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Congestive Heart Failure in Dogs

What is Congestive Heart Failure in Dogs?

Congestive heart failure (CHF) in dogs is a condition where the heart’s ability to pump blood efficiently is compromised, leading to fluid buildup (congestion) in the body.

In CHF, a dog’s heart struggles to pump blood effectively, causing fluid to accumulate in the lungs, chest, abdomen, or limbs, depending on the type of CHF. Similar to humans, a dog’s heart comprises a right and left side. The right side receives oxygen-poor blood from the body and sends it to the lungs for oxygenation, while the left side pumps oxygen-rich blood to nourish the body’s tissues.

CHF in dogs can manifest as either left-sided or right-sided:

  • Left-sided CHF: This is more common in dogs and occurs when blood backs up in the lungs, leading to pulmonary edema. Dogs with left-sided CHF typically exhibit symptoms such as coughing and difficulty breathing.
  • Right-sided CHF: In this type, the right side of the heart fails to function properly, causing blood to accumulate in the body’s main circulatory system. This leads to fluid buildup in the abdomen (ascites) or limbs (peripheral edema).

Stages of Congestive Heart Failure

The progression and risk of congestive heart failure (CHF) in dogs are categorized into stages similar to those used for humans with CHF. These stages range from the initial risk of developing CHF without showing symptoms (Stage A) to severe symptoms (Stage D).

  • Stage A: Dogs at higher risk of developing CHF but currently exhibit no symptoms or structural changes in the heart. Breeds with a genetic predisposition include Miniature Poodles, Cocker Spaniels, Terriers, and some larger breeds like Great Danes or Dobermans.
  • Stage B: Dogs with a detectable heart murmur (a “whooshing/swishing” sound) that a veterinarian can hear but do not show any symptoms. A murmur indicates turbulent blood flow within the heart.
  • Stage B2: Dogs showing structural changes on X-rays or echocardiograms (specialized ultrasounds to diagnose the heart) but without symptoms.
  • Stage C: Symptoms of heart disease are evident in this stage. Dogs in Stage C exhibit current or historical clinical signs of congestive heart failure but still respond well to medications and treatment.
  • Stage D: This stage is considered “end-stage” disease. Dogs in Stage D typically have severe symptoms of the disease that unfortunately no longer respond to medications or other treatments.


The symptoms of congestive heart failure (CHF) in dogs may include one or more of the following clinical signs:

  • Coughing, sometimes accompanied by coughing up foam
  • Difficulty breathing
  • Increased breathing rate, even when at rest
  • Inability to engage in exercise
  • Fatigue, lethargy, and weakness
  • Cyanotic (blue) gums
  • Distended abdomen
  • Collapse or sudden death

If your dog displays any signs of respiratory distress or difficulty breathing, seek emergency veterinary care immediately. Dogs experiencing moderate to severe symptoms of congestive heart failure may require hospitalization and urgent medical attention.


The causes of congestive heart failure (CHF) in dogs vary, but the most common is myxomatous mitral valve disease (MMVD), also known as chronic mitral valve disease, degenerative mitral valve disease, mitral insufficiency, or endocardiosis.

MMVD occurs when the mitral valve, situated on the left side of the heart and serving as the gateway between the left atrium and the left ventricle, fails to close properly, leading to blood leakage through the valve. This condition gradually leads to left-sided congestive heart failure due to the diminished ability of the left side of the heart to pump oxygen-rich blood to the body. While the cause of mitral valve disease remains unknown, there appears to be a significant genetic component, particularly in small-breed dogs prone to developing congestive heart failure due to this condition.

In large-breed dogs, the most prevalent inherited form of heart disease is dilated cardiomyopathy (DCM), characterized by the weakening of the heart muscle and its inability to contract effectively, resulting in heart dilation. Breeds such as Doberman Pinschers, Boxers, and Great Danes are predisposed to DCM.

Other factors contributing to CHF in dogs include:

  • Heart valve disease
  • Defects or holes in the heart walls (ventricular septal defect)
  • Congenital cardiac defects (such as patent ductus arteriosus, pulmonic stenosis, and aortic stenosis)
  • Accumulation of fluid around the heart (pericardial effusion)
  • Heartworm disease
  • Arrhythmias (irregular heartbeat)
  • Elevated blood pressure
  • Infections (such as endocarditis)
  • Tumors (including chemodectoma, lymphoma, and hemangiosarcoma)


The process of diagnosing congestive heart failure in dogs typically begins with a veterinarian listening to the heart and lungs using a stethoscope. Most dogs with congestive heart failure will exhibit a heart murmur, which is graded in severity on a scale from 1 to 6:

  • Grade 1: A very soft murmur, often challenging to hear.
  • Grade 2: A soft murmur but easily detected.
  • Grade 3: A moderately loud murmur.
  • Grade 4: A loud murmur.
  • Grade 5: A very loud murmur audible through the stethoscope without touching the chest. The veterinarian can feel a vibration over the heart (palpable thrill) through the chest wall.
  • Grade 6: A very loud murmur that is audible without stethoscope contact with the chest. The veterinarian can feel a palpable thrill over the heart through the chest wall.

If congestive heart failure is suspected, the veterinarian may recommend a chest X-ray or radiograph to assess for heart enlargement or signs of fluid accumulation in the lungs (pulmonary edema). An electrocardiogram (ECG or EKG) may also be utilized to evaluate the heart’s rate and rhythm.

At this stage, the veterinarian may refer the dog to a veterinary cardiologist for more specialized testing, such as an echocardiogram or ultrasound of the heart. An echocardiogram is particularly valuable for identifying the underlying cause of a murmur, determining the likely cause of congestive heart failure, and assessing the heart’s ability to pump blood effectively.


