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Sasha’s Pulmonary Hypertension

June 5, 2011

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8-Year Old Japanese Chin Does Not Have Heart Failure; She has Pulmonary Hypertension!

Sasha sat on Doc Truli’s exam table and coughed.  Her little body wracked up and down, her nose touched the table,  Then the spasm passed, she wagged her black and white fringed tail and smiled for attention.  What a sweetie!

black and white japanese chin with a typical short nose, small chin, and cute big brown eyes framed by wispy, floppy ears

Japanese Chin

“She’s been on her heart medication for about 2 months, but her cough is getting worse and worse,” said Sasha’s mom.

Sasha’s physical examination did not add up to a diagnosis of heart failure. Doc Truli put the stethoscope to Sasha’s chest.  A normal heart beat, no murmur sound, no crackles or fluid sound sin the lungs.  No enlarged belly.  No weight loss.  Hmm.  No symptoms of heart failure.  You have to put together the symptoms and the physical exam to get an idea of the actual diagnosis.  But there’s a critical test for dogs that Sasha never got!

Symptoms of Heart Failure in a Dog

  • Weight Loss
  • Exercise Intolerance
  • Difficulty Getting Up in the morning
  • Coughing, but nothing comes up
  • Lack of appetite
  • enlarged abdomen
  • crackles in the lungs
  • open-mouthed breathing, lavender color to the tongue
  • hind end gives out, especially when standing to eat or when climbing stairs

Sasha’s X-Rays

Next, Doc Truli reviewed Sasha’s radiographs (X-rays).  The heart was enlarged.  The front part of the heart silhouette had a “loss of the cranial waist.”  This means the front margin of the heart did not curve inward to meet the bronchial tubes, but continued straight up.  So the heart has an enlarged chamber.  But is there failure?
Heart failure means the heart muscle is no longer strong enough or efficient enough to pump the blood to the lungs and the body.  When the heart fails, fluid builds up on the lungs because the heart cannot pump it and circulate it around properly.
Sasha’s X-rays showed essentially normal lungs.  No fluid build-up.  Hmmm.  Maybe her medication had fixed the fluid build-up.  But if that was true, then why was she coughing still?

Other Reasons Sasha Will Cough

The elevated carina (see the X-Rays) – the point where the windpipe ends and the bronchial tubes begin – can press on the aorta, which runs above the heart just underneath the backbone and provides fresh arterial blood to the back half of the body.  When the heart is enlarged, and the carina is elevated, then the bronchial tubes can be irritated by pressing against the underside of the aorta and the back muscles.  This is called “bronchial irritation.”  It can cause a tickling, annoying cough.

Doc Truli told Sasha’s mom, “There’s another diagnosis here that has nothing to do with heart failure.  It may be the reason the heart medications did not help.  Sasha could have pulmonary hypertension.

Pulmonary Hypertension in Dogs

Pulmonary hypertension means elevated pressures in the blood vessels in the lungs.  For reasons no one understands, some dogs can develop high pressures in the vessels in the lungs.  It causes the heart to work extra hard when the right side of the heart contracts and pushes the used-up blood into the lungs so it can pick up oxygen and return to the left side of the heart from pumping out to the aorta and the body.

Pulmonary hypertension patients cough.  Heart failure patients cough.  So what is going on with Sasha?  How can we tell?

Sasha Gets an Echocardiogram

In Sasha’s case, the physical examination and the radiographs did not give a clear answer why she was coughing.  An echocardiogram performed by an experienced dog cardiologist was invaluable in fixing Sasha.

Pulmonary hypertension in dogs can only be diagnosed with an echocardiogram.

As of 2011, in dogs, pulmonary hypertension can only be diagnosed, for all practical purposes, by echocardiogram (which is an ultrasound of the heart.)

The “echo” showed normal heart muscle thicknesses, normal contractility – think of it as a measure of the strength and efficiency of the heart – but very high pressures in the lungs.  Sasha had pulmonary hypertension, not heart failure!

Guess What Treats Pulmonary Hypertension in Dogs?

Sildenafil. That’s right, basically, Viagra.  The cardiologist’s price was $100 for 1 pill made into a special liquid that would last Sasha several weeks.  We custom ordered her the medication from a reputable veterinary compounding pharmacy instead in order to make the treatment more affordable.

The original use of sildenafil was to treat hypertension and affect blood vessel tonicity.  The tone of the walls of the blood vessel basically determines if the walls will give just the right amount when the heart beats.  Sasha needed help ion that area and this medicine was perfect for her.

Sasha’s dad said, “Holy sh*t! Doggy Viagra!”

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2 Comments leave one →
  1. November 14, 2017 10:28 pm

    My 70lb male red Husky has pulmonary hypertension of the right side.
    Loki takes Sildenafil capsules twice a day, Vetmidin twice a day, and Benazapril twice a day. He’s also prescribed Salix but I don’t give it to him all the time because it dehydrated him (they told me that after blood work). He was diagnosed 5 months ago but he probably had it longer. Here were the symptoms that made us take him into a vet: he collapsed during 2 walks (he’s always hot in south Texas but he laid down panting heavily and I had to wait awhile for him to get up. He appeared to be bloated. He slept way more than a typical lazy dog is supposed to. His tongue sometimes has a blueish tint.
    The medication is very expensive, it’s close to $300 a month though I have a mental block about doing the math. The vet always charges at least double what you’d find from a reputable pharmacy online. We get Loki’s meds online (Wisconsin), we get his doggy viagra from a compounding pharmacy in Arizona.
    They did the echo-cardiogram, xrays and even blood work to try and figure out what the original cause of his pulmonary hypertension was, but they were unsuccessful. He has never had heartworms, that is the most common cause.
    We are lucky to be able to afford his meds, a few years ago we were living in our car and Motel 6’s with Loki and lived off of fast food. The vet bills alone, in just one day, maxed out my brand new, legit, credit card. THANK GOD FOR THAT CARD!
    Truli mentioned in this article that in 2011 the only way to diagnose pulmonary hypertension is through an EKG, this is still the case in 2017. Your local vet does not have the equipment to do it, they will either have a mobile EKG guy drive out to his office and perform the whatever-it-is, or refer you to someplace probably out of town. I live in a city of almost 2mil and yet the only ones capable of diagnosing P.H. are out of town, in Austin and New Braunfels (of all places lol). Most vets are not familiar with the condition, and they’re quick to diagnose with the more common congestive heart failure, which is easier to treat.

    • November 26, 2017 6:26 pm

      Kudos to your vet team for diagnosing and managing pulmonary hypertension. It is rare, difficult to diagnose and difficult to manage. To my knowledge, a Doppler echocardiogram (a type of ultrasound) is needed to diagnose pulmonary hypertension in dogs. A Board-Certified Veterinary Cardiologist is a specialist trained to handle this illness. Thank you for sharing your experience. It may help others.
      -Doc Truli

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