Pet 411: Treating congestive heart failure

As we all know, medication can be a powerful tool when fighting illnesses in pets. But in most cases, medicine is just one element of a much larger treatment plan. Diet, exercise and environment all play a big role in our pets’ overall health and wellbeing.

I was reminded of this fact the other day when I received an email from a reader who has a dog suffering from congestive heart failure. She wanted to know what she should be doing in addition to administering medications.

For guidance, I turned to my friend and colleague Dr. Kursten Pierce, who is board-certified in veterinary cardiology and practices in our Waltham, Massachusetts hospital. Here’s what she had to say:

For those who aren’t familiar with congestive heart failure, it occurs when the heart becomes enlarged in size and reaches a point where it can no longer handle the increase in pressure or volume, which results in fluid backing up around or into a dog’s lungs. There are many conditions that can cause congestive heart failure, but the most common in dogs are chronic mitral valve disease due to a leaky valve and dilated cardiomyopathy with weakening of the muscle walls and reduced pumping.

Signs of congestive heart failure include shortness of breath, coughing, lethargy and fainting. If your dog exhibits any of these signs, please get to a veterinarian as quickly as possible. The gold standard for diagnosing congestive heart failure is an echocardiogram paired with chest X-rays to assess the heart, blood vessels and lungs.

Once a diagnosis is made, the veterinarian will prescribe medication to help manage the illness. These will include a diuretic to reduce fluid; another medication to help the heart pump more efficiently; and an ACE inhibitor to decrease pressure on the heart. It’s very important that pet owners are diligent about giving medication. Missing even one dose could cause fluid buildup in the lungs.

As our writer correctly notes, there’s more to treating congestive heart failure than just medication. One recommendation I give my patients is to closely monitor their dogs’ respiratory rates while they sleep. The rate should be less than 36-40 breaths per minute. If it’s higher, that could be a sign of distress. The earlier this is caught, the better chance we have of treating it.

A low-salt diet and treats are also advisable for patients with congestive heart failure. Just like in people, salty foods can cause pets to retain water and lead to fluid buildup. There are a variety of low-salt dog foods on the market. There’s a good list of resources here.

Patients with congestive heart failure should also avoid strenuous exercise. While we want these dogs to have a good quality of life and enjoy the outdoors, exercise should be restricted to walks on leashes. Off leash play should be avoided.

Finally, do everything possible to reduce stress in your dog’s life. For example, if going to the groomer causes your dog anxiety, stop taking him. These stressful situations can lead to fluid buildup around the lungs.

While congestive heart failure can’t be cured, it can be controlled. With the right treatment and care, these patients can enjoy a high quality of life for quite some time.

Thank you so much for your valuable insight, Dr. Pierce! It’s a great reminder to consider a multitude of factors when managing your pet’s health. Thanks to our reader for writing, and keep us posted on how your pup is doing!

Have a question about your pet that you’d like answered? Write to Dr. Cathy Meeks at She’d love to hear from you, and your letter may be picked for an upcoming Pet 411 column.