing and noisy breathing. Without repeating x-rays of the chest and neck, it’s hard to say for certain. And, of course, the possibility of there being additional fluid buildup in the lungs that may need to be addressed. If he hasn’t been in for a recheck recently, it may be helpful to get some chest X-rays done. It would help identify the reason for the ongoing cough. With that information, your vet can make adjustments to the medication regimen to try to alleviate the worsening symptoms.

    How is his breathing rate when he is sleeping? How many breaths in one minute?

  34. Rachael Lee

    hi there

    my 6 year old Yorkie has recently shown up a collapsing trachea, enlarged heart and has some fluffliness in her hungs. this was due to an x-ray taken when she went for a dental cleaning.

    she doesn’t cough much but say once a week she would try to clear her throat and that’s when her body starts to contract and expand somewhat like a slinky. the last few days i have seen two episodes and she hasn’t been able to clear her throat, resulting in squinting eyes and i can only sit with her, rub her throat, back, attempting to give her relief.
    she would even eat (i was taking a risk and attempting to make her stop gagging) if i gave her dry food or a snack.

    her regular vet says it’s collapsing trachea (50%), enlarged heart, no heart murmur, not yet bronchitis. and prescribed theophylline. which i havent not started.

    i brought her to another vet, who did another x-ray, who says the trachea has at most collapsed 30%, moderately enlarged heart, and fluffiness (asthma)
    he prescribed Montelukast Sodium (for the asthma), Kelapril (first line medication for the heart), and since he practises TCM (Traditional chinese medicine) he also prescribed a herbs syrup to improve blood circulation given he observed a “lavender” tongue.

    i would be more than happy to email you the x-ray for your review if you found it appropriate for me to do so. i need all the help i can get.
    if you think i ought to do other tests please also let me know your comments.

    she is not fat. 2 kg, her ribs can be felt clearly. great appetite. firm stools. patella luxation in both knees. her urine test showed no abnormality.

    thank you in advance,
    Rachael

  35. Hello, Rachel. It sounds like your Yorkie has a few different things going on. It’s not uncommon for small dogs to have a collapsing trachea. Their hearts can be a bit more tricky to figure out. They often look like they’ve got an enlarged heart, but that may be more normal for them. Allergic airway disease isn’t as common in dogs as it is in cats, but it can happen. The best way to really rule out heart disease as the main problem is an ultrasound and a consult with a cardiologist. You’re welcome to send me the x-rays. I have to be careful about diagnosis and treatment recommendations, though, as I’m only licensed to practice locally. Once you’re sure about the heart, it will be easier to decide on a good course of treatment for the cough.

  36. Laura Brockway

    Dear Pet Authority
    Thank you so much for providing such great information and clear explanation. I’m a clinical nurse specialist (TV & Derm) and so to have such extensive clear explanations is real helpful.

    My Westie is about 13/14 years old. We rescued him when he was around 5/6. He has a severe bunch of allergies (typical Westie) and was in a pretty bad way when we got him.

    Diet management, good antihistamines and TLC have given us all 8 happy years. About a year ago he started to cough. I took him to the vet and we discussed it at length and as it had just began I opted for the ‘watch & wait’ approach. Apart from the cough he was fine. The vet did suggest x-rays, which I was not keen on for fear of the anaesthetic with his age etc. His exercise tolerance slowly decreased (he was always soooo slow anyway!!!) and in August we reviewed. He had gained weight due to the slower/shorter walks. X-rays were mentioned again, but I was in denial, hoping that extra exercise would ‘get him fitter’. We began extra exercise and even less food than before.

    At his next review in Feb things were at a head and we started on Convetal D. He had the x-rays on Monday. He has DCM. The x-ray on Monday was prompted because he got knocked over in the park by another dog on Sunday and was limping. He has torn his ACM (back left). I am heart-broken. Like so many of your readers I have been crying non-stop since Monday. He has ‘a little’ bit of fluid on his lungs.

    His cough has 95% gone on the Convetal. I was thrilled and he’d lost .05kg already. Now he’s on total bed rest for his leg.

    I feel so guilty as I should have had the x-rays done a year ago (?), but I didn’t want to put him through it. He’s such a happy boy, even now. He’s now on Convetal, Pred, Fortekpr, Tramedol and Tavegil (anti-histamine).

    Would you recommend ACM surgery for a dog in his condition?
    Have I made him suffer by not starting treatment earlier… if I had, would he live longer?

    His weight is going to soar with the bed rest and he’s already hungry all the time and on a special diet for his weight/skin allergies/colitis tendency etc so swapping is not an option.

    I’m taking him out in an old donated buggy and he loves it. He’s such a happy boy.

    Your experience with surgery for a dog like him with this condition would be greatly appreciated and any other advise.

    Laura & Dusty,
    England

  37. Laura and Dusty,
    Thanks for writing in! I’m really happy that the post was able to help you out. DCM is a pretty devastating diagnosis. Dogs with valve disease will also often have enlarged hearts. An echocardiogram is often necessary to determine what’s really happening in a heart that showed itself as enlarged on a radiograph.

    I’m not familiar with Convetol. What is it?

    Pred is used here for allergies, too, though it can push dogs into heart failure in some cases, so I’m usually VERY careful with it in cases like this. Fortekor is useful for dogs in heart failure, so I’m happy to see that as part of his therapy.

    There are alternatives to surgery for a torn cruciate ligament. Physical therapy, a leg brace, or simply pain control are sometimes better options if patients aren’t fit enough to undergo anesthesia safely. It will all depend on the condition of the heart, and how fast that is progressing. Check out dogleggs online for an idea of some of the braces that are out there. Consultation with a veterinary physical therapist or board-certified surgeon are also advisable options.

    Hang in there! I know you’re concerned for him, but you have some time to think and explore options for the knee. I would prioritize his heart condition until you’re certain that’s as stable as it can be.

    I wish you and Dusty the best of luck!

  38. R Boettcher

    I have a 7 month old Dobe who was diagnosed 3 weeks ago with DCM he has fluid build up and a enlarged heart. I didn’t think he was going to make it, it came on so fast and severe. He dropped down to 48 pounds, wouldn’t eat, couldn’t walk. It was scary. My vet didn’t seem to know what was going on with him and wanted to send me out of town to Iowa State, a week later. I ended up getting a second opinion here in town, my new vet diagnosed him and put him on Vetmedin Lasix and Enepril right away. Hours later he was eating and playing around with the other dogs. So far the meds have been working, some fluid is gone and his heart has gone down a bit. I am still very scared and devastated, he is so young. I now noticed this morning there was a I believe a tape worm in his fecies. I don’t know what to do, should I keep walking him? How do I continue life as normal for him?

  39. The tapeworm is easy to deal with. Just let the vet know and they can give you some medication (or possibly give him an injection) that will clear out the tapeworm. Then just make sure he’s free of fleas and isn’t eating rodents, etc., as those are other sources of tapeworm infestation.

    As for the exercise level, I would definitely defer to the vet that did the ultrasound on his heart. If you haven’t had an ultrasound done, please consider it. While it won’t change the diagnosis, it can give you more information about the heart than a plain x-ray can.

    I’m hesitant to recommend any given amount of exercise because I’m not sure how bad his heart is. Exertion can worsen heart problems, but you can’t keep patients locked up 24/7. At the very least, restrict him from having heavy exercise — running, jumping around, chasing dogs/squirrels/etc. Those kind of things might push his heart too hard.

    I wish you the best with your Doberman! This is a very young age for him to have so much trouble. 😦

  40. R Boettcher

    Thank you for the reply, it helps to hear from other people going through the same thing. I have just been letting him be a puppy and do as much as he can. We have another vet apt today, I now noticed over the weekend he has developed a ping pong ball sized tumor looking lump on his side back by his stomach. He has had 3d x-ray, an ultra sound and a lot of blood work, I just wonder what now can this little guy go through. What type of dog food or food would be good for him? He is my 3rd Doberman and this is the first time I have ever heard of any of this or experienced it. My 5 year old came from the same breeder and has been in good health.

  41. A new bump? Jeeze, you and your pup just can’t catch a bit of good luck. 😦 Checking a small mass is an easy thing — just a quick needle poke and a look under the microscope. It may not be a big deal at all.

    The question about food is a good one. It seems that low-sodium diets are of use in DCM dogs, but a young dog’s growing needs might make one of the cardiac diets inappropriate. Definitely speak to your vet about good choices for that.

    You can also ask about Taurine supplementation, omega-3 fatty acid supplementation, Carnitine supplementation. These things might be helpful in his case depending on what the ultrasound showed.

