Congestive Heart Failure in Dogs: Guide + Vet Q&A

Congestive heart failure in dogs is more common in senior dogs, however, it can develop in any dog at any age and breed.
It is caused by heart disease which can have different causes, for example, health issues, genetics, age, etc.

So if your dog is diagnosed with CHF, this guide could help you better understand the condition, and recognize different stages of condition development and available treatment options. 

What Is Congestive Heart Failure in Dogs?

Congestive heart failure in dogs is a condition where the heart is unable to pump enough blood to the body, resulting in increased pressure and fluid buildup in the lungs and sometimes other major organs.

It can be congenital or acquired, and factors like age, diet, illness, or infection can contribute to its development. 

vet explains CHF in dogs

What are the signs of congestive heart failure in a dog?

  • Coughing: Dogs with CHF may experience a persistent cough, especially during or after exercise or a few hours before bedtime.
  • Tiring easily: Dogs with CHF may become easily fatigued or show a decreased tolerance for physical activity.
  • Restlessness or difficulty settling down: Dogs with CHF may exhibit pacing or restlessness, particularly before bedtime, as they struggle to find a comfortable position.
  • Increased respiratory rate: Dogs with CHF may have an increased breathing rate, which can be observed by counting the number of breaths per minute. An elevated respiratory rate can be a sign of respiratory distress.
  • Cyanosis: In severe cases of CHF, dogs may develop a bluish tinge to their gums, tongue, or skin due to inadequate oxygenation.
  • Fluid accumulation: CHF can cause fluid to accumulate in the lungs, chest, or abdomen. This can lead to symptoms such as coughing up foamy or blood-tinged mucus, difficulty lying down, or a distended abdomen
  • Weight loss
  • Crackling sound in the lungs.

Right-sided vs Left-sided CHF?

Right-Sided CHF

Right-sided CHF occurs when the right side of the heart is unable to pump blood effectively. The right side of the heart receives oxygen-poor blood from the body and pumps it to the lungs to receive oxygen. In right-sided CHF, blood backs up in the veins and causes fluid accumulation in the chest or abdomen. 

Common causes of right-sided CHF in dogs include chronic lung disease, heartworm disease, or heart defects.

Symptoms of right-sided CHF may include

Abdominal distension or swelling

Fluid accumulation in the limbs (edema)

Difficulty breathing or rapid breathing

Exercise intolerance


Weakness or lethargy

Loss of appetite

Left-Sided CHF

Left-sided CHF occurs when the left side of the heart is unable to effectively pump oxygen-rich blood to the body’s tissues. The left side of the heart receives oxygenated blood from the lungs and pumps it out to nourish the tissues. When left-sided CHF occurs, blood backs up in the lungs, leading to fluid accumulation in the lungs and chest cavity.

Symptoms of left-sided CHF may include

Coughing (especially at night or after exercise)

Difficulty breathing or rapid breathing

Bluish tint to the gums or tongue (cyanosis)

Exercise intolerance

Weakness or lethargy

Decreased appetite

Many signs and symptoms can overlap between right-sided and left-sided CHF, as they are both forms of congestive heart failure. The severity of symptoms can vary depending on the underlying cause, the progression of the condition, and individual variations.

Biventricular failure is when both sides are not working properly. 

What are the 4 stages of congestive heart failure in dogs?

There are four stages to classify the severity of CHF in dogs:

Stage of CHF in dogsSigns 
Stage AA dog at risk of heart disease
Stage BSigns of heart disease (eg, a murmur but no structural changes; eg, left atrial enlargement). The dog is asymptomatic.
Stage CCongestive heart failure is present or has been present and the dog is receiving treatment.
Stage DCongestive heart failure is present and refractory to standard therapies. The patient requires hospitalization.

Stage A: Preclinical Heart Disease

In this stage, dogs are at risk of developing heart disease but do not show any clinical signs. 

It includes dogs with breed-related predispositions to heart disease, such as dilated cardiomyopathy (DCM) or degenerative mitral valve disease. Regular check-ups, appropriate diet, exercise, and cardiac monitoring may be recommended for these dogs to detect early signs of heart disease and manage risk factors effectively.

Stage B: Asymptomatic Heart Disease

Stage B represents dogs that have structural heart disease but have not yet shown any symptoms of heart failure. 

These dogs may have heart murmurs or echocardiographic abnormalities indicating heart disease. Close monitoring and appropriate interventions, such as medication to manage underlying heart conditions or prevent disease progression, are crucial at this stage.

Stage C: Compensated Heart Failure

Dogs in stage C of congestive heart failure exhibit clinical signs of heart failure but are still able to maintain adequate cardiac output. 

Symptoms can include coughing, exercise intolerance, increased respiratory rate, or abdominal distention due to fluid accumulation. Treatment aims to alleviate these symptoms and slow disease progression. 

Medications like diuretics, angiotensin-converting enzyme (ACE) inhibitors, and positive inotropes may be prescribed to manage fluid retention, improve cardiac function, and reduce the workload on the heart.

Stage D: End-Stage Heart Failure

This stage represents dogs with advanced heart failure and severe clinical signs. Dogs in stage D may experience severe exercise intolerance, difficulty breathing even at rest, persistent coughing, and a poor quality of life. 

Treatment options become limited, and the primary focus shifts towards palliative care to improve comfort and manage symptoms. Hospice care, oxygen therapy, and medications to relieve symptoms may be utilized.

early stage of CHF

Causes of Congestive Heart Failure in Dogs?

