Introduction:
Heart Disease in Dogs, Cats, and Other Pets
by Roger Ross, DVM
It surprises some owners that heart disease is common in cats and dogs...just like in humans. And just like in humans, the heart is a mechanical-electrical pump made out of living tissue and is prone to not only to all the biological hazards affecting cells, but also to all kinds of mechanical, stretching, leaking, and electrical mishaps, pressure problems, clogs, and disasters that affect non living tissue.
Unlike with diarrhea or skin problems, most pet owners don't know or even suspect their pet has heart disease, but veterinarians often detect the problem during routine physical exams early enough to make a wonderful difference to the longevity and well being of the pet.
This is one of several major reasons for making sure your pet has a good check up at least once a year.
Your veterinarians will also suspect or detect heart disease when your pet is brought in for
coughing or hacking
wheezing
decreased energy or stamina
edema
abdominal bloat
signs of poor cirulation
fainting
Sometimes your vet will pick up on early heart disease even when there are no obvious symptoms yet because
you're the wonderful type of pet owner that allowed your vet to spend a little extra for pre-anesthetic blood work and/or EKG monitoring prior to and during a surgery or dental cleaning procedure that was needed.
And, of course, heartworm disease ... the most common type of heart disease... is frequently detected long before obvious symptoms occur because of the routine testing done in just about every clinic in those parts of the country where heartworm is prevalent.
One last introductory comment: Just like in humans, heart disease is associated with genetic factors but also with
Obesity
Lack of Exercise
Poor Diet
What To Expect When You Take Your Dog To The Vet For Heart Disease
Exam and History:
There are lots of clues on history such as being tired after a little bit of exercise, coughing after exercise and so forth.
We will be giving your pet a good general exam that will include listening carefully to your pet's heart and lungs, feeling the quality of the pulse, checking the color and nature of the mucus membranes, checking the tiny vessels in the eyes, palpating the abdomen, and maybe rechecking everything after exercise.
We will also be asking a lot of questions that will help us with the diagnoisis and hopefully prevent us from going down some expensive false trails. (such as mistaking indigestion for heart disease and vice versa)
It's interesting that certain breeds are more likely to have certain types of heart disease:
Murmers: Cockers, Poodles, Schnauzers, Dachshunds, Chihuahuas, Pomeranians, and Min. Pinschers
Myocarditis: Boxers, St Bernards, and German Shorthair Pointers
Cardiomyopathy: large breeds of dogs
Heart base tumors: Boston Terriers, Boxers, and English Bulldogs
Various Congential Heart Problems: Poodle, Collies, Poms, Sheperds, Eng. Bulldogs, Schnauzers, Pointers, Keeshonds, Fox Terriers, Irish Setters, and Weimaraners.
Once heart disease is suspected, your vet will discuss and offer and least some of the following laboratory and imaging choices:
A. Rule out heartworm disease with an elisa test:
B. CBC and Chemistry; this is important because so often heart disease is seen in association with other diseases...especially kidney and liver diseases.
C. Radiographs; to see if the heart is enlarged typical of certain types of heart disease, to see if there are tumors, to see if the lungs are very congested, and to see if there is fluid around the heart.
D. Urinalysis: This test is not likely to tell us anything specific about the heart, but it's included in the work up of pets suspected of serious disease.
Why? Because most serious diseases also involve other organ systems and this fairly inexpensive test of urine gives us a good feel for the heatlh of the kidneys and bladder as well as hints about pancreatic, liver, and gall bladder health. It helps with our asscessment of tissue hydration too.
E. EKG: EKG's help us rule out cardiac blocks and arrthymias, electrical conduction problems of the heart, and also are pretty good at indicating cardiac enlargement.
If your vet, like me, is not expert at reading EKG's...or chest x-rays, for that matter, with the modern miracle of the digital age, we can have an expert read your pet's EKG or X-ray from a remote location through the phone lines!
F. Echo, Ultra Sound, Angiograms, MRI's, Cat Scans, and other types of Imaging: All this is now available in veterinary medicine, although usually a trip to a specialist facility is necessary.
As you might suspect, while many heart problems can be greatly improved with inexpensive medicine and nutritional support, the best available testing and treatment for heart disease can be quite expensive.
I mention this for three reasons:
One: To prepare you to think realistically. Heart
disease is farily common and often stikes
without much warning.
Two: To motivate you to take the trouble and
relatively minor expense of providing
a good lean diet, lots of exercise, and
heartworm preventive.
Three: To consider Pet Health Insurance. It sure is
nice to have when your beloved pet needs it.
Once a Tentative Diagnosis is Made, your vet will discuss these treatment options:
1. Consider referral to a specialist for heart disease...Your vet will give you an honest accessment of his or her skill level in treating any serious disease. Don't expect your general practioner to be an expert in everything...especially a complex disease like heart disease where highly specialized equipment is often needed and where new, potentially dangerous, medications are frequently being introduced.
2. At our clinic, if you elect to let me treat your dog after making a tentative diagnosis of heart disease, here's what we'll consider trying:
A. Nutritional support. We'll recommend taking advantage of one the several superior diets made especially to minimize cardiac problems.
