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for dogs and cats diagnosed
with heart disease.

Congestive Heart Failure

Overview, Diagnosis, and Prognosis

Congestive Heart Failure is the end result of the heart’s inability to provide the body with adequate circulation to meet its needs (Eldredge,et. al., 2007). Health of the liver, kidneys, lungs and other organs are affected by the circulatory failure. If caused by congenital heart disease such as cardiomyopathy or valvular dysfunction, your pet will not overcome congestive heart failure once he has entered this state. It is, however, possible for your pet to live relatively comfortably in this state if you take responsibility for taking extra special care of him.


Early Signs:

  • tiring easily
  • decrease in activity level
  • intermittent coughing which tends to be during periods of excitement or exertion. It also tends to occur at night, about two hours after going to bed. Eldredge, et. al., (2007) states that dogs may appear restless, pacing around instead of settling down to sleep.

Later signs:

  • lack of appetite
  • rapid breathing
  • marked loss of weight
  • coughing, which is caused by fluid in the lungs caused by the heart’s inefficiency. Rapid accumulation of fluid can cause the dog or cat to cough up red bubbly fluid, called pulmonary edema. Pulmonary edema indicates left-sided heart failure.
  • abdominal swelling, or “ascites”, is indicative of right-sided heart failure. Fluid leaks into the abdomen causing a marked potbellied appearance, which is sometimes accompanied by a swelling of the legs called “edema.”
  • pleural effusion is when fluid backs up into the lungs causing coughing. This can happen with right or left sided heart failure.


With proper treatment, dogs and cats with congestive heart failure may live longer and more comfortable lives! (Eldredge, et. al., 2007 & Eldredge, et. al., 2008 – exclamation mine). No matter what, it is important to treat the underlying cause of congestive heart failure, as some causes (heartworms, bacterial endocarditis) are potentially curable if they are caught before the heart becomes too permanently damaged.

Major forms of treatment for animals in a state of congestive heart failure mimic treatment of other forms of serious heart disease including valvular dysfunction and cardiomyopathy.

  • low salt diets or other special cardiac formula veterinary diet: See Heart Disease:Resources:Diet
  • exercise restriction
  • medication therapy, commonly diuretics and drugs that increase the heart’s pumping efficiency and control moderate arrhythmias. They are generally the same drugs used in people – however, do NOT under any circumstances feed your own heart medications to your pets! Dogs and cats metabolize medication at a far different rate that human beings do, and dosages need to be prescribed by your veterinarian.
  • vitamin B, taurine, carnitine, or coenzyme Q supplements – again, if you intend to add supplements to your pet’s diet, consult a veterinarian.

The “ABC’s” of CHF Management!

A: Activity

Your pet’s activity should gradually increase to near-normal levels if therapy is being effective. A sudden reduction in activity, or persistent inability to perform basic tasks may be a sign that medication changes are necessary. In dogs, we commonly see exercise intolerance, or “slowing down” that is often attributed – inappropriately – to “getting older”.

A: Appetite

Appetite is a very important sign of disease in animals, as they generally do not eat if they don’t feel well. CHF is no different; animals with fluid in or around the lungs will not eat. This is also the primary sign of most medication side effects, thus it is very important to call your veterinarian if your pet stops eating or has a diminishing appetite while on therapy for CHF.

B: Behavior

Changes in behavior are often the first sign of CHF, especially in cats. It is important to watch for subtle and not-so-subtle changes in the way your pet behaves at home. In cats, this usually manifests as hiding in unusual places, inability or unwillingness to perch in normal locations, or reduced interaction with family members or other pets in the house. In dogs, this is usually less obvious, although they may develop exercise intolerance, and may also be less interactive with family members or other pets. As fluid accumulates, pets may appear agitated or restless – this is usually a sign that you need to take your pet to the hospital.

B: Breathing

Difficult or labored breathing is a medical emergency, and you should seek veterinary attention immediately. Most commonly, this is somewhat slow in onset; you may notice increased panting, or that your pet seems out of breath; this may wax and wane, or may consistently worsen until labored breathing develops. It is often worse at night or in the early morning when they first wake up. When the fluid accumulation becomes even more severe, animals cannot lie down, and will sit on their chest or stand with their elbows out and neck extended. This means there is so much fluid in the lungs that they cannot live much longer, and therefore require immediate therapy. One simple way to monitor for breathing problems is to keep a short diary of your pet’s respiratory (breathing) rate. To do this, count the number of breaths your pet takes in 15 seconds while sleeping or resting quietly, then multiply by 4. A normal animal will have a resting respiratory rate below 40 per minute. If you notice your pet is consistently over 40 breaths per minute while sleeping, or is trending upward (gradually increasing respiratory rate over days), then contact a veterinarian for advice. A twice daily record is sufficient.

C: Coughing

This is a very common sign of CHF in dogs, but is rare in cats. In cats, coughing is usually associated with asthma (may look like “coughing up a hairball”) or heartworms. In dogs, it may be due to CHF or concurrent tracheal or lung diseases. Coughing due to heart disease is usually present to some degree, but should be at a level that you and your pet can tolerate. If you notice that the coughing is increasing in severity, length or frequency, this may be a sign of fluid accumulation in the lungs. You should call your veterinarian right away. If you notice the cough is worse at night or in the morning, or it is keeping you and your pet awake at night, call your veterinarian – medications should be adjusted to maintain your pet’s (and your own!) quality of life.

C: Communication

Communication is paramount to successful management of congestive heart failure at home. Optimal outcome depends on your observations; you know your pet best, and if they seem “off” in any way, it is important to discuss this with a veterinarian. Sometimes, it is a minor problem that can be addressed over the phone; other times, it can save your pet’s life.
Our primary goal is to make your pet comfortable, while extending that quality of life for as long as possible. CHF is usually a terminal condition, but there are many steps owners and veterinarians can take to make sure it is not a miserable one. It can be a very complicated, confusing process; there are many medications, doctor visits and potential problems that can arise throughout therapy, and we are here to help. Please do not hesitate to ask questions (no matter how silly they seem at the time). The more you know, the less intimidating and frightening this process will be. Our hospitals are always open, with professionals who can help answer your questions and address concerns whenever they may occur.