    Thank you for the update!

  42. Ken D

    Hello,
    A few days ago my miki / shih tsunami mix starting breathing faster and shallower with periods of coughing. We took him to the vet today and after x-rays he was diagnosed with an enlarged left side of the heart. However I keep reading enlarged hearts don’t usually happen in smaller dogs. He’s only around 7 lbs. We have to wait a week before we can see the cardiologist and was just wondering if we could email a copy of the X-ray to see what you think. We’d just like to get a second opinion before we go next week as we’re worried sick about our little Oreo. I see you mentioned collapsed trachea as something that affects smaller dogs. Maybe you could look at the X-ray and give your diagnosis. Thanks–Ken

  43. Ken, I’m sorry that your pup has developed trouble with his breathing and heart. It’s true that in small dogs, we sometimes have trouble distinguishing a cough from heart disease or something else like a collapsing trachea. I do think that many small dogs get problems with their heart valves, which can eventually lead to heart enlargement and/or failure.

    Radiographs and then ultrasound are the best ways to figure out which things(s) you’re dealing with. I can look at the radiographs for you and give you my impression of what I see. I just won’t be able to recommend any specific treatments.

    Be sure to report any additional coughing or difficulty breathing to your veterinarian, especially if no medications have been started yet. That could be a sign that things are getting worse and that more urgent care is needed.

    One of the ways for you to evaluate at home is to count how many breaths he takes in one minute when he’s sleeping. Or at complete, quiet rest if awake. This is called the Sleeping Respiratory Rate. It can help us decide if there is trouble brewing in the lungs/heart. A normal number of breaths per minute is less than 25.

  44. Rachael

    May i know where i should email you?

  45. Ken D

    He has started medication last night and his breathing as well as his whole demeanor have improved greatly. While he is feeling better for now I know the inevitable is coming. Is there any way to post his X-ray photo? If so I could but I’m fairly sure after studying his photo it is indeed an enlarged heart. Basically I’m just grasping at straws and trying to hope for the best. Thanks for your insight and if you’d like that photo let me know. Thanks again.

  46. Doug

    I HAVE A MIN PENN 13 YEARS OLD WITH CARDIOMYOPATHY. HE HAS BEEN SICK FOR TWO YEARS NOW. MY WIFE HAS ASTHMA AND I HAVE CLEAN AIR MACHINES ALL AROUND OUR HOME. I SAT ONE ON THE FLOOR NEXT TO HIS BED. WHEN HE HAS A PROBLEM HE WILL GO AND LAY DOWN NEXT TO IT AND HE SEEMS TO GET OVER HIS BREATHING PROBLEM MUCH QUICKER. I HOPE THIS INFORMATION WILL HELP

  47. Depending on what’s found on the ultrasound, you might well have a good long while with him still. Try to remain optimistic! 🙂

  48. My dachshund was diagnosed with an enlarged heart and fluid on the lungs a few weeks ago. He is on the Lasix and Enapril. For the first couple days it seemed to be working well, but now it seems as if he is struggling again. I have increased his Lasix (per the vet’s orders) and am hoping for the best. He is 10 years old. When he was about 4 years old he had gotten anti-freeze poisoning. After a week in the hospital he pulled through like a champ. 3 years ago he nearly died from eating an entire pork butt bone… This lead to another week in the hospital, touch and go, and again pulled through like a champ. I have been told that both of these incidents have compromised his heart and kidneys. 6 weeks ago I had his mouth done. Deep cleaning and 6 extractions.
    My question(s) is…
    1. Did this last surgery just put too much strain on his heart? It seems odd that his heart started giving out soon after his surgery. My other questions is…
    2. Is he in pain or suffering…. He certainly does not seem happy. 😦 My heart breaks watching him breathe so heavy, and feeling that heart beat so rapidly (we cuddle a lot so I am always feeling it) I can see his heart beating through his rib-cage..
    3. Should I be carrying him up and down the stairs? (3 story home) or is it ok to be letting him put this strain on it? He is a very little dog so stairs require jumping up and down rather than just walking.

    I don’t want him to be suffering at all.

    I will do whatever I have to do to keep him comfortable, but I don’t want to prolong his life if it is not a happy one. I do NOT want to lose him…. But I don’t want him to suffer… I feel helpless.

    Any advice is greatly appreciated.

    Thank you.

  49. Faye,
    Thanks for being patient about a reply. I’m happy to try to answer your questions.
    1. It’s possible that the anesthesia put some strain on his heart and pushed him into actual failure. Sometimes the amount of IV fluid is more than the heart can handle (even when we are very very careful about it), or simply the stress on the body in general. It’s really tough to weigh major health concerns like dental disease against heart and kidney disease. They all influence one another, and you can’t really ignore any of them when you’re working on one or more problems. We can typically safely anesthetize animals with heart and kidney disease and not have those conditions worsen. Unfortunately, when your pet is part of the minority, it doesn’t much matter that the odds were in favor of a no-impact outcome.
    2. Animals that are struggling to breathe are really uncomfortable, in my opinion. It’s exhausting for them to struggle to breathe. Hopefully the increase in his lasix has helped.
    3. I would avoid strain and exercise until the heart/lungs are under better control. Carrying him up and down the stairs would be a good idea. Simply jumping up and down on furniture shouldn’t be a big deal for his heart, though I counsel against letting Dachsunds do that because of the risk to their backs.

    Many dogs can be brought back under good control with heart medications and a diuretic. Once stable, their quality of life is pretty good overall, and certainly good enough to let them lead a reasonably normal life. The downside is that heart disease tends to be progressive, so over a period of time, things will get worse. Currently your guy is only on a couple of meds. There are others that might be able to help further, so ask your vet about additional options if he’s not improving a lot on the lasix and enalapril.

    I wish you the best of luck with your dog. Thanks again for being patient!

  50. Angelinna

    My Joonie (Yorkshire Terrier, female, 3.3 lbs, almost 9 y.o) was just diagnosed by x-ray with an enlarged heart. She has been coughing a bit when excited (usually when people come to the door) but her blood and urine tests were normal. I actually thought she had pyometra due to some post-heat discharge, took her in to get blood work done… when the blood and urine came back normal, her doctor said I could do an x-ray of her uterus to totally r/o pyometra, or not. I chose to do the x-ray and that’s when they discovered her enlarged heart. Joonie is otherwise healthy, active, and happy, not over- or underweight, alert as ever. I am extremely interested in aggressively preventing progression of her illness. Could you please advise? We moved apartments two days ago, she coughed a LOT from the excitement and 85+ degree weather. However, once we got settled in and turned on the a/c, (which turned out to be much colder than in our previous unit) I have not heard a single cough from her all day. I read that cucurmin can reverse enlarged hearts in mice, could I add this to Joonie’s diet safely? Thank you so much for your time and consideration.

  51. Joonie sounds like she might have two problems: heart disease and a collapsing trachea. It’s great that your vet was able to notice the enlarged heart before she goes into overt/severe heart failure and develops fluid in her lungs or another serious complication. The collapsing trachea is very common in small dogs. It tends to be far worse when these dogs are excited or are breathing hard for another reason (heat, exercise, etc.). That generates a loud cough. Lastly, there is a small chance that Joonie may have an asthma-like condition. That would be diagnosed from chest x-rays or a special fluid wash of the lungs (called a BAL).

    My best advice for you is to have a cardiologist perform an ultrasound examination of her heart. That will tell you if you have a leaking valve, heart muscle disease, or something else entirely. The cardiologist and your vet should then be able to piece together whether the heart or the lungs are the main problem. (And how much the trachea is factoring in.)

    I’ve heard a lot of good rumors about cumin/curcumin, but there isn’t any good data to support that it actually does what people believe it does. A quick search of some veterinary internists, cardiologists, and alternative med experts showed a very wide disagreement about the effects curcumin can have. I’m not trained in herbal/homeopathic/holistic/alternative medicine at all, so I can’t fairly comment on its use in those practices. There are always concerns that a given product will not contain what it says it does, or may contain more than it says it does. Those unknown ingredients can have side effects, and even the curcumin can influence the way drugs are metabolized in the body.

    My short answer on the curcumin is that I think you would be far better off spending money on the ultrasound. Later, after you know what’s going on with Joonie’s heart and have all of your medication options in front of you, curcumin might become part of your treatment plan. Try not to pin all of your hopes on any single treatment or medication or supplement.

    I hope I’ve answered your questions. If not, please keep asking! Thanks for commenting on the blog.