B. Weight Loss if appropriate...Many heart disease patients are way too fat.
C. Furosimide tablets as needed to control coughing and congestion. This is a diuretic and will make your dog urinate and drink more but often works well in relieving the fluid load in the lungs associated with heart disease.
D. Digoxin tablets: this poison, given in tiny amounts helps improve cardiac function. This medication is not tolerated by many pets (causes nausea etc), so we will start out with a small dose and work up.
E. Blood Pressure tablets: Ace Inhibitors (Enalapril or Captopril) greatly reduce the work load of the heart by causing dilation of the blood vessels. Possibly dangerous if your pet also has kidney disease. Another reason to do blood work and an urinalysis to check other organ systems.
F. Potassium or Multivitamins; loss of potassium is a problem with both heart disease and the medications used to treat heart disease.
G. Aspirin; small amounts help prevent secondary problems such as blood clots that are sometimes part of the cardiac disease syndrome.
The aspirin dose we will be recommending is small enough that problems such as GI inflammation is not likely.
H. Beta Blockers decrease outflow obstruction common in heart disease and are often recommended by cardiac specialists, especially in cardiomyopathy.
I. CoEnzyme Q10: a neutriceutical highly touted by the people that sell it for improving cardiac and vascular health. CoEnzyme Q10 does seem to be helpful, but beware that it hasn't been accepted yet as safe and effective by cardiac specialists, the FDA, etc.
It's hard to get approval in the medical industry for neuticeuticals and despite lots of testimonials for these medications it's very hard to get honest information about them. I'm presently a believer in the usefulness of CoEnzyme Q10 but based on pretty flimsy medical evidence. (See my comments on the neutriceutial business in the medication section of this site.)
Despite these warnings, supplementation with coenzyme Q10 has resulted in dramatic increases in cardiac contractility in humans with cardiomyopathy. Coenzyme Q10 is a member of the electron transport chain essential in myocardial energy production. Clinical trials examining the efficacy of coenzyme Q10 in the dog are underway.
J. Frequent rechecks. Heart disease and the medications used to treat heart disease both merit frequent rechecking and adjusting.
K. Again...consider referral. Especially if results are poor.
Note: Summer 2007: there's a new medicine available called Vetmedin that has greatly improved both the quality of life and the length of life in many heart patients
Heart Problems in Cats
It turns out that cats also suffer from heart disease, especially cardiomyopathies of unknown causes just like in humans.
They also get heartworm disease and outdoor cats should be on preventive medication.
Symptoms of heart disease include labored breathing, weight loss, rear end weakness (due to blood clots), loss of energy and respiratory congestion or wheezing.
Here's what to expect: when you go to a vet with your cat
and heart disease is suspected:
Exam and History: We will be checking for a laboring heart, throbbing jugular veins, bulged eye vessels, and any hint of lower lung respiratory sounds in addition to our normal all over exam. Heart disease in cats is often subtle in the early stages, but if suspected, here are your options:
Lab and Radiographic Work up: (very important with heart disease to confirm the diagnosis; trial and error treatment is not appropriate with heart disease. Imagine your physician putting you on expensive and potentially dangerous heart medication based on a cough or exercise intolerance)
A. Heartworm Elisa Test: more and more cats are being positively diagnosed with heartworm disease causing a range of symptoms from minor to deadly.
B. CBC and Chemistry Blood Work: Heart disease is often associated with kidney and liver disease and is sometimes infectious; all things we can find out with blood work. Also a good idea prior to anesthesia which we will need to get decent radiographs.
Cats are prone to hyperthyroid disease which affects the heart, so we also recommend a thyroid test.
C. Radiographs. Usually diagnostic; in other words we can usually confirm the disease except in the early stages and see how bad the disease is on radiographs. This is because cardiomyopathy diseases cause enlargement of the heart as well as pulmonary edema and effusion (fluid in the lungs).
D. Urinalysis: This test is not likely to tell us anything specific about the heart, but it's included in the work up of pets suspected of serious disease. Why? Because most serious diseases also involve other organ systems and this fairly inexpensive test of urine gives us a good feel for the heatlh of the kidneys and bladder as well as hints about pancreatic, liver, and gall bladder health. It helps with our asscessment of tissue hydration too.
E. EKG:
F. Echo, Ultra Sound, Angiocardiography, MRI's, Cat Scans, and other types of Imaging: All this is now available in veterinary medicine but expect to go to a specialist, more and more of whom are now available in most regions of the modern world. The only reason not to take advantage of specialists is expense. I mention this mainly to motivate you to consider pet health insurance. It sure is nice when you need it.
Treatment Options to Consider:
1. Consider referral to a specialist for heart disease. Don't expect most general practioners to be expert cardiac physicians!
2. If you can't afford to go to a specialist, here's what we will do in hopes of controlling the problem:
A. Diets that minimize the problem
B. Weight Loss if appropriate...Many heart disease
patients are way too fat.
C. Furosimide tablets as needed to control coughing and congestion. This is a diuretic and will make your cat urinate and drink more but often works well in relieving the fluid load in the lungs associated with heart disease.
