tvpjournal.com | July/August 2015 | TodAy's VeTerinAry PrAcTice
HeArT FAilure in dogs: 6 PrAcTicAl TiPs From cArdiologisTs Peer reviewed
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Cough:
Caused by
Heart Failure
or Respiratory
Disease?
Cough is a common complaint that does not
necessarily indicate heart failure. Instead, it may be
related to an enlarged heart compressing the airway
(ie, mainstem bronchial compression) or primary
airway/lung disease.
In a dog with a good appetite and normal activity
level, a chronic, harsh cough that ends with a gag is
less likely to be associated with heart failure. Cough
from mainstem bronchial compression can occur
before onset of congestive heart failure (CHF) and
often persists after active pulmonary edema has been
resolved with diuretic therapy (Figure 1).
It is useful to ask the following questions about a
cough:
` How long has the cough or respiratory signs been
present?
` Is the cough harsh (often described as "ending
with a gag" or a sound similar to "a cat with a
hairball")?
` How are the dog's appetite and activity level?
FIGURE 1. Right lateral thoracic
radiographs in 2 dogs with
DMVD and radiographic
cardiomegaly, including
left atrial enlargement (LA):
A 14-year-old shih tzu (A)
was receiving heart failure
medications (enalapril,
furosemide, pimobendan),
but still had a chronic, harsh
cough that had been present
for several months despite
administration of cardiac drugs.
The dog had a good appetite
and activity level, with an at-
home resting breathing rate
of 24 breaths/min. Mainstem
bronchial compression ( arrow)
was documented. Following
progressive enlargement
of the left atrium, a cough
from mainstem bronchial
compression can develop
before heart failure, and persist
after initiation of heart failure
therapy. Although this type
of cough does not typically
resolve, it is often managed
with a cough suppressant once
the dog is not in active CHF. A
9-year-old Cavalier King Charles
spaniel (B) presented for acute
onset cough and breathing
diffculty over 24 hours.
There is pulmonary venous
enlargement (arrow) and an
interstitial pattern consistent
with pulmonary edema as
evidence of CHF.