  52. Angelinna

    Thank you so, so much for such a thorough and thoughtful answer. I will do as you suggest and get her the ultrasound as soon as I can. For now, her vet has put her on Aminophylline for the coughing, which I will start her on today. She is actually not coughing much now, maybe 2-3 small coughs a day sometimes after drinking water. The a/c has helped tremendously. I am in China now for work, so finding quality veterinary resources is difficult! I can’t thank you enough for your time!

  53. You’re more than welcome! Good luck with Joonie!

  54. Stephanie

    What a fantastic blog and an incredibly helpful resource for those of us trying to manage our dogs’ heart problems.

    I have a beautiful 8 1/2 year old black Lab/greyhound (neutered male). In Feb. 2013 he was diagnosed with stage IV/b-cell lymphoma. He went through five months of the CHOP protocol with the wonderful doctors of NC State and went into remission after the first few treatments. Unfortunately he came out of remission earlier this year, so we went through CHOP again. He finished a month ago, but now we’re faced with another problem.

    It appears the doxorubicin my dog received as part of his first round of CHOP has caused him to have dilated cardiomyopathy (we knew this was a risk with this particular drug but went with it because of its efficacy in treating lymphoma). About a month and a half ago he was chasing a deer and collapsed. He laid on the ground for about two minutes, paddling his front legs, then stopped and got up (albeit shakily). He did it again a week later; it appeared to me he was having seizures so the vets put him on anti-seizure meds (mainly to ascertain that it wasn’t a case of the lymphoma affecting his brain).

    He had another fainting spell a couple of weeks later, again while running. That’s when we did the diagnostics and discovered the DCM. His vets are fairly devastated by this development as they were really careful with the dosing and administration.

    My dog’s appetite is great and until the diagnostics were done he was going on two or three mile walks with me daily (as well as having free run of our farm). His diet consists of Canidae Life Stages dog food and
    Whole Foods canned dog food. He is currently receiving taurine (1000mg twice a day), carnitine powder (1 teaspoon twice a day),
    pimobendan (10mg twice a day), and enalapril (15mg twice a day). We also had him on atenolol (6.25mg once a day; only went up a quarter tablet for a few days) but he seemed so lethargic and still had a fainting spell so we stopped it. He also gets Dasuquin and one Prilosec once a day, and fish oil in his food once a day. He has intermittent diarrhea (which he had occasionally post-chemo treatment; I suspect it is now due to the increased amount of canned food I’ve been giving him).

    My dog’s vets have told me it’s probably wise not to let him chase deer and run full out. I have been walking him out on a leash and haven’t allowed him to run for the past couple of weeks (although he trots along on our walks with no problems).

    His last vet visit was Monday. His chest x-rays did not show any significant changes compared to those taken in Nov. 2013, but due to the cardiomyopathy they recommend restricting his exercise to shorter walks. I understand that when his activity level is increased (and increased heart rate) his heart cannot deliver enough oxygen to his body and this can cause him to collapse. I also understand the heart disease in
    addition to exercise can result in arrhythmias which can predispose to fainting and in some cases, sudden death.

    I am a big believer that quality of life should trump any sentimental feelings I as an owner have for my dog. He honestly seems a little depressed that I hook the leash on him whenever we go outside. I would like to point out that he has not fainted EVERY time he’s run since the diagnosis, but I understand that it’s likely he will on occasion and that there is a possibility he won’t get up from it.

    I’m not trying to second–guess my doctors; I believe they are right about not letting him run full out. But is a little trotting around the fenced in property okay? I would hook him up to the leash if I saw a deer or rabbit or anything he wanted to chase. I just feel like I’ve taken away most of his enjoyment in life. I have spoken with a couple of people who had dogs with DCM that lived for two or three years on the all the medications. They also continued to run and play though they would often having fainting spells.

    Our vets have told us that because my dog does not appear to have an arrythmia, it is unlikely he would die as the result of one of these spells, though it is, of course, possible. Right now, his respiratory rate and blood work are perfect, I should mention.

    Putting aside his heart issues for a moment, I realize that his lymphoma is going to return at some point and that may end up trumping his heart problems.

    We are hoping to return to our home state (California) soon but if my dog’s time is going to be limited to just a couple of months I don’t want to put him through the stress of moving. I want him to have as good a life as he can have while he’s still here. Any advice you have would really be appreciated. Thanks so very much.

  55. This is absolutely heartbreaking, and I’m certain much more than that for you. Having his severe lymphoma go into remission and emerge again, then go into remission a second time is more than enough for one dog and one owner. Now, being faced with the worst possible complication from the doxorubicin, you’re stuck in a really difficult spot. It’s evident how much you care for your dog and how committed you are to doing what you can and what is right for him. Kudos to you for that!!

    I’ll say clearly and right up front that I really focus on quality of life, too. No matter what we do, or don’t do, we should be watching to make sure that our dogs are living well, and sometimes, an owner can rightly decide that a shorter time that’s good is better than a longer time that’s not good. That’s always a very individual decision based on how good “good” is; and how bad the bad may be.

    The cardiologists in our area have said that syncope (fainting) is a failed “suicide” attempt by the heart. That phrasing really shocked me, but it made sense. When the heart is pushed hard enough that it fails to do what it must do — provide blood flow and oxygen to the vital body systems — that’s not compatible with life. Pushing the heart that far repeatedly is probably asking for lethal trouble.

    I’m really torn here. I can see your side. Denying your dog his favorite thing has to be terrible to endure. I’d like to think that sudden death from syncope would be a quick and painless way to go, but who can really say that it is? And is it fair to have him hover near death each time this happens? He really isn’t aware of the connection between overexertion and the fainting, but we are. I suspect that ultimately I wouldn’t put my own pet in that situation. Which, in turn, means I wouldn’t recommend it to a client, either.

    Lastly, you’re to be commended for putting his best interests and quality of life first. Moving can indeed be stressful. I always tell clients that it is better to say goodbye on a good day than to show up with a sudden deadly emergency that means suffering for pet and owner alike. It’s never easy for owners, harder still on a ‘good’ day. In the end, you must do what will let you sleep well at night.

    I realize this has been a really ambivalent response. In the interest of being straightforward, I’ll say that I think letting him run to the point of syncope (even just occasional fainting) is not a good idea. I think you’ll regret it if his final moments are a syncopal or arrhythmia-caused death. Far better to make that decision when not in a crisis moment.

    Don’t hesitate to ask more questions. I hope that the time he has remaining is good for you and he both.

  56. An owner left a comment about this post on another page in the blog, so I wanted to repost it here along with my response. Here’s her original:
    ——————————–
    This is an excellent blog on canine DCM, thank you! I am amazed at your patience and attention with each inquiry. I have a 10 year old very large male Dobie (not a breeder -out of a Dobie-czech mom and US dad), diagnosed with DCM (ultrasound) about two months ago. I have a question and also wanted to tell you/your readers what I’m giving my Dobie to hopefully prolong his “good time” left with us. My question is: why is there consistent weight loss with this disease? He does not have arrhythmia.
    Also, although you may feel that my regimen is “overkill” or perhaps some of the supplements are contraindicated, I did my research on human DCM and read several vet blogs and I am giving my boy the following supplements (he was over 100 lbs, probably is about 80 or 90 now).:
    taurine
    CoQ10
    acetyl-L-carnitine
    creatine
    selenium
    potassium (because of the diuretic)
    Hawthorne Berry
    Rutin
    Turmeric
    Ginger
    Ginkgo
    vitamin E
    Omega 3s (Fish oil)
    L-Ribose
    Choline
    coleus (Forskolhii)
    [cayenne-recommended but I just can’t give my dog hot pepper!]
    Garlic (blood thinner as we suspected a blood clot or spinal embolism occurred which has caused him partial single rear leg paralysis)
    nattokinase (similar to streptokinase to prevent blood clots)
    bladderwort (Blood thinner)
    kelp (blood thinner)
    I’m asked how I get him to “eat” all that! I empty all the capsules and grind any tablets and put it in dog food or meat and sometimes “coat it” in salmon. (honey smoked salmon from Costco).
    I have gone down to every other day and omitted blood thinners.
    My vet is surprised as he thought Oden had only a few weeks to live.
    I’m going to have another ultrasound if Oden continues to do well.
    I’d appreciate your comments (and concerns) about my “mix” of supplements. I’d also appreciate your comments on the promise of stem cell therapy for DCM.
    Thank you. Sara in California

  57. Sara,

    Wow, talk about dedication!! I’m always impressed when owners take this much time to study and learn on behalf of their companions. Huge kudos to you!

