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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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