Pulmonary Hypertension in Dogs: Treatment Options, Palliative Care, and How to know when it’s time for Euthanasia

Pulmonary hypertension (PH) in dogs is a serious condition where the blood pressure in the lungs’ arteries becomes abnormally high. It often results from underlying issues like heart disease, chronic lung disease, or heartworm disease. PH can cause difficulty breathing, fainting, exercise intolerance, and fatigue. While some dogs live well for months or even years with treatment, others decline more rapidly depending on the severity and underlying causes.

As a hospice and palliative care doctor, my goal is always: regardless of the path you choose, to make sure your dog’s remaining time left on this Earth is full of love and happiness. If your options are confusing, or you aren’t sure how to know when it’s time for euthanasia, don’t hesitate to schedule a comprehensive teleconsult with one of our doctors.

Treatment options for Pulmonary Hypertension (PH) 

Treatment for pulmonary hypertension in dogs depends on the underlying cause. The main medication used is sildenafil, a medication that lowers the blood pressure in the pulmonary vessels. Other medications are aimed at treating the underlying condition that is causing the pulmonary hypertension. Lifestyle changes are also important in managing this disease.

1. Sildenafil

• Sildenafil is the main medication used to lower blood pressure in the pulmonary (lung) blood vessels. 

• Works best in cases of idiopathic pulmonary hypertension

• Can take a few days to up to a week to start working

2. Steroids

• May be used in cases where inflammatory lung diseases such as chronic bronchitis are the cause of puolmonary hypertension

3. Bronchodilators

• May be used in cases of pulmonary hypertension caused by lower airway/lung disease

4. Diuretics

• May be used in cases of pulmonary hypertension caused by left sided heart failure to remove fluid in the lungs

5. Pimonbendan

• May be used in cases of pulmonary hypertension caused by underlying heart disease to help the heart pump more efficiently which may indirectly reduce the blood pressure in the pulmonary vessels.

6. Oxygen therapy

• Pets with advanced pulmonary hypertension may benefit from oxygen therapy, and may even need to be hospitalized with oxygen to get through a crisis

• Pawprint oxygen makes oxygen canisters for use at home, although if your pet is having enough trouble breathing that they need oxygen, this should just be a stopgap measure and they should be brought to the hospital.

7. Lifestyle changes

• Avoid heat and humidity, which can put excess pressure on the pulmonary system

• Avoid travel to altitude

• Use a harness instead of a collar to present airway pressure

• Limit physical exertion but allow gentle activity

• Maintain a calm, stress-free environment

How to know when it’s time for Euthanasia in dogs with Pulmonary Hypertension

Pulmonary hypertension is a progressive disease leading to distressing symptoms including difficulty breathing and collapse.

I highly recommend making a comprehensive end of life care plan for your pet as soon as they have been diagnosed with pulmonary hypertension. A comprehensive end of life care plan includes:

• Deciding which treatments you would or would not pursue, for example:

  • Would you hospitalize your pet when the disease is very advanced?

  • Are you prepared and able to administer medications multiple times a day?

  • Are you able to be home enough and present with your pet to monitor them?

  • Do you want to ensure your pet has a home euthanasia and does not pass away at a hospital? This may mean making a decision a little sooner and not waiting for a crisis.

• An objective set of criteria for euthanasia. The following are some criteria I would consider in cases of pulmonary hypertension:

  • Frequent collapse/fainting/passing out: If your pet is frequently collapsing or passing out and medications are no longer helping, it can both endanger their safey and affect their quality of life.

  • Labored breathing at rest: If your dog is having trouble breathing even when they are sitting or lying down, it may be time to consider euthanasia.

  • Blue or purple gums: If your dog’s gums are blue or purple this is a sign their body is not getting the oxygen they need

  • Inability to even walk around without getting winded or turning blue: If your dog is unable to even walk a short distance without getting winded or turning blue, their quality of life is likely poor.

  • Any difficulties breathing that cannot be controlled by medication

  • When your pet becomes oxygen dependent, meaning they cannot breathe well without the assistance of oxygen.

  • Extreme weight loss or muscle wasting: A dog that has lost too much body condition may start to have multiple organ failure leading to an emergency situation

  • Persistent loss of appetite, nausea, or vomiting: if nausea medications are no longer helping and your dog refuses food and water, they may be experiencing significant suffering

  • Lack of interest in life: If your dog no longer responds to their favorite activities, seeks out affection, or engaged with their surroundings, their quality of life may be poor.

It is much easier to make these decisions when you are in a relatively calm frame of mind. When we are facing an immediate crisis of possibly losing our pet, it’s easy to make a decision we regret in a panic.

I also recommend keeping a daily journal of your dog’s quality of life. I recommend simply putting a smile for a good day and a frown for a bad day. The journal can also be a place where you write new memories you made with your dog each day. It is important when facing the end of life to live in the moment and cherish every single day. 

Our comprehensive quality of life scale (https://pawsatpeace.com/quality-of-life-scale/) can help you assess your dog’s quality of life. This quiz can be taken once to give you a snapshot of your dog’s quality of life, or taken multiple times to assess trends over time.

Finally, the most compassionate choice is to give your dog a peaceful goodbye before too much suffering has set in. If you do this, you can give your dog the gift of a peaceful last day, and they don’t need to know the severe suffering that often accompanies end-stage pulmonary hypertension. 

When you are starting to see more bad days than good days, it’s a good time to give them a beautiful send-off. When clients wait too long, they often end up having to rush their beloved dog to the emergency room for euthanasia.

Final thoughts

Pulmonary hypertension is a challenging diagnosis and sometimes can progress rapidly no matter what we do. But always remember, the goal is do what you can to make sure your dog’s remaining time on Earth is full of love and happiness, no matter how long or short that time is. 

If you are not sure what to do and would like guidance and support, schedule a comprehensive teleconsult with a compassionate veterinarian. We will review all your dog’s medical record and history, discuss all your options, and help you formulate the most compassionate and loving plan for your family.

And when it does come time, Paws at Peace offers in-home euthanasia to help your cat pass peacefully at home, surrounded by family. Home euthanasia can provide your cat with a gentle and dignified transition without the stress of a veterinary visit.