    The question about weight loss is a good one. The consensus seems to be that it’s a combination of reduced intake of calories and nutrients, reduced absorption of nutrients, increased calorie burning, and consequences of the medications we put pets on to treat cardiac disease. Complications with kidney, liver, and intestinal status as a result of the disease or medications also have an impact.

    I’ll have to be really honest about the herbals that you’ve got Odin on. I just don’t have enough training to feel comfortable making recommendations or commenting on the list in a comprehensive way. That being said, there’s only one thing on there that It hunk you should avoid, which is the garlic. I assume that you omitted that with the other blood thinners. Garlic can damage and destroy red blood cells. While a big dog like Oden would have to have a LOT of garlic to have any visible symptoms of garlic toxicity, we know that *any* amount of garlic does some damage to red cells. For a dog that already has circulation problems due to his heart disease, every red cell counts. They need to be delivering oxygen to the body, and if we’re impeding that at all with damage, it’s the wrong way to go. I don’t mean to imply that you’ve done any harm, or irreparable harm, to the cells — usually there’s enough in reserve to make up for what a small amount of garlic will damage. It’s just one of those things that I personally feel there’s not enough hard evidence to support regular use.

    CoQ10, taurine, and carnitine are recommended for sure in DCM dogs. I support potassium supplementation if the dose of lasix/furosemide is causing trouble. Omega 3s are great. I’ve heard good things about turmeric, too, but again, I don’t think we have a lot (any?) good data on that.

    The way I generally try to approach big lists of supplements is to make sure that nothing on there is harmful. If they’re safe, we can give it a try. The interactions of herbals and traditional meds is difficult to predict or know about in some cases, so ultimately we really have to ask: is the patient better? If it’s working for you and Odin, stick with it!

    Hopefully I’ve been of some help to you. I wish you and Odin the very best, and I’m grateful for you sharing your experience with other owners. This post has been incredibly popular, far beyond what I thought it could be. The more owners and dogs we can all help by sharing info, the better!

    Almost forgot the stem cell question! The stem cell therapies that are out there are still in that tough spot where those using them swear by them but academics are gathering data and trying to rigorously evaluate scientifically whether the therapies actually work. I’d say that it’s another area where there’s promise and it may help. We’re not using stem cells in our practice at this point, so I’m a little sketchy on details here. As with the supplements, if there are minimal to no risks and you don’t mind spending the money, no harm and possible help is likely to be worth it for you. You just need to be prepared for the results to be less than perfect. :\

  58. doug bennett

    I have read most of of your comments about your pets with DCM. It I pretty much of a downhill battle. I did everything for my Min-pin including supplements. The only thing that helped him was a clean air machine that I put on the floor so he could get fresh air. That was the best thing I ever did for him. I lost him a couple of weeks ago. The best thing you can do is pet you dog and let him know that you love him. He lived one and one half years after diagnosis. I hope you don’t try to keep your pet alive and let him suffer. When he gets to a certain point you must let him go.

  59. Knowing when to stop can be tremendously difficult. I agree that making sure your dog is comfortable has to be the primary goal above all else. You were able to do that, as difficult as it was. I’m sorry for your loss.

  60. liz

    Not to sound like money is more important because it’s not. Our boxer was just diagnosed with this and I’m wondering what an average cost of the medications is going to be just so I’m not too shocked

  61. The cost of medications will vary quite a bit depending on which ones and where you get them. Most of the cardiac meds are relatively inexpensive– about $20-25 a month. Some other meds are more expensive, such as Vetmedin, which can range well over 100/month for a bigger dog. It will all depend on how your vet decides to treat and how the medications are provided.

    I’m sorry if this answer seems vague. There’s just so much variability in how individual vets/hospitals handle pricing and therapy that it’s impossible for me to be more specific.

  62. Dee

    I was googling for research on DCM. I thought I would never have a Doberman Pinscher come down with it based on researching their pedigrees to reduce the risk of known parents at least in the first 5 generations. I was under the impression the further the generations with known dogs documented of DCM the risks could be weighed less for future puppies to be diagnosed with this disease. My favorite breed Doberman Pinschers. I have selected for my pets based on the researching pedigrees to weed out dogs with strong cause of death based on dcm and bloat. These 2 are the most concern of health issues with the Doberman Pinscher breed for me based on what others have gone thru with their Dobies. From there I looked at hips, cancer and other documented COD from the Euro Doberman Pinschers pedigree data banks. I am hoping for improving health and longevity in my lines, trying to reduce those known health risks. For a long story short, my oldest female born 05/2006 is a possible diagnosed candidate of dcm. Her annual health exam should have been 100% passing with flying colors this December 2014. No issues at all with her until the vet told me she is detecting a murmur. So a chest radiography (3) were done. Shows a possible right side enlargement, lungs clear. (wonder if something happened when she was running and ran into me hitting her chest and she yelped a little bit upon impact? She was running to me fast upon recall. I had to move quickly or I would have been knocked over. ;o) This was within 1 week of her annual checkup.) So now next steps – senior bood test, and schedule EKG, and echo. TBD in January 2015. She shows no signs of dcm IMO and was shocked after all these years of excellent health to develop a murmur? I am shocked for I never thought she would develop dcm. Maybe she does have dcm beginning stages or something else going on. I am as a pet parent in denial or being shocked of the word dcm from my baby girl vet’s diagnoses. At 8 1/2 yrs old I was hoping I will get more than 10 yrs with her. In dogs yrs that is good. I was always worried on the bloating. So what options do I have? My vet said unless a valve or something other showing up on the January tests, there is nothing to do except to see a cardiologist specialist. So off to research more data on dcm again. I am overwhelmed and heart broken for I had hoped my baby girl didn’t come down with the known health issues of the Doberman Pinscher breed. I thought I was doing good on the pedigree history of reducing the risks and improving the lines with my fine Dobermans. I guess it is not an absolute for each parent’s genes are forever within the genetic makeup of future generations born.

    I truly enjoy reading this blog and wanted to state this. Keep up the good work and blog.

    I really liked the information you posted from Sara, California. I have read that much of those herbs – taurine, carnitine are some of the herbs highly recommended for the Doberman. I wonder if there is somewhere where one can buy these herbs to supplement in feedings with proper doses?

    For added information, tests I do my Dobermans I get are DNA – vwd, DNA – DCM, OFA hips/elbows, Thyroid, T4, heartworm – all the necessary health stuff making sure I have healthy dogs.

    Dee

  63. Dee.

    I’m sorry that, after so much careful research and selection, that your female is experiencing trouble with her heart. The ultrasound will tell you if it’s true DCM or something else. There’s always the chance it’s just a small valve leak or similar. And, if it does, you being proactive and heavy into research will benefit her tremendously.

    Thanks for taking the time to share your insights and comments. This post is really the only active one on the blog, but it’s got some surprisingly wide-spread popularity, so I believe it’s helpful to others to keep comments up to date and approved. 🙂

    I wish you and your pup all the best that luck and science can bring you!

  64. My miniature dauschand is very obese. We have tried low fat foods for her recommended by our vet. We also feed her broiled chicken from time to time. She had experienced mild pancreatitis 5 months ago, but seemed to recover well with medications and diet changes per vets request. She is a miniature dauschy and weights 18.9 lbs. Way too large. We are fearful she has developed heart disease. I can see the front of her chest – seems to be jumping and pulsating. If you put her hand there, you can feel it. You can actually see it as well. Do you know what causes this? thank you,
    Charles

  65. Thanks for writing in to the blog! Obesity can contribute to a pretty wide range of problems, one of which is heart disease. If you can see a pulse in the neck, it will either be the carotid artery or the jugular vein. Sometimes seeing the carotid artery pulse isn’t a problem at all. The jugular vein, however, indicates a problem (possible heart disease). If your vet has heard a heart murmur, that’s another indication for heart disease.

    My recommendation at this point is to have your vet listen for a murmur and take chest x-rays. In addition, bloodwork to establish a baseline for organ health and thyroid function are a good idea. A complete databse includes a urinalysis, as well. All of these things will help us rule in or out various problems. There’s a blood test for heart failure, too, but I don’t think it’s going to be as useful as the x-rays for your dog. If the x-rays show a problem, your vet may also recommend an ultrasound of the heart.

    Weight loss will be an important part of treatment for your dog as well. Your vet can help you figure out how many calories a day she needs and help you select a low-fat food that will help weight loss. Don’t try to start a crash diet or push her to exercise. Both could have really bad consequences.

