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Heart medication questions.

Species: Dog
Breed: Chihuahua
Age: More than 15 ye
My dog’s name is Yoda. He is 16 years old. But for his heart, he is in good shape. He has been diagnosed with congestive heart failure (CHF). Below is a brief medical history accompany by labs, diagnostics and reports:

1. 7/2012 Based on thoracic x-rays and physical exam, he was diagnose with CHF. SInce he was asymptomatic, we decided to not treat and take a see and wait approach.

2. 7/2013. Based on occasional hacking cough, EKG, echocardiogram and physical examination.we decided to treat. He was prescribed Lasix 6.25 mg once a day and Pimobendam 1.25 mg twice a day.

3. 4/2014 Base on seizures, a fainting spell, EKG and physical examination, he was prescribed Lasix 6.25 mg twice a day, Pimobendam 1.25 mg twice a day, and Digoxin .0125 mg twice a day.

I have a few questions and concerns. I hope you can provide me some guidance:

Medically speaking, are we doing everything we can? What additional treatments could he benefit from?
Would he benefit from a kidney blood profile? How frequently?
Would he benefit from a liver blood profile? How frequently?
Would he benefit from a digoxin blood level profile? How frequently?
Would he benefit from a digoxin blood level profile? How frequently?
Would he benefit from a taurine blood level profile? How frequently?
Would he benefit from a carnitine blood level profile? How frequently?
Would he benefit from a doppler echocardiogram? How frequently?
Would he benefit from a set of thoracic x-rays? How frequently?
Would he benefit from an EKG, How frequently?
Would he benefit from diet supplement like Taurine, Carnitine and Coenzyme Q10?
How do I know when his gig is up?

I welcome and appreciate your comments.

Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that your dog is having these problems with his heart. It sounds like he is getting good, thorough care though.

I'd like to start off by saying that these are all questions that ideally your veterinarian should be able to answer for you. Every case is different and he or she knows ultimately what is best for your dog.

It's never wrong to do a blood profile on an older dog. Lasix can potentially make kidney problems worse so it's not a bad idea to monitor the kidney enzymes. The problem is that if we find out that the kidneys are having problems then we're limited in what additional things we can do to help them. So, while bloodwork may be helpful to know what is going on, the meds that he is on are necessary and likely the blood results would not change much.

For dogs on digoxin, the general recommendation is to check blood levels about 10 days after starting and then again every 1-2 months. This can eventually be spread out to 3-6 months eventually. However, this is just a recommendation and your vet may have a different plan.

I rarely check taurine and carnitine levels. There are some types of spaniel dogs that can have heart problems that are connected to these amino acids, but this wouldn't happen in a chihuahua.

A heart ultrasound (echocardiogram) could be helpful to know what is going on. However, I'm not sure that it would change the treatment. It might...but probably not. An echocardiogram is usually expensive, so it's not something I would do routinely.

Regarding the EKG, normally I would say it probably wouldn't help much. However, often when Digoxin is prescribed it is because of arrhythmias. If your vet is suspicious of an arrhythmia (irregular hearbeat) then it's not a bad idea. Again, your vet will be the best judge as to whether or not this test will be likely to provide benefits that will change the treatment plan.

Similarly, xrays are not wrong, but may not change anything. I usually treat heart patients on the basis of how their clinical signs are changing. You could take an xray periodically to see if the fluid in the chest is decreasing, and subsequently decrease the lasix level. However, I'd probably base my changes on lasix dosages on whether the coughing was improving or getting worse.

Regarding the supplements, you'll need to consult with your vet on those. They're not supplements that I would routinely prescribe.

And to answer your last question, the answer really lies in how is condition is. If he is routinely having trouble breathing and the medicines are not helping then it is time to make the hard decision. Another possibility is if he suddenly goes into respiratory distress which is a common way for dogs with heart disease to end up. If he is really struggling to breathe then you may need to make this decision quickly.

I have seen a good number of heart condition dogs that are maintained on medicines for a year or more. However, if the condition is severe, then it can sometimes be a much shorter time.

I hope things work out well.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

I greatly appreciate your advice.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.