D. Blood Pressure tablets (enalapril) to help reduce the fluid load the heart has to pump against.
E. Beta-adrenergic Blockers (atenolol) reduces the oxygen demand by the heart
F. Taurine ( an amino acid that is poorly synthesized by cats and a lack of can cause both blindness and heart disease. (Available in inexpensive multivitamins made especially for cats)
G. A course of antibiotics is often needed to fight or control the associated respiratory disease.
H. Sometimes steroids are needed to make breathing easier.
I. Frequent rechecks. Both the disease and the medications used merit frequent rechecking and adjusting based on how well everything is working.
Lots more about Heart Disease on other pages:
Heartworm Disease in Cats and Dogs
The History of Heart Disease and Why the Stethescope was invented
Discussion of various heart diseases in cats and dogs
Heart Disease in Dogs
"When it comes to heart disease, regular visits to your veterinarian could mean the difference between life and premature death," says Joanne Bicknese, DVM, Manager, Technical Services for Merck AgVet, the animal health division of Merck & Co., Inc. "Dog owners may not realize that their pets are susceptible to many forms of heart disease. In most cases, heart disease can be successfully managed with early detection and treatment".
Heart Failure
One major threat to your dog's health is heart failure. Of the dogs in the United States examined annually by a veterinarian, approximately 3.2 million have some form of acquired heart disease and may be in heart failure.
Heart failure results from the heart's inability to pump blood at a rate required to meet the body's needs. While continuing to work harder to pump blood, further heart damage can occur.
Although some of the early stages of heart failure in dogs have no visible signs, heart failure can be diagnosed through a clinical evaluation by a veterinarian. Dogs with mild to moderate heart failure typically experience heart enlargement, coughing, lethargy and difficulty breathing.
Severe heart failure is characterized by difficulty breathing (even at rest), fainting, profound intolerance to exercise, loss of appetite and weight loss.
"Too often, dog owners do not take their dogs to visit the veterinarian until they are displaying severe signs of heart failure, and by then it may be too late," says Dr. Bicknese.
"When heart disease is detected in your dog, your veterinarian can recommend a schedule of regular visits and discuss a treatment plan that can help."
Overall Good Health
In addition to safeguarding your dog's heart, there's a lot you can do to keep your dog happy and in top shape. Ensure that your dog gets a moderate amount of exercise on a regular basis and has a balanced diet. An obese dog may have a harder time staying healthy.
Avoid the heartbreak of seeing your family's best friend fall ill. Proper care and veterinary supervision can help you watch your dog grow to a "hearty" old age.
TWO TOUGH QUESTIONS JUST FOR FUN: Not related to heart disease:
Question 1:
If you knew a woman who was pregnant, who had 8 kids already, three who were deaf, two who were blind, one mentally
retarded,and she had syphilis; would you recommend that she
have an abortion?
Read the next question before scrolling down to the answer of this
one.
Question 2:
It is time to elect a new world leader, and your vote counts. Here are the facts about the three leading candidates:
Candidate A:
Associates with crooked politicians, and consults with astrologists. He's had two mistresses. He also chain smokes and
drinks 8 to ten martinis a day.
Candidate B:
He was kicked out of office twice, sleeps until noon,used opium in college and drinks a quart of whisky every evening.
Candidate C:
He is a decorated war hero. He's a vegetarian, doesn't smoke, drinks an occasional beer and hasn't had any extramarital affairs. Which of these candidates would be your choice?
Decide first, no peeking, then scroll down for the answer.
Candidate A is Franklin D. Roosevelt
Candidate B is Winston Churchill
Candidate C is Adolph Hitler
And by the way, the answer to the abortion question: If you said
yes,you just killed Beethoven.
Pretty interesting isn't it? Makes a person think before judging
someone.
Just Something Else Interesting; Not related to Heart Disease:
(except for the heavy cream sauces alluded to in this story)
Momma Mia, Life is pretty interesting when you're looking. Have you noticed?
There's an imaginary line you can draw across a map of Italy.
At just about the latitude of Rome.
It's called the Veal line.
The line where the veal you eat changes its sex.
North of the veal line the soils are rich enough to support dairy cattle. So farmers keep the females and slaughter the bull calves for veal. Vitello. Masculine gender suffix.
And with all that milk of a dairy region, you get pasta sauces enriched by cream. And the principle cooking fat is butter. The great cheeses are made from cow's milk. That's your rich, Northern kitchen.
Like in Emilio-Romagna. Or Parma, where the prosciutto comes from hogs that are fed on the whey left over from making parmesan cheese.
But south of the line, in the Mezzogiorno, people tend to be poorer. The soils are poor. Water is often scarce.
Too scarce to support dairy herds. This land is better suited to hardy grazers, like sheep and goats.
And if you do keep cattle, you keep the bull calves for beef or for a work ox and you slaughter the she-calves: Vitella.
You cook more with olive oil instead of butter. The cheeses are made from goats' and sheep's milk. Pecorino, or caciocavallo.
And the tomato flourishes in such conditions, so sauces are more likely to be tomato based.