    I wish you the best! I’m happy to answer questions as you work through her results and care.

  66. Recently, my mini dachshund had begun acting weird. Once, I was throwing his Pedigree around so that he would eat it(He is very picky about food). For a 10 year old boy, he is pretty active. He could be 7 really.
    Suddenly, he collapsed, in a slow motion. I was stunned. I sprung over by his side. He was not breathing and he lay still. I called out his name aloud and began to gently compress his rib cage( a mistake as I later learned from his vet)
    I noticed two things:
    He had peed.
    He began to cough after he regained consciousness.

    I decided to get him checked. His vet decided that it might be some heart or lung issue. His breathing has ever since been erratic and fast. Not deep. Just shallow and fast. He is not in any pain whatsoever. He still spends half his day in the kitchen begging for us to throw him a piece of carrot or cucumber( he loves this stuff. He is fond of almost evey vegetable)
    He is able to jump on and off furniture and is quite an excited chap. The only major problems he has ever faced so far in life is his dental issues. His teeth are horrible. Got 2 removed a few months ago.
    Anyway, I decided to observe things after he collapsed the first time.
    Two mornings ago, it was early at dawn that he collapsed the second time. He sprinted a a few yards chasing a couple of pigeons. I was watching the rising sun, when suddenly I heard a slithering sound. Chester was slowly sitting down on the floor in a sluggish motion and breathing deeply and heavily and fast, like perhaps a breath per second. I massaged his head and called out his name aloud. He came to in about 20 seconds and he slowly raised his head, gazing into my eyes for about 1minute as I continued petting him and he continued to breathe deep. He tried to get up, but there seemed no energy in his body to do that. I waited, and sat down with him.
    Then slowly he sat up and then stood up.
    I took him down for a walk and he was perfectly fine: wagging his tail like as always whenever it was walk time and went about with the same surefooted walk as always.

    But this time I knew for sure that something was messed up.
    We got am X Ray done a day ago and today I found out that he has an enlarged heart.
    The wicked internet proclaims this to be an indication of DCM.
    I am ready to face the worst and have accepted mentally that if it comes to it, and my boy starts to suffer, I shall have him put to rest. He will be the first loss I will experience in my life.
    But when I read in the comments by some peeps as how their pets have surpassed expectations, I think I have my hopes raised.

    Thanks a ton for your post, because via the comments generated, I have found light in the seemingly obvious darkness.

  67. I’m sorry that you’ve had to have such a scary experience with your dog. 😦

    It sounds like your vet is on the right track with the chest x-rays. Consider having an ultrasound and EKG done. These fainting episodes are sometimes caused by an arrhythmia. The ultrasound will help your vet decide between DCM and other types of heart disease (such as a leaky valve, which is really common in smaller dogs). If your dog doesn’t have a heart murmur, the EKG may be even more important.

    At this point, I hope that your vet has started him on heart medications. Fainting is a pretty serious consequence of heart disease (regardless of the type), so he most certainly needs something.

    I hope that you’re able to have a good long while with your boy. I can see how important he is to you. It sounds like you’re staying on top of everything you need to do.

    I wish you the best!

  68. Medication was prescribed and it seems that he does not have DCM! His heart has enlarged probably due to his hyper activity. The medication has worked wonders and has already slowed down his heart rate and his breathing has stabilized. Of course, it will be confirmed 6 months later what’s the course of the condition!

  69. sozzer

    My mastiff had fuild around his heart the vet did test on him and said that he had heart disease they drain 2l of fuild from him for 3 weeks he was good they he went bad again with very heavy breaking to dieing he was only 3 all this happen very suddenly why did this happen

  70. I’m very sorry to hear that your Mastiff was taken from you so quickly. Sometimes when dogs get heart disease, they compensate and show very few signs until the disease is very advanced. At that time, when they finally show that they are sick, there’s very very little that we can do for them. It sounds like your dog might have been this way.

    Often, by the time that fluid builds up in the abdomen, the heart has gone into a state of fairly advanced failure. We’re not able to heal the heart muscle, so if it’s too damaged to function well, we simply can’t get it back into a condition that is strong enough to survive.

    Dilated cardiomyopathy, a torn valve in the heart or a very bad arrhythmia could cause a more sudden decline/death. No matter what, it’s an extremely traumatic thing for an owner to have to go through.

    You have my deepest sympathy for your loss. Sudden decline and loss like this is by far the most difficult.

  71. Tracey holdsworth

    Just an update and to give a little hope to those people whose dog has a DCM diagnosis .In Dec 2013 my gorgeous Cocker Spaniel Jake was diagnosed with DCM. I was told his heart was twice the size it should be following xrays,ecg,echo.
    I was so afraid he would be taken from me as I love him so much and cannot imagine life without him.
    My vet had told me if he was a Doberman he would only give him 3 months to live but assured me Cocker Spaniels seem to do much better than the bigger breeds with DCM. I scoured the internet trying to find out how long he might live and any information that might help me prolong his life, DCM seems to have such a poor prognosis and in the end I just thought lets take a day at a time and just love him to pieces and see how we go.
    Just over a year later he is still with me and still very well. My vet is very pleased with him, his last echo shows his heart has shrunk slightly on his current medication. He is due another echo in June.
    Its hard to tell he has such a severe condition. My vet says he has learnt to compensate. He is coming up to 12 years old in April and still walks daily for an hour or more and often runs around in circles….. I call it his “puppy run”. He is just amazing. He has had 2 or 3 faint/collapse episodes last year, none were after exertion, all were whilst he was at home and my vet says its probably a combination of an arrythmia and a drop in blood pressure. If these become more regular he will investigate further.
    Last year I felt for sure he would not survive but he is a fighter. I am also very diligent in ensuring he gets all his meds and any treatment he needs, I even suggested the taurine medication to the vet after reading online about taurine deficiency in Cockers so he has been on this too. I hope he continues to do well for as long as possible. I know its a difficult diagnosis and that some dogs may do better than others but I just wanted to share a little hope. I sincerely wish everyone well with their own dogs. Kind Regards Tracey

  72. Thank you for sharing your experience with others. It’s great that Jake has done so well! I’m sure that other owners will find some comfort and hope in your story.

  73. I would like to thank you for the clear description and example X-rays you provided. I had a rough night with my Lucy Belle at the emergency vet. Lucy was set to turn 10 years old on March 20th and she fell short by 20 days. I have owned Dobermans all my life and am used to the cast of lethal characters the breed is predisposed to. I’ve been though stomach distension, cancer,, wobbler’s syndrome and cardiomyopathy (the latter twice now).

    If you would indulge me. I’d like to share my story as I am still reeling from my loss to this nasty disorder last night.

    Lucy was on a good run, showing signs that she’d live well past the magic 8 years that my previous dobes seemed to hit like a brick wall. A progress dry cough, panting and wheezing were the first signs something was amiss. The kennel we boarded her warned that kennel cough had broken out and so when she started coughing a couple weeks later, we figured she might have contracted it so we went by the vet for a check-up, blood work, etc. Of course, she didn’t cough at all at the vet, and I’m told adrenaline associated with the trip could have suppressed it. Anyway, the blood work came back fine and there were no signs of abnormal heart beat in spite of a very increased rate that we attributed (falsely perhaps) to anxiety associated with the “dreaded vet trip”.

    Over the next two weeks, the cough came and went and we just sort of monitored her, thinking that maybe allergies were the culprit. The onset of spring in Houston can be brutal for sufferers – man and beast alike.

    Yesterday morning was a typical morning. Dad finished breakfast and grabbed the leashes for another walk. I took Lucy the Dob, Daisy our Dane every day for a 2.5 mile walk. Nothing rigorous but a nice trip and a decent bit of exercise. Lucy ran around the kitchen table like she does every time I ask them if they are ready, as if it was the first time to go. She coughed only a couple times on the walk but I noted that she wasn’t as exuberant as usual, and fell in line with the Dane instead of taking the “I am alpha dog out in front of this team” as usual. Other than that, I didn’t notice anything.

    Then we got home and the dry coughing started again. In force this time. My daughter had a dance competition throughout the day at the local high school so I returned back home three times over the course of the day. She was still dry heaving on and off, mostly on and I was getting nervous. Finally, I loaded her in the car and we arrived at an emergency vet clinic for X-rays in 35 minutes. And they were telling. Her heart was larger in top view than even your example X-rays. Massive fluid in the lungs and her blood saturation was a reported 88%. Gums were blue and the vet gave us the bad news that hit me like a two-ton heavy thing. Most likely heart failure but she wanted a radiologist consult. How could that be I wondered out loud, there is no arythmia?! As if all heart conditions are the same and I had a vague clue as to how to diagnose it. But my response was in relation to my last dobe that did exhibit it while Lucy did not. And the vet explained that it is not always detectable without X-ray.

