Changes in Medications

end stages of heart failure in dogs
Drug adjustments may need to be made in end stage heart failure in dogs

In the end stages of heart failure in dogs, medications, which, before were well tolerated, may no longer work well. Managing congestive heart failure symptoms therefore takes a balancing act. For example, a dog in the earlier stages of heart failure may have tolerated well a combination of drugs such as furosemide, ACE inhibitors (enalapril, benazepril) and pimobendan, but at some point these drugs may no longer help.

Some dogs may benefit from increasing doses of certain drugs or the addition of other drugs. For instance, another diuretic drug called spironolactone may be added to help get rid of fluid out of the lungs in end stage congestive heart failure in dogs, explains veterinarian Dr. Andy.

This drug operates in a different location in the kidney compared to furosemide. Sometimes, this helps remove excess fluid when furosemide has lost some of its effectiveness, explains veterinarian Dr. Bob.

It therefore becomes necessary in the late stages of heart failure to re-evaluate existing therapies and introduce new therapies, in an effort to make symptoms less severe, explains  Johnny D. Hoskins, a board-certified veterinarian specializing in internal medicine.

Report to your vet if your dog is in the end stages of heart failure and you are having trouble managing his symptoms with the medications that were previously prescribed.

“It is important to remember that heart failure is progressive, and medications that were historically well-tolerated may lead to, or potentiate, clinical signs at a later stage.”~Johnny D. Hoskins, DVM, PhD, DACVIM

Helping Your Dog Eat

As mentioned, many dogs in the late stages of heart failure may be unwilling to eat.  This can be due to several reasons that may be worth investigation with the help of your vet. Some causes may be directly related to the heart failing, some may be concomitant or even totally unrelated.

During the end stages of heart failure in dogs, because the dog’s digestive system receives less blood, affected dogs may feel nauseous or they may feel full due to the presence of ascites.

The loss of appetite at the very end may be a natural sign of the body starting to shut down and many dog owners are distressed by this because feeding is associated with care and love. Dogs with advanced heart disease may start losing weight and develop cardiac cachezia.

If your dog has loss of appetite consult with your vet, loss of appetite may also occur as a side effect of some medications (like digoxin) or your dog may have stomach ulcers.

Loss of appetite can also result from dietary indiscretion (owners feeding different foods to tempt their dogs to eat or take their medications but such foods may not agree with their stomachs). In some cases, dogs may be unwilling to eat due to teeth problems which are common in elderly dogs.

Depending on the underlying cause, your vet may suggest a few therapies. Appetite stimulants along with supportive digestive care may be suggested. A home-made salt restricted diet or a commercial diet for congestive heart disease in dogs may be helpful to increase palatability.

Managing the Cough

Coughing in dogs with end stage heart failure may be directly linked to the heart but in some cases there may be other dynamics at play. For instance, small dogs may be affected by collapsing trachea, a condition where their trachea weakens and causes coughing.

An enlarged heart may secondarily cause coughing by putting pressure on the dog’s bronchi. Cough may also be directly related to the failing heart. The coughing in this case occurs because the heart is unable to cope with the demand of supplying oxygen to the body. Fluid at some point will start building up in the lungs (pulmonary edema).

The vet can implement a management plan using several strategies such as increasing dosage or frequency of diuretics (water pills, such Lasix, generic name furosemide). Furosemide helps because it helps pulls any accumulating fluid out of the lungs.

Dogs already receiving maximum doses of this drug, may benefit from injections of diuretics under the skin. Ask your vet for guidance.

“Your dog may need injections of a diuretic (such as Lasix/furosemide) to quickly move the fluid out of her lungs so she can breathe more easily. Once she is stablilized, she would likely go home with Lasix in pill form so that the fluid doesn’t build up again, as well as the Enalapril (which is something called an “ace inhibitor” to help the heart function more effectively). “~Dr. Fiona, veterinarian

Managing the Shortness of Breath

The fastest way to help with any breathing issues is to have the vet deliver an injection of lasix so to remove excess fluid from the chest. Affected dogs may need some oxygen therapy too while waiting to see if the injection helps.

Drug dosage adjustments once the dog is stable may help. Never increase dosages on your own, always consult with your vet. 

If excess fluids in the abdomen are causing trouble breathing excess fluids can be removed through a procedure known as abdominocentesis. Afterward, diuretics should be administered.

As breathing becomes difficult, dogs may engage in open-mouth breathing and may be reluctant to lie down. These dogs may be wanting to keep their head high so to keep their air passages open. These dogs can be helped by propping a pillow or two so that they can sleep with the head raised up enough to be comfortable.

Dogs in the end stages of heart failure are very fragile and stress and exercise should be kept to a minimum. As breathing becomes more and more labored, it’s a sensible choice to elect for euthanasia to prevent unnecessary suffering associated with the inevitable.


  • DVM360: Keys to managing end-stage heart failure
  • Textbook of Veterinary Internal Medicine Expert Consult: Expert Consult, 7e(2 Volume Set) 7th Edition. by Stephen J. Ettinger DVM DACVIM (Author), Edward C. Feldman DVM DACVIM (Author).