Congestive heart failure - when is it time?

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Elderly DDog is 14 and has been medicated for CHF and arthritis for the last 4 years.

In the last couple of months I've noticed his breathing is getting more laboured - he's panting a lot at rest, tiring quickly on walks, and started having little wheezing attacks. We live in a hot country and with summer approaching I'm expecting the next 6 months to be tough for him.

I know that end-stage CHF can be much worse, with blue gums and a swollen belly, and that it carries a risk of seizures when it gets really bad.

I don't want to put him through that – I'd rather he went out before it gets too severe – but I also don't think it's so bad right now that I should be considering saying goodbye.

Anyone had any experience of heart failure and can give me some guidance on what to look out for or when might be the right time to let him go without entering the stage of too much suffering?

My vet is (probably rightly) not saying too much on the topic, but I'd appreciate some thoughts from other owners who have been through it.

I lost my little 14 Yr old chi to CHF last year so I do sympathise, it is horrible watching them struggle.

My boy had a nasty cough that got worse and worse and would make him collapse sometimes.
Then one day I looked at him and I could just see he was done. It was like a light had gone out and he looked so tired.

I took him to the vets that day and held him as I said goodbye. I don't regret anything about it though, my one worry was that I'd lose him in an emergency when he was suffering and scared....as it was he just went to sleep being cuddled.

Sorry you are going through this but I do honestly believe it is better to be a little too early then too late.

Ah, @Magpie50 I'm so sorry to hear about your loss. Sounds like you did exactly the right thing, and it's helpful to hear that you made the choice you did.

My boy's got a bit of a cocktail of arthritis, the CHF, and a bunch of lumps and bumps that we can't operate on to remove because his heart wouldn't cope with the anaesthetic – so I'm finding it tricky to see what's the most problematic at the moment.

He's still eating well and wagging his tail in the mornings and having a nice time on our (short) walks – but I've definitely noticed a bit of a downturn in his mood in recent weeks. Sometimes he cries under his breath while he's at rest, and he seems to be finding it harder to get comfortable.

I think the time is getting closer – I just worry that I won't 'know' the way you did until something awful happens, and I'd never forgive myself if he went in pain.

Our previous Shih Tzu had CHF. We knew it was time when even the smallest walk had him coughing badly, and he wasn't able to play with our other dog at all. Our wonderful vet took us out into her back garden and sat us on a blanket with our old boy between us. She used a very long line so that she was off the scene and our wonderful boy passed gently, being stroked and loved by both of us.

I've never forgotten that act of incredible kindness on her part, and I never will. She made a wonderful old dog's passing a time of great love and no pain at all.

Do you have the cardalis app as it helps you record and track breathing rates, I lost my dog to MVD but I used to check his resting heart rate in the evening, but we had to make the horrible decision to pts when he woke up and just flopped every time we stood him up and refused a sausage, we knew it was time. I'm so sorry you are having to face this.

@FlipFlops4Me that's beautiful – what a hard-but-precious memory.

@Moanycowbag Not the Cardalis app, but a similar one, PetBreathCounter. Most of the time his breathing is relatively normal but during and after walks it really spikes high. I counted 116 breaths-per-minute yesterday while he was sitting on the sofa with me about 15 minutes after a walk.

I think maybe I'm giving myself too small a window to look for – I need to accept that toward the end things will be uncomfortable for him, and I can't protect him from any and all suffering.

We lost our beautiful oldie to AV heart block a few weeks ago. I do understand how hard it is. Our dog did detriorate quite quickly in a day and the decision was easier for us to make.

The vet was awesome, so empathic, kind and respectful. We were in a special room and our loyal beautiful boy went to sleep with us all close by and being cuddled and kissed on his head. So peaceful and calm for him.

Although so hard I think it is better to be controlled and planned than in a rush of an emergency but that makes it even harder to decide when the time is right.

I am so sorry you are going through this

Is seeing a cardiologist an option? What is his breathing rate when he is totally asleep? It should be less than 30 breaths in 1 minute.
What dose of furosemide tablets is he on and what is his weight? Is he on pimobendan and cardalis?

That is a hugely high heart rate we were told under 30 good 35 and over needed to see vet when resting, so I used to do it in the evening after his dinner, I have always tried to aide the 'a day to early is better than a day too late' it is very hard when facing the decision.

I'm so sorry OP it's a horrible position to be in. I note you said:

"Sometimes he cries under his breath while he's at rest"

I think it's time now tbh. He's in so much discomfort he's crying in his sleep? Poor old chap. It's time to act.

Go to the vet. At the very least to see if anything further can be offered. Tomorrow.

And if the answer is no. At least you know you did the kind thing. Nobody should cry in their sleep.

I'm so truly sorry. It's so hard. It's our final gift to them, to be out of pain. ❤️

@Gymmum82 we've got a phenomenal vet who's got him on all the right meds - pimobendan, cardalis, cardisure (not sure if that's what it's called in the UK but it's furosemide), UpCard, painkillers for the arthritis... he's well-medicated. Totally asleep today his breaths were 15 per minute - a completely different situation, which is part of what's so hard to get my head around!

@KeenOtter I'm so sorry for your loss, and so glad to hear that such a hard moment was as smooth and easy as it could possibly have been. And yes – really tough to try to judge when the signs aren't 'extreme'.

Thank you so much for your empathy, @Elieza - it is really hard, isn't it? To clarify, by 'at rest' I didn't mean asleep, just lying down and resting. I think that's the arthritis, although it could also be early doggy dementia / confusion due to his recent hearing loss... there's just no way of being sure.

We check in with the vet every month or so and he's already been very straight with me - he's been on the maximum meds he can have for a long time now, so we just need to watch and wait.

Cardisure is pimobendan. He’s on upcard which is torasemide so he should not be on furosemide as torasemide is a more potent diuretic than furosemide and they cannot be given together. If his sleeping breathing rate is 15 his congestive heart failure is well controlled.
Only you know when the time is right. But it sounds like the symptoms he has currently are caused by something else (possibly pain from his arthritis) rather than heart failure.

Just a thought- what is he on for his arthritis? Pain can be a major factor in increasing respiratory rate/ panting, especially as you say he struggles to get comfortable. I'd want to make sure we were doing all we could to treat pain, as there are so many options now (vet).

We're using Carprox for pain. His arthritis has definitely been worsening over the last few months - back legs getting weaker, lower back aching, licking his ankles a lot...

It honestly sounds as if he's had enough. I'm sorry OP.

I wouldn't want him to be suffering. I was a bit too slow in taking my much loved companion on her final journey. I loved her so much I just didn't want to say goodbye.

The list of problems and the crying and confusion really do make it clear that he's not enjoying life the way he used to.

Over my years of dog companionship, I have sadly had 2 dogs die of heart issues.. murmurs that lead to enlarged hearts / heart failure. Mine both ended up with dreadful coughs due to the fluid build up (very common) and when it got to the point that they were coughing more often than not coughing, we knew it was time. But really, regardless of the symptoms, assess honestly whether your dog is an acceptable amount of discomfort and whether they are still enjoying life.

Hi, my DDog doesn't have heart failure but has cancer and is very ill. I've found this https://www.lapoflove.com/quality-of-life-assessment useful.