    The options were grim for my 10 year old girl and the vet noted the med that “might” be worth a shot, possibly extending her life about 6 months to a couple years even (if we were lucky). But underlying the thinly veiled hope was a look on her face that said the time had come. That my girl of rock-solid heath, previously running with me and now walking religiously for the last 5 years was near death. I was in shock. My 12 year old son sat next to me as his dad of 51 years lost it for the first time in his life.

    We had our last few moments with “woo bell” as we held her for the final moments. It was serene and oddly peaceful. There were no kicks, yelps or even gasps that might have come with it. Only slow lowering of head with the drug and then stopping of the heart. My best friend of 10 years was gone and with her a huge part of who I am as a man. A child took residence in this aging frame as we chased each other through the house, played hide and seek and even wrestled like little kids with puppies. She was an angel in every way, loved all the neighbors and made friends with old and small along the road of our walks. She lived a proud and happy life and enjoyed every damn minute of it. How long she might have hid the pain from us is unclear but it must have been worth it to her because she didn’t squander any time. And when I told her she shorted me 20 days on making it to ten, I thought that I would use that time to remember all the good times and gather a nice photo album of her life. And that’s what I’m going to do. And when I’m over the pain enough to get myself together, I’m going to get another one because there is nothing like the courage, compassion, loyalty, energy, intelligence and foolishness of a Doberman Pinscher. God Bless Lucy Belle. Thanks for the sweet memories and now she is returned back to her maker where I look forward to seeing her again where the pains of this world our trounced and replaced with eternal fields of squirrels and deer to badger, and every trip out is like the first one.

  74. Mr. Cook, thank you for taking a moment to share your experience with other readers. This has to be an incredibly difficult time for you. I’m so sorry for your loss. Lucy Belle sounds like a wonderful dog. I’m sure she will be deeply missed.

    It’s difficult for any of us – vets and owners alike – to recognize heart disease in its early stages. Even with exams twice a year, a heart murmur can be absent now and present six months from now. Those six months can be enough time for serious progression of disease. You consulted your vet as soon as something was amiss, which is all we can ask of anyone. I know that that doesn’t soften the blow of losing a deeply loved family member. In time, I hope that it will ease your mind some to know that you did all that you could do.

    I think that a photo book is a fantastic way to create a memorial to Lucy Belle. It’s comforting to me, as well, to know that our pets will patiently wait for us to join them in due time.

    Thank you again for sharing Lucy Belle’s story. You are in our thoughts!

  75. Karen

    Karen from NC — medications and quality of life
    My heart goes out to Robert Cook who just lost his beloved Lucy Belle the close-to-ten year old Dobie. We were lucky that our Dobie, Calvin the Wonder Dog, made it to 12 1/2 years, with decent quality of life in the year or so after diagnosis. Calvin, like many Dobies, was a bon vivante, ready to take on the world and every adventure. A friend to all, loving, inquisitive, with boundless enthusiasm for life, people, and our cats (they were friends, when he wasn’t persecuting them), he filled our household with his presence. We just had him put down this week, however, when living got too tough and his kidney failure made it clear that his remaining days would be numbered and painful. I want to write about our experience with medications and Calvin’s quality of life, in hopes that it might help others. When Calvin was 11 1/2 he developed a frequent cough that sounded like a goose honking. We took him to the vet and he was diagnosed with dilated cardiomyopathy and arrythmia . The cough was from significant fluid buildup that was pressing on his lungs. He was put on Enalapril and Vetmedin (pimobendan) for his heart function, Lasix (furosemide) as a diuretic to keep fluid from accumulating, and Diltiazem for his arrythmia. On these meds, Calvin’s cough disappeared and xrays showed the fluid had disappeared. For about 7 months, he continued on these meds with the vet periodically increasing the lasix when his coughing returned. His life was normal in many ways. He peed alot from the lasix. We had to replace hour long walks with 10 to 15 minute walks given his limited energy. But he continued to enjoy eating, and hanging with his people, and his personality was pretty unchanged other than his sometimes seeming disoriented and confused on his walks. The cost of maintaining Calvin was high mainly because Vetmedin is very expensive. Fortunately our vet matched the online price for Vetmedin so we were able to get a months’ worth (100 tabs) for about $120. We bought the other meds inexpensively at Costco. Calvin’s energy level was falling, however, and after about 7 months our vet recommended that we transfer to a cardiologist. We did. The doggie cardiologist added two more meds, hydrochlorothiazide and spironolactone, to his array of meds, and increased his Vetmedin beyond the standard dose for his weight. She also continued to increase the lasix when he had coughing breakthroughs. With the medication adjustment he perked up and his functioning improved for the next 6 months. He resumed jumping on the sofa to sleep, and counter surfed more frequently for food tidbits. He seemed in many ways like his old self, other than taking more limited walks. Unfortunately, however, his cough would return every 6 to 8 weeks at which point the cardiologist increased his lasix. He got to the point where he was taking the maximum amount of lasix the vet could recommend. She then substituted Torsemide, a different diuretic that is more powerful and is only given twice a day (a godsend), for the lasix. With the Torsemide his functioning improved once more for several months. Unfortunately after a few months of good functioning again, he practically stopped eating, refused treats, became disoriented most of the time, and began shaking uncontrollably. His bowel movements changed to total diarrhea, and were unpredictable. His blood work showed that his creatinine and BUN levels were off the chart and he was in kidney failure. It became clear that his time had come and on both vets’ recommendations we had him put down, peacefully though with lots of tears. He was 12 1/2 and it was 13 months after his diagnosis.

    I share all this to let folks know that: a) the right combinations of meds can keep your dog alive and with decent quality of life though at reduced functioning for many months; b) the cost of extending your dog’s life is high. Although most of the drugs are in generic form and are available from Costco or pharmacies for low cost, Vetmedin is very costly and seems to be the key to extending the life of many dogs with heart conditions. Buy it online or get your vet to price match if you go the medication route. Plus, there is the cost of vet visits to keep up with what is going on. (Fortunately our vet did not insist on many xrays or ultrasounds, though they did continuing blood work to monitor kidney values). c) many “normal” vets may not know about some of the drugs our cardiologist prescribed which seemed to give Calvin another 6 months of quality life. Those drugs were not expensive — like the enalapril they were human drugs that are also used on dogs.

    Ultimately, however, a Dobie with dilated cardiomyopathy is going to die and their quality of life will progressively deteriorate. We were lucky to have Calvin for his final 13 months, cuddling with us on the sofa, stealing our food, and cocking his head in that inimitably inquisitive and cute Dobie way. His life was not totally normal. His had lower energy, his walks were limited and he was often disoriented when outside, we think from the drugs. However, inside he acted much like himself. Fortunately until the last few days he was not in pain and he did not struggle much with breathing as we were quick to increase the lasix dose when his coughing returned. We were happy to have him in his “reduced state.” However, people who cannot afford the many drugs and vet visits to keep their dog alive for those final months should not feel badly. Given how progressive and relentless the disease is, there is something to be said for a dog’s having a quick end with good quality of life to that point. I’m not recommending any particular course. Every owner has to make their own decision based on their personal situation and their dog’s history and prognosis. It is so, so difficult, and there should be no guilt.

  76. Nicki Penaluna

    I have two dobermanns with DCM. Diagnosed eight months ago within three weeks of each other. Bella was four years old and investigated as I had news from her breeder that her sire had died with DCM. There it was on the echo graph. The unseen killer, as yet in occult phase. She was put on Prilenal and her progress to be monitored in six months time.
    Vecchio started coughing three weeks later. He was a rescue from a life on a chain in a yard, and had only been with us eighteen months. At just under 10 years old he was enjoying life for the first time. The echograph showed a very enlarged heart and a very noisy irregular heartbeat. He was put on Vetmedin and Frusemide and my vet told me to expect him to only live a few weeks his heart was so bad. I started to research supplements that would help. They are both on a regime of home cooked food, rice and vegetables with a mixture of beef, lamb, chicken and turkey. I include organ meats. For supplements they are both on a regime of Taurine, LCarnitine, CoEnzyme Q10, Salmon Oill, Serrapeptase, Garlic and a Multivitamin. After three months Cardalis and Digoxine were added to Vecchio’s drug regime. Eight months later they are both well. Bella has changed to Vetmedin instead of Prilenal as that was causing excessive drinking and urination, an echograph showed no changes, she is still in occult phase. Vecchio appears to have stabilised. There have been no significant changes in his heart since diagnosis and he is well and active.. He has maintained his weight and although he has some days when he is tired his activity levels are good. I am hoping against hope that he will reach his 11th birthday. I write this to show that with early diagnosis, the right balance of medication, food and supplements…there is life after DCM diagnosis.

