We have an 8-year-old Doberman Pinscher named Max and he was coughing so we took him to see his veterinarian last week. It sounded like something was in his throat and he would bring up foam he coughed so hard. His veterinarian took one listen to his chest and told us she was worried about his heart and wanted to do more testing. We never saw that coming. After a couple of hours when we went to pick him back up, she told us that he had atrial fibrillation and left-sided heart failure. She painted a pretty poor long term survival picture for Max. We are shocked and confused. What do we do now? Is he in pain? Should we go forward with treatment knowing all we know at this point? He was just coughing…
I am so sorry that you are hurting over Max’s newly diagnosed heart condition. The unfortunate news is that Doberman Pinschers seem to be genetically predisposed to heart disease and specifically to a condition called dilated cardiomyopathy. There was a survey study in Dobermans older than 6 years old that found 44% of those dogs were had the condition. When they looked at Dobermans of all ages that number went up to 58% of dogs were showing signs of the disease. It’s rough.
But let’s start at the beginning with clinical signs, diagnostic tests and treatments for your puppy. The clinical signs of dilated cardiomyopathy (DCM) and heart disease in dogs can be pretty mild. Some dogs will show exercise intolerance by not wanting to play and sleeping more. Some will cough, like Max did. Others will start to have episodes of heavy breathing, which may look like panting but it occurs at times when they are not exercising, typically at rest.
You did the right thing by taking him to your veterinarian because, as with any type of heart disease, these dogs are at risk of sudden death from a clot or a fatal arrhythmia. It is the same as that young person playing football or basketball that suddenly passes away before anyone ever knew they had an underlying heart condition. I am sure your veterinarian picked up initially on Max’s issues simply by listening to his chest and heart. With atrial fibrillation, there is no beautiful “lub-dub” sound to his heart. It is all over the place. Odd beats and runs of noise are all that you can hear. In some pets, the femoral pulses in their back legs don’t even coincide with the strange beats we can hear in their chest.
After the general physical, I am sure Max went off to x-ray to get a view of his chest and heart. This gives the veterinarian an idea of the size of his heart and if there is any pulmonary edema, or fluid, present in his lungs which will make him cough. I would assume he had what appeared to be an enlarged heart on X-ray. Dobermans have a huge barrel chest anyway and to see a large white globe of a heart filling it up can be pretty dramatic.
At this point, general bloodwork needs to be done to see if there are any other problems going on with his organs that would make treating his heart disease harder, such as kidney disease or anemia. Also, at this point it would be wise to get a board-certified cardiologist involved to double confirm the working diagnosis and to make therapeutic recommendations. There is a service called Cardio Pet that does just that. An EKG can be sent online with his X-rays directly to a cardiologist after clipping the leads onto the dog’s legs for a few minutes. They read the tracing of the heart on the EKG and couple it with the X-rays to get the accurate diagnosis and make their recommendations. It is a wonderful service we have.
Treatment is multi-factorial. Lots of the components of the heart disease must be treated. A very important point must be understood at this point. Heart disease cannot be cured. It will progress and it will cause the pet to die at some point. Treatment aims to lengthen survival times and to most importantly, give the pet their quality of life back if they are able to respond to the treatment.
Survival times after diagnosis are anywhere from six months to one year sometimes two if the disease is diagnosed early. It is somewhat helpful to know that heart disease is not a painful condition like certain cancers. Heart patients just feel tired mostly, not painful.
The typical treatment is a combination of oral medicines. A water pill is a must to clear the pulmonary edema and stop the coughing. A medicine called Vetmedin is needed to increase the force of the heart muscle contraction. Remember, the heart is very stretched out and beating poorly and not as a unified muscle. An ace inhibitor is used to improve blood flow through the body and lower blood pressure.
Lastly in Max’s case, you need to address the atrial fibrillation with a fourth oral medicine. Monitoring blood work every few months with blood pressure, EKG and X-rays is critical to his treatment plan. His heart disease will progress and by carefully monitoring his heart, his medicine levels can be changed to try to stay ahead of the disease.
Another thing you should do at home is monitor resting respiratory rate, or how many times he breathes in a minute. A normal rate is 15-20 breaths per minute or so. Thirty is a little high and anything above 40 means the dog needs to be seen by your veterinarian. I think by monitoring that you get some power over his disease and can be proactive when you need to be.
I know this is a lot, but it’s the best way we have to manage this disease in Dobermans and other pets with heart disease. The most important thing you can do as a pet owner is to arm yourself with as much good information as you can so you will go into his treatment with eyes wide open. Good luck to you and know you are doing everything you can to help Max.