Your veterinarian will typically suggest addressing both the root heart condition (if feasible) and any fluid buildup. While an underlying cause like heartworm disease might be treatable, in the majority of cases, the root cause of congestive heart failure cannot be eradicated; it can solely be managed.

Medications for CFH in Dogs

The medication regimen for treating congestive heart failure (CHF) in dogs varies depending on the underlying cause and the severity of the condition. Your veterinarian or cardiologist will determine the appropriate drugs, dosages, and frequency, and should be consulted before making any changes.

Typically, the primary treatment for congestive heart failure involves the use of diuretics (water pills). Diuretics help reduce fluid accumulation in the lungs, abdomen, or legs, depending on the initial cause of heart failure.

Pimobendan is another commonly prescribed medication for treating CHF. This drug enhances the heart’s ability to contract, improves pumping action, dilates blood vessels, and reduces the heart’s workload.

In cases of myxomatous mitral valve disease and dilated cardiomyopathy, studies have shown that Pimobendan can delay the onset of heart failure and prolong overall survival time when initiated before symptoms appear (stages A and B CHF).

Additional medications that may be beneficial in managing CHF include Digoxin, Diltiazem, Angiotensin-converting Enzyme (ACE) inhibitors, beta-blockers, and calcium channel blockers. Your veterinarian will likely recommend a combination of these medications tailored to address your dog’s specific CHF and underlying heart disease.

Oxygen Therapy for CHF in Dogs

For dogs experiencing left-sided heart failure or those with significant lung fluid accumulation, adequate oxygen transfer from the lungs to the bloodstream may be compromised. In such instances, oxygen supplementation can be beneficial.

Your dog might receive oxygen therapy in several ways. They may be placed in an oxygen cage, where oxygen levels are carefully regulated, or provided with oxygen through a nasal tube. Alternatively, direct airflow toward the face, known as “flow by” oxygen, may be administered.

In severe cases, a dog may require intubation, involving the insertion of a tube into the trachea to deliver oxygen directly, or even mechanical ventilation, where a machine assists with breathing. However, such interventions are typically associated with a poor prognosis.

Nutrition for CHF in Dogs

In addition to medical treatments, nutritional management and dietary adjustments can play a crucial role in managing congestive heart failure (CHF) in dogs. Tailoring nutrition to address your dog’s specific heart condition may help slow disease progression and enhance overall quality of life. It’s important to discuss nutritional goals, dietary recommendations, and potential supplements with your primary veterinarian, veterinary cardiologist, or a veterinary nutritionist.

Certain dietary supplements such as fish oil/omega fatty acids, taurine, and L-carnitine may be beneficial in reducing inflammation, managing arrhythmias, and improving heart function. Additionally, maintaining appropriate weight, preserving muscle mass, and ensuring a balanced diet are important considerations for dogs with CHF. As always, it’s essential to seek guidance from your veterinarian, cardiologist, or veterinary nutritionist before making any dietary changes or adding supplements to your dog’s regimen.

Living and Management

The recovery and management process for congestive heart failure (CHF) in dogs vary depending on the underlying cause and should be customized by your veterinarian and/or veterinary cardiologist to suit your specific dog’s needs. However, most dogs can enjoy a moderate level of exercise and activity without stringent restrictions.

In managing left-sided congestive heart failure patients at home, it’s crucial to monitor the respiratory rate, which indicates the frequency of breaths per minute. This helps gauge the level of fluid accumulation in the lungs and alerts you to any need for veterinary attention.

Typically, a resting dog should have a respiratory rate of fewer than 30 breaths per minute. It’s important to count both inhalation and exhalation as one breath, and ensure the dog is at rest or asleep during counting. Avoid assessing the respiratory rate immediately after physical activity.

Your veterinarian will conduct periodic chest X-rays to evaluate heart size and detect any signs of lung fluid accumulation. Blood work, including kidney values and electrolytes, should be performed every 3-6 months to monitor your pet’s tolerance to heart medication. Additionally, the veterinary cardiologist will likely recommend rechecking an echocardiogram every 6-12 months to assess heart changes and make necessary medication adjustments.

While there is no cure for congestive heart failure in dogs, diligent management and daily medications can contribute to a good quality of life and potentially extend survival time. However, once stage D congestive heart failure sets in, the median life expectancy typically ranges around nine months.

Congestive Heart Failure in Dogs FAQs

What is the life expectancy of dogs with congestive heart failure?

Dogs diagnosed with congestive heart failure can typically expect a survival time ranging from 6 to 14 months at stage C. Early detection and appropriate medical intervention are crucial for improving a dog’s prognosis.

What are the signs of the final stages of congestive heart failure in dogs?

Stage D represents the “end-stage” of the disease. During this phase, dogs typically exhibit severe symptoms that no longer respond to medications or treatments. These symptoms may include coughing, difficulty breathing, increased respiratory rate even at rest, exercise intolerance, weakness, cyanotic gums, abdominal distension, and potential collapse or sudden death.

How can I assist my dog with congestive heart failure?

If you suspect congestive heart failure or respiratory distress in your dog, promptly seek emergency veterinary care. Timely intervention is crucial for managing the condition and ensuring your dog’s well-being.

 Is congestive heart failure painful for dogs?

While dogs with congestive heart failure usually don’t exhibit obvious signs of pain, humans with the condition have reported experiencing chest discomfort. It’s plausible that dogs may also experience some level of discomfort. If you suspect your pet is in pain, consult your veterinarian for appropriate management.

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