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Dr. Taus
Dr. Taus, Veterinarian
Category: Veterinary
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Experience:  Veterinarian with experience in equine and small animal medicine.
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2nd Opinion Enlarged heart in Pekingese.

Resolved Question:

Hello. My 11 year old male Pekingese has been suffering with seizures for a few years but of decreased length and intensity after adenocarcinoma (benign) / perianal tumours (benign) removal with neutering 1.5 year ago. Three days ago, he almost had what I thought was another seizure. Had all the pre-ictal phase symptoms but never went into seizing, though it took just as long to recover. His tongue was bluish. He had another such episode in early August and the first two in January with "normal" seizures in between (not that great many). I was actually happy thinking that meant his seizures were getting milder :( ... that's what I thought it was and not what the vet later suspected (syncope). Friday morning, I took him to the vet for a totally unrelated health issue. He was sedated to have X-rays taken to determine cruciate ligament rupture etc. The vet also drew blood and was very worried when he heard his heart... He told me it was very bad and asked to have chest X-rays taken as well. Vet said they showed an enlarged heart, fluid accumulation and a windpipe parallel to his spine... He was prescribed Lasix (0.5 40mg tablet/day, for 10 days) and Fortekor (0.5 5mg tablet/day)... My questions: What could have caused this? He's been very inactive, almost sedentary due to his leg issues, could this have contributed to DCM? Is the fluid accumulation always a sign of heart failure? Could it be anyhting other than DCM/CHF? Other than those episodes earlier mentioned and some minor intermittent breathing problems (was told it was nothing to worry about, he's a Peke right?) he didn't have any other symptoms... He has had a tight belly for sometime now and again I was told it was nothing to worry about (since I noticed it immediately following his adenectomy & neuter and was flat out told I was being paranoid)... The vet on Friday also did an ultrasound on his belly but didn't say anything about fluids there... just commended on "all the fat"... Which brings me to my next question. Can a dog with advanced DCM not suffer from weight loss? By the way, he got fat only when he stopped going for his regular walkies. What about nutritional DCM? Is that form of DCM reversible? Can that also result in fluid in the lungs if untreated? Or just heart enlargement? Would the defficiencies causing it show up on the general blood work results? or would the vet have to run specific tests? I can't really ask all this as our vet is running out of patience with me... Symptoms wise, there's has been a lot of panting for some time now with slight wheezing sounds, but it was a fierce humid summer this year so again, thought nothing of it. No coughing yet... ever! Just weird gagging (like when he drinks water too fast or goes the wrong way) on very rare occasions. Is it possible for DCM / CHF to be in an advanced stage with no cough? When DCM is diagnosed and medication is started will the damage stop at that point, will it slow down or will the disease progress at the same rate while the symptoms are merely masked? Why hasn't my vet prescribed Vetmedin? Lastly, how long do you honestly think he has? I need to know even though I'm genuinely afraid I will follow shortly after... He's my only son, my baby, my life :( Thank you for your time. I am anxiously awaiting your response. Here's a couple of pictures (taken a while ago) to help you put a face to the name... I don't take pictures of him anymore... It breakes my heart :(


 


http://postimg.org/image/5zh0hka43/


http://postimg.org/image/hr9h63u43/


http://postimg.org/image/a9vod5f77/


 


 

Submitted: 1 year ago.
Category: Veterinary
Customer: replied 1 year ago.
Relist: I prefer a second opinion.
Expert:  Dr. Taus replied 1 year ago.
Hi there,

I'm so sorry to hear about your dog's heart problem. First of all, I think there may have been a communication issue between you and your vet involving what the heart problem actually is. DCM is rare in small breed dogs, and while it is a possible cause of heart failure, it is not the only reason why your dog can develop congestive heart failure. I think it is much more likely that your dog has a problem with his mitral valve that is causing CHF, as this is much more consistent with what your are describing. When the valve fails, the heart functions as a dam rather than as a pump. Blood backs up within the heart and causes enlargement, and fluid backs up in the space around the lungs. We know the problem is on the left side of the heart, and not the whole heart (as we would see with DCM), because he isn't accumulating fluid in his belly or places like his hind limbs.

It is absolutely possible to have CHF without seeing coughing. In fact, I see wheezing, restless sleeping, and syncopal episodes a lot more than I see overt coughing, even in dogs that have gotten so bad as to be almost nonresponsive when they come into the clinic. Wheezing can be normal for pekingese when they have very flat faces; however, it can also be a sign of heart problems, so I wouldn't ignore it or consider it nothing to worry about. In these little guys that have pretty relaxed lives and noisy breathing anyway, though, early signs can be tough to spot!

Heart disease in small breed dogs is usually caused by degeneration in the valves of the heart due to age and due to genetics. There's nothing you could have done differently that would have prevented this from happening, and it's quite common in poodles, pekes, shih tzus, and similar breeds.

It's great that you had the X-rays done. Your vet prescribed the lasix to pull the extra fluid out of your dog's chest, and the fortekor to control blood pressure, which often can become dangerously high in heart disease. Vetmedin is a very good drug, and it helps the heart beat more strongly and in a more coordinated way. However, it was developed very recently (it's only been around for about 5 years), and many vets were trained to manage heart failure very well without it. In addition, it is expensive, and your vet may be assessing the response to the lasix and fortketor before deciding to add Vetmedin if those drugs are not sufficient. Your dog may not need it.

It's going to be very important to follow up regularly with your vet. We want your dog on the lowest dose of heart medication that controls his clinical signs, so medication adjustments may be needed from time to time. We also have to watch for side effects of CHF like losing protein in the urine, which can damage the kidneys, and damage to the liver from fluid buildup. These are monitored with periodic bloodwork and urinalysis. Your vet is already working to prevent this from happening by prescribing Fortketor.

As far as prognosis goes, it's tough to put a number of months or years on the situation until we know how he responds to medication. With careful followup and being sure to give meds religiously, your dog could live several more years if other diseases don't develop. If he is overweight, weight loss will help in managing his CHF. If he enjoys a lot of treats or people foods, or if he is eating more than the recommended amount of dog food, he may not lose weight even with CHF unless he goes on a diet.

If you find that you are uncomfortable with the way your vet is managing his case, I'd recommend asking for a referral to a veterinary cardiologist. It's critically important that you follow up frequently with the vet managing his care, so now is the time to find someone you are comfortable with and who isn't making you feel as if being vigilant means you are paranoid.

I hope this is helpful. If so, please rate me positively, and don't hesitate to let me know how I can help further.
Dr. Taus, Veterinarian
Category: Veterinary
Satisfied Customers: 440
Experience: Veterinarian with experience in equine and small animal medicine.
Dr. Taus and 7 other Veterinary Specialists are ready to help you
Expert:  Dr. Taus replied 12 months ago.
Hi there,
Just checking in to see how things are going. How is your dog?

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