  77. Diane Cook

    I hope you are still checking this thread, and I do not mind the straightforward facts. It’s what I’m looking for… My Yellow Lab saved my life and he never leaves my side. He joined our family at 9 or 10 weeks of age and is now 12 years. His coughing has worsened considerably over the last few weeks and just a few days ago – backed away from his food. I added some “Alpo” which I never feed him but I know it’s like junk food to a dog and he did eat his dry food after I added the Alpo.

    He had many tumors removed 1 year ago and I elected not to know if they were cancerous. I don’t want to put him through any more surgery or “attempts” at prolonging the wonderful life he has had, if it means he experiences fear, pain and …. He’s 12 and weighs about 75 pounds.

    Question, what do we do to keep our baby boy comfortable? He still loves to go for walks, but I suspect the coughing is a result from fluids in his lungs… What do we do to keep him comfortable until the day arrives when we have to say our good byes? 😦 There is NOTHING Good in saying Goodbye to our dogs, our guardian angels on earth.

    Thanking you in advance for your advice.
    Diane

  78. Diane, thanks for writing. We do still watch the blog, so I’m happy to offer my advice. Please take your dog in for an exam and x-rays of the chest if you haven’t already. X-rays (and even ultrasound) are not invasive or painful tests for a dog. Most labs are very agreeable patients, which makes it even easier. The medications can definitely improve quality of life with very few side effects.

    If there’s enough fluid in his lungs to make him cough, he’s not comfortable, and would benefit at least from a trial of a diuretic. This is one case where it’s really better to get the testing done so that you know what’s going on for sure. We all aim for better quality of life no matter what we’re doing with tests and treatments.

    I wish you the best of luck. It’s clear how much you love and cherish your dog.

  79. Adrianna

    My 17 year old dachshund was diagnosed with an enlarged heart and fluid in her lungs today, however she passed away a few hours later. I hope your dog is doing ok.

  80. Lauri H

    Thank you for the great information! My 3yr old Boxer was just diagnosed with severe DCM. He showed on clinical signs until one wkend he collapsed 12xs in a 24hr period. We didn’t think he was going to make it. Fortunately he did and his vet started him on Vetmedin 10mg am, 5 mg pm and enalapril 10mg twice daily. A strict no strenuous exercise and low sodium diet. He has improved somewhat and in the last month only collapsed 5xs. Today was one of those days and along with that he has started retching with nothing coming up then two different occasions gasping. So, sadly I think his heart failure is progressing. My biggest concern is, is he suffering? I don’t want to selfishly prolong his life if he is. I don’t want to lose him but if he’s suffering a hard decision will have to be made for what’s in his best interest. I’ve read a lot of your replies and actually surprised I didn’t see more posts with owners/boxers. Again, thank you for posting information on DCM. I’ve been reading everything I can on it.

  81. Hi,

    My 6 year old boxer mix was just diagnosed with DCM. He is on Lasix, Enalipril and Vetmedin. He is doing a lot better with the medicine, he has energy and a huge appetite. He still breathes heavy sometimes and has a fast heart beat. We put a vest on him to track his heart and we were told he has an slight arrhythmia, enough to cause concern and a very fast beat. The cardiologist recommended we put him on an arrhythmia drug to slow down his heart rate but said this comes with risks. She said it was more risky to not give him the drug then to give it to him and if the drug negatively effects him then we can stop it. It breaks my heart to think about losing my baby who could have lived another 6 years. Healthy, large dogs in my life have lived until 14 and it is so hard to accept this won’t be my boys case. What do you know of arrhythmia drugs?

  82. Robin,

    Hello! I’m sorry to hear that you’re facing a tough diagnosis. I would definitely recommend that you go ahead with the arrhythmia drug, which I assume is something like sotalol or mexilitene. The cardiologist is right: benefit outweighs risk. The majority of dogs do well on them and they help protect from some life-threatening rhythm disturbances that can happen in DCM.

    I wish you the best of luck with your dog!

  83. heidi Coghlan

    I’m sad you cannot afford the treatment. Is there an animal charity who could help. I’m elderly my cat only seven has cardiomyopathy after the initial diagnoses which was paid on credit card the treatment of diuretic twice daily injection was reasonably better still
    My vet gave me s prescription to buy the medicine syringes needles etc on line at a reasonable price. Don’t know how long he will be with me but he is well at present but resting more on my lap. Hope all goes ok for you.

  84. Steve

    Our 11 year old schnoodle has a distended belly and breathing problems from the DCM. She props her head up on a footstool or the edge of a chair and stand there for long periods, which seems to help with her breathing. She doesn’t like to lie down and the standing seems to be making her rear legs a bit gimpy, so we are carrying her quite a bit. She is taking lasix and Kalispell. We’ve stacked up some pillows for a headrest. Do you have any suggestions to make her physically more comfortable?

  85. If you haven’t been to a cardiologist for an ultrasound of her heart, that would be a really good idea. In addition, there are other medications that might benefit her, such as pimobendan or digoxin. I’m not familiar with Kalispell, so I can’t really comment on that. Your veterinarian might also be willing to adjust the doses of diuretic (lasix or another one) to help reduce the fluid buildup in the abdomen. I’m not sure if cardiac disease is her only problem at this point, but conditions like arthritis can also be treated to make pets more comfortable. That’s also worth looking into. Best wishes for you and your dog!

  86. Darlene J

    Thank you so much for your post Sarah! My little white pom was diagnosed in August and I struggle every day with whether I’m being selfish putting him through this or not, but he seems very happy, nearly like nothing is wrong. He loves to run around in the backyard chasing the birds, chewing his bullies and will come into the house – wheezing but still grab a toy and want to play fetch! As large as his heart is, I’ve had ultrasounds and x-rays done, he still will roll upside down under my feet to get his belly rubbed for as long as I will accommodate him. I’ve been disheartened, but again, thank you so much for giving me hope he may still be with me for a number of years to come.

  87. Erika

    Hi there,

    I’m in dire need of some advice. My 9 year old chihuahua/mini pincher mix seems to have this condition. His heart is enlarged, he coughs a lot, there is some fluid in his lungs and his trachea is narrowing. We have taken him to the vet and they have not given us a clear diagnosis of what he has rather than just stating what is wrong with him. We were told there is no heart medication he can take and our vet is suggesting we take our dog in for surgery on his collapsed trachea. My family and I are worried he won’t make it through the surgery given his old age and the fact that his heart is enlarged. Are there any medications we should try first before giving into surgery?

    Please please please help!

  88. I would definitely advise that you request a referral to a cardiologist for work up. If there isn’t one located nearby you, then at the minimum x-rays of the chest should be taken. Ultrasound is preferable in most cases. It sounds like they have been, but if they indicate heart failure, there are meds to help with that. If your dog has problems with his liver or kidneys, that can sometimes make it very hard to medicate for heart disease. We are usually able to start -something- for the heart even if there is liver or kidney damage.

    Collapsing trachea is a whole other ball game. For that, if he is having difficulty breathing to the point that he’s turning blue or fainting, then surgery is an option for him. Weigh that carefully by asking about the expected outcome, quality of life, recovery time, etc.

    Good luck with your dog. I hope he recovers soon!

  89. Christine

    Hi, thank you for the great information on your blog. Our 9 year old maltipoo was diagnosed in October with CHF, confirmed by the Cardiologist our Vet contacted to do the ultrasound.
    Its hard to wrap around since 9 years old isn’t that old.
    They put her on 2 x’s a day Enalapril, 3x’s a day Furosemide and 2x’s a day of Vetmedin.
    Since she has been on the medication she has had improvement, eating well and occasional bouts of spunk, but still has the cough, more at night. Last Thursday and Friday she had a couple rough days that left me a little shaken so we made a vet appointment on Saturday. They ran her blood panel to make sure her kidney’s are functioning with the medicines (they are). The vet did notice her breathe rate was very high and wanted to do xrays. Prior to the ultrasound in October she had xrays done too. He compared the October xrays to her new xrays and her heart has enlarged more and her trachea is more curved. She had a little fluid build up too, but not much. He increased her Furosemide dosage to 1.25, 3 times a day and contacted the cardiologist who has added another diuretic and increased her Vetmedin to 3 times a day. My husband has been the one who originally took her to the vet for her last appointments due to scheduling and this was my first appointment to attend. I tend to ask more questions, the harder questions and the vet said diagnosis wise most do not live past 6 months after diagnosis. I have Googled and found many varying things. I am trying to prepare myself while doing everything I can to keep her comfortable while truly not keeping her in pain for my selfish need of not being ready to let go. My difficulty is she has great days where you wouldn’t know she was sick and then she has the bad days where you feel helpless, which is what the last few days have been even with the increased medication.
    I feel her cough is more prominent due to the pushing on the trachea.
    Is there anything that can be done to alleviate this? (not cough suppressants)
    Are we doing everything we can be doing?

