Congestive heart failure (CHF) is an unfortunately common condition in dogs and often presents a significant emotional, psychological, and financial challenge for dog owners. While there is a lot of information on the internet about treating congestive heart failure in dogs, there is very little information about how to maximize your dog’s QUALITY of life and how to know when it’s time for euthanasia.

Congestive heart failure overview
There are two types of congestive heart failure:

  1. Left sided (the most common kind) – with left sided heart failure, the left side of the heart enlarges and fluid accumulates in the lungs, leading to coughing and difficulty breathing. The gums can become pale or blue.
  2. Right sided – with right sided heart failure, fluid begins to accumulate in the belly or the limbs, causing a swollen belly or swollen legs.

Both types of heart failure can cause lethargy, exercise intolerance, fainting/syncope (often looks like little seizures), and weight loss/muscle wasting.
The most common underlying causes of heart failure are heart valve abnormalities (most commonly the mitral valve), dilated cardiomyopathy, heartworm disease, and other congenital heart defects.

Treatment of heart failure usually includes a regimen of numerous medications given multiple times a day. Pets also often require frequent monitoring of bloodwork and imaging (echocardiograms). During acute episodes of heart failure, treatment can involve hospitalization in oxygen in the ICU.

Challenges of treating heart failure
It goes without saying that treatment of heart failure in dogs can be challenging. I want to highlight some of the most significant challenges of treating heart failure. Some of these can feel a little taboo to discuss but you should know you are not alone in having these thoughts:

  1. Intensity of the medication regimen: dogs with congestive heart failure often require multiple medications given multiple times a day. Sometimes a pet parent needs to be able to medicate a pet up to 4 times a day, which can present a logistical, time-intensive, and financial challenge.
  2. Intensity of monitoring: episodes of respiratory distress can come on very quickly, and often pet parents are afraid of leaving their pet alone for more than a few hours at a time out of fear they may suddenly become unable to breathe.
  3. Frequent veterinary visits: pets with congestive heart failure need frequent monitoring of echocardiogram, electrocardiogram, bloodwork, and blood pressure. This can become both time-consuming and expensive.
  4. Financial burden: medications, monitoring, and in particular hospitalizations can really add up. Visits to the cardiologist can cost between $500 and $1000 and hospitalization for an acute episode of heart failure can cost $5000-$10,000 each time it happens. This can lead to serious financial stress and often feelings of guilt.
  5. Emotional toll: Congestive heart failure can be particularly emotionally taxing because episodes can come on so suddenly and be so severe. It also comes with this dread of knowing your pet has a terminal illness and not knowing when another acute episode will occur and when you will have to say goodbye to your pet.
  6. The episodic nature of the disease: one of the biggest challenges of this diseases is that for many patients, symptoms are episodic and severe – meaning that when a pet is experiencing an episode of congestive heart failure they are in severe respiratory distress, struggle to breathe and are suffering greatly, but between episodes they are mostly normal. This can take a great psychological toll on pet parents and make it difficult to make decisions about euthanasia because pet parents are left with a decision to either say goodbye when their pet is gasping for breath or say goodbye when the pet is relatively normal.

How to know when it’s time for euthanasia
One of the challenges pet parents face with congestive heart failure is that the symptoms are often episodic and very severe; that is, when the pet is experiencing an episode of acute congestive heart failure they are often gasping for breath, turning blue and require hospitalization with oxygen in the ICU. They can even pass away from not being able to breathe, a very unpleasant way to die. These severe episodes are often punctuated, however, by periods of relative normality. As a result, pet parents are often faced with the decision of risking their pet passing away from not being able to breathe vs. choosing euthanasia when their pet is doing relatively well.

This is a very personal decision. As a hospice veterinarian, I believe in quality over quantity. Our pets do not care how long they live, only that they are happy for the days they are here on this Earth. We have it in our power to make sure our pet’s ending is peaceful and free from fear and suffering. But this often means saying goodbye while the pet is doing relatively well between acute episodes.

If a pet parent is able to continuously monitor their pet, sometimes we can catch acute episodes before they become extremely severe. However, it is often a matter of hours from when a pet starts to show signs of an acute episode to when the pet is in full-blown respiratory distress.

If you are able to very closely monitor your pet’s breathing at home (by monitoring their resting respiratory rate – see how to do this here: https://www.youtube.com/watch?v=ev8QN29QIxs), it is reasonable to wait until you see a small change so that you can quickly get them to the vet for additional treatment or euthanasia before they are in severe distress.

However, if you’re like many of us and work long hours and need to leave your pet alone for more than a few hours, often the kindest thing is to say goodbye with a peaceful euthanasia at home when they are having a good day.

If your pet has already required intensive treatment, even multiple hospitalizations, you may find yourself faced with the decision of whether to hospitalize again or euthanize if your pet experiences another episode. I recommend making this decision while you are in a calm frame of mind rather than waiting until an episode to make an emotional decision. I recommend WRITING DOWN a set of objective decision-making criteria while you are in a calm frame of mind so you can make the right decision for your pet and your family in an emotional moment.

While most pets with congestive heart failure (particularly left sided) have this pattern of severe episodes while being normal in between hospitalizations, some pets do not exhibit this typical episodic course, rather, they have progressive worsening of coughing, sometimes fainting episodes, severe lethargy/exercise intolerance, and sometimes weight loss and muscle wasting.

For these pets, we often consider euthanasia when the symptoms of the disease are leading to a deteriorated quality of life at home. I recommend keeping a daily diary and putting a smiley face, frowny face or neutral face and when the bad days are starting to outnumber the good days it is reasonable to consider euthanasia.

Conclusion
If you are struggling with decisions around what to do for your pet in congestive heart failure and how to think clearly through decisions, consider scheduling a teleconsult with one of our compassionate and experienced veterinarians.

Each pet and family have their own unique set of challenges. Our doctors can help you manage your pet’s symptoms to maximize their quality of life and help you come up with a set of objective criteria for when it is time to say goodbye so your pet can have happiness even up to their last moments on Earth.