  90. I’m sorry that your little girl isn’t doing as well as we’d hope with all of her meds. Heart disease is so individual that there will always be a range of survival times after diagnosis. We often don’t find the disease until the heart is actually in failure. Sometimes it takes a LOT of medication to dry out the lungs and get them back to breathing more comfortably.

    You’re right that compression of the trachea might be a cause for the cough. In that case, cough suppressant is appropriate to alleviate that. Cardiac meds don’t affect that case for cough. (Except the furosemide, which seems to have a little effect; clearly not enough for your dog.)

    I try to have clients measure their dogs’ breathing rate at home when they are sleeping. You count the number of breaths in one minute while your dog is asleep. That number really should be under 20 for clear lungs. Cardiologists will often tolerate a rate of 25 if the lungs also sound reasonably good and the patient isn’t struggling to breathe.

    You can use this questionnaire to evaluate quality of life. If it’s poor, talk to your vet about making some adjustments to meds. http://vet.osu.edu/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

    I wish you and your dog the best!

  91. lin o'reilly

    Hello, I hope you can help my husband and myself decide what to do for the best. Our 4 year old dogue was diagnosed with an enlarged heart in March, he is on 3 vetmedin a day, 1 1/2 cardallis a day, 4 furosemide and 1/2 prilactone 80mg a day, his stomach is still quite large though. He is losing weight rapidly even though he eats, not as much as before he was sick though. His sleeping breath rate is sometimes as high as 60. He can hardly walk when my hubby takes him for his walk and doesn’t enjoy it anymore. He is having trouble breathing and makes some very strange noises when he breathes, what we really want to know I suppose is whether he’s close to the end, we have made the decision a few times and then all of a sudden he surprises us by acting like there is nothing wrong with him. Do you think he’s in pain or suffering at all. We have 4 weeks till we go on holiday and we do not want him to die when we are not here (my daughter is looking after him in our home while were away, this holiday cannot be cancelled sadly as it was cancelled last September after I suffered a heart attack) but my husband thinks by having him euthanized soon then it will look like we are doing it because we are going away which is definitely not the case, my husband and I both idolise this dog and are devastated that he is so sick, we really don’t know what to do for the best but we know he is not going to get better, thankyou

  92. Lin, thanks for writing. I’m sorry to hear that your dog isn’t doing well. One of the major criteria that I use to assess quality of life in patients with heart problems is how well they are breathing. If he’s at 50+, that’s not comfortable for him. I can definitely understand the dilemma that your upcoming vacation poses, but really, four more weeks of being uncomfortable even when at rest and trying to breathe isn’t good quality of life. I know that often once an owner makes a decision to euthanize, the pet will rally and have a good day. What we have to remember is that there are days after that which may well be worse. If his bad days of not wanting to walk, breathing hard, not eating well, etc. outnumber his good days, then we either have to treat more aggressively or call a halt. The veterinarian that sees him will best be able to tell you if there is anything else that can be done with medications.

    I don’t think that it’s wrong to let our pets go with a little dignity and without suffering. I fear a terrible end for cardiac patients in which their lungs are full of fluid, or they have a stroke from a clot that leaves the heart and lodges in the lungs. To be blunt, I think that preventing that kind of death is the best thing to do. It’s not about convenience or a lack of care. It’s wanting to be sure that they’re not suffering a ‘natural’ death. You have a month before you go, so there is a little time to talk things over with the family and to have your veterinarian give you her/his advice also. Most of us will give a solid answer if you ask for it, though the decision must always rest on the owner’s shoulders.

  93. Hi I have a five mounth old jack russel x fox terrier, I noticed her heart beating on the bottom left side of her rib cage, I can see it beating threw her ribs and it beats very loud and to me it is unusual, she is a active and happy dog she does not show any of the symptoms above, but I am concerned about her, for instance is it possible that her heart developed in the wrong place and can this cause any problems for her?

  94. It’s not unusual to be able to feel a dog’s heart on the left side of the chest, down kind of near the elbow. In some smaller dogs, the beating heart can nudge the chest wall without there being anything wrong. However, the only way to really know if there is heart disease or any other problems is to have a vet check her out. Listening to chest, followed by X-rays of the chest and/or an ultrasound of the heart are the steps we would take to figure out an actual heart problem. If your dog is generally feeling good and isn’t coughing, the likelihood of heart disease is lower. It’s not impossible, though, so I recommend you have her examined by a veterinarian.

  95. Colleen Fontenot

    Hi! My Weimar turned 12 on June 25, 2016 and that evening starting coughing which ended in a loud retching sound always. Took to vet, showed he had an infection. Put on Batril and theophylline. And lasix. Was told he was in early heart failure, enlarged heart. No X-rays etc. Cough went away but he quit eating. Was just on lasix at the time. We decided to change vets because he was just wasting away. They immediately put him on Vetmedin 5mg. Twice daily, Enalapril 20mg. Once daily and atenolol25 mg. 1/2 a tab once daily for an arrhythmia. Ultrasound showed the left side of his heart was enlarged and thin.
    He seems to be doing better. Maintaining. He is eating pretty well, he wants to go out when I go out but tires quickly. On his birthday he was 116 lbs. and now weighs 89. 😟. He does this thing from time to time, where he sticks his head up in the air and breathes hard, although closed mouth. And looks a little stressed. Hind legs shake after going out. I noticed also that he has diahrea.. He had this after his antibiotics in the beginning but we gave him probiotics. Noticed he was a little constipated a couple weeks ago but now he is very loose.
    Before the bout with the retching cough, he was in good shape for his age. Still playing and exercising. Although he had slowed down a lot. My main question is if his dosages sound right to you? The Vetmedin was 10 mg. twice daily which was changed to 5 mg. twice daily. The Enalapril was 20mg. Twice daily and has since been changed to once a day. they were lowered because he was having trouble evry once in a while upon rising with his coordination his hind end would be all over the place, so he would just stand there. The vets said his BP was being lowered too much probably. They don’t take his BP. Is the Enalapril too strong possibly still? Any advice/opinion is greatly appreciated. I would never change anything with out asking his vet first. Thanks, Colleen

  96. Dee

    Hi, I recently brought my two year old jack Russell to the vets as he had been more tired than usual. The vet advised that his heart was slightl enlarged but that this was normal in some breeds. She told me that he was perfectly healthy and not to worry as there were no signs of heart disease. I am confused as internet research seems to suggest that this could be something to worry about. As far as I can see, his tiredness suggests he is symptomatic. Also, the vet did it carry out any x-rays etc, she just listened to his heart and I am concerned that this was not suffice. Can you make any suggestions concerning the way forward?

  97. Dee,

    Thanks for writing in. Most of the time, dogs with heart disease have a murmur, which is what your vet was listening for. However, a murmur doesn’t always occur when there is a problem with the heart. If radiographs (X-rays) were not done, I think it’s fine to ask your vet to do so. If there is no indication of heart problems there, the tiredness may be from something else. That can be investigated with bloodwork, urine analysis, etc. Just get those X-Rays done to see what the heart looks like and go from there.

  98. Colleen,

    I’m sorry that I can’t comment on doses for medications. I know that you would check with his vet first, but it’s not legal for me to give specific doses. I can list out the ranges for dosing according to Plumb’s Veterinary Drug Handbook (a popular formulary).

    Vetmedin: 0.5mg/Kg total daily dose, divided into two portions
    Lasix: 0.5 – 6 mg/Kg up to 3 times daily
    Atenolol: 0.25 – 1 mg/Kg every 12 hours
    Enalapril: 0.5 – 1 mg/Kg every 12-24 hours

    If he’s not had his doses adjusted because of the decrease in his weight, you should call your vet to see if reductions in dose are appropriate or not.