  1. Mitral Valve Insufficiency (MVI): This is the most common cause of CHF in dogs. MVI is a condition where the mitral valve, which separates the left atrium and the left ventricle, becomes leaky. This leads to a backflow of blood, causing the heart to work harder to pump blood effectively.
  1. Dilated Cardiomyopathy (DCM): DCM is a disease that affects the heart muscle, causing it to become weak and enlarged. As the heart enlarges, it becomes less efficient at pumping blood, eventually leading to CHF. Certain dog breeds, such as Doberman Pinschers and Boxers, are predisposed to develop.
  1. Other Cardiac Conditions: Various other heart conditions, such as hypertrophic cardiomyopathy (HCM), arrhythmias, congenital heart defects, and heartworm disease, can also contribute to the development of congestive heart failure in dogs.
  1. Age and Genetics: Aging is a risk factor for the development of heart disease and congestive heart failure in dogs. Additionally, certain breeds may have a higher genetic predisposition to heart problems, including CHF.
  1. Diet and Lifestyle: Poor diet and lack of exercise can contribute to obesity and other health conditions, such as hypertension, which can increase the risk of developing congestive heart failure in dogs

How is Congestive Heart Failure Diagnosed?

The veterinarian will start by obtaining a detailed medical history of the dog, including information about symptoms, duration, and any underlying conditions. A thorough physical examination will be performed to assess the overall health, heart rate, rhythm, and the presence of any abnormal lung or heart sounds.

Radiography (X-rays): Chest X-rays are commonly used to evaluate the heart and lungs. X-rays can reveal signs of an enlarged heart, fluid accumulation in the lungs (pulmonary edema), and other changes that indicate heart failure.

Echocardiography (Ultrasound): Echocardiography is a non-invasive imaging technique that allows visualization of the heart’s structures and function. It provides valuable information about the size of the heart chambers, the thickness of the heart walls, and the functioning of the heart valves. Echocardiography helps identify structural abnormalities and assesses the heart’s pumping efficiency.

Electrocardiography (ECG/EKG): An electrocardiogram measures the electrical activity of the heart. It helps identify abnormal heart rhythms (arrhythmias) and may provide clues about underlying heart disease.

Blood Tests: Blood tests are performed to evaluate the dog’s overall health and check for specific markers related to heart function. These tests may include a complete blood count (CBC), blood chemistry panel, and measurement of certain cardiac biomarkers.

Additional Tests: In some cases, additional tests may be necessary to determine the underlying cause or contributing factors for CHF. These may include blood pressure measurement, cardiac catheterization, or other specialized imaging techniques.

x-ray of murmur leading to CHF

Treatment Options for Congestive Heart Failure in Dogs

The treatment of congestive heart failure in dogs involves two phases: acute and chronic. 

The acute phase focuses on relieving congestion and supporting cardiac output, which is particularly critical for left-sided heart failure to prevent pulmonary edema and dyspnea. 

In the chronic phase, the goal is to manage stable, compensated congestive heart failure, preventing decompensation, controlling clinical signs, and slow disease progression


The specific medications prescribed may vary, but commonly used drugs include:

  • Diuretics: Diuretics such as furosemide (commonly known as Lasix) help reduce fluid accumulation and relieve symptoms of congestion.
  • ACE inhibitors: Drugs like enalapril, benazepril, or lisinopril are ACE inhibitors that help dilate blood vessels and reduce the workload on the heart.
  • Pimobendan: Pimobendan is a medication that improves heart function by increasing the heart’s ability to contract and improving its efficiency.

Dietary management: A heart-healthy diet is important for dogs with congestive heart failure. Low-sodium diets can help reduce fluid retention and ease the workload on the heart. Your veterinarian may recommend a specific commercial diet or provide guidelines for home-cooked meals.

Exercise and weight management: Regular, moderate exercise can help maintain muscle tone and improve cardiovascular health. However, the exercise regimen should be tailored to the individual dog’s condition. Weight management is also important, as excess weight can strain the heart.

Supplemental therapy: In some cases, veterinarians may recommend additional supplements such as omega-3 fatty acids or coenzyme Q10 to support heart function. These supplements should only be used under veterinary guidance.

Monitoring and follow-up: Dogs with congestive heart failure require regular monitoring to assess their response to treatment and adjust medications if needed. Follow-up appointments with your veterinarian will be necessary to evaluate the dog’s condition and make any necessary modifications to the treatment plan.

How long do dogs live when they have congestive heart failure?

In general, the life expectancy of dogs diagnosed with congestive heart failure (CHF) can vary depending on the age of the dog, the severity of the condition, the medications being taken, the dog’s responsiveness to treatment, and any underlying medical conditions present, such as kidney disease or pneumonia.

The lifespan of dogs with CHF can range from 6 months to 1 1/2 to 2 years on average. However, each dog’s situation is unique, and some dogs may live longer or shorter lives depending on their individual circumstances.

Vet Q&A

Q: How do I know if my dogs congestive heart failure is getting worse?

A: Your dog may show signs of respiratory distress, such as open-mouth breathing or struggling to breathe.

A persistent cough may be accompanied by the production of white or pink-tinged foamy mucus.

Dogs with worsening heart failure may experience a decreased appetite and subsequent weight loss, episodes of weakness, or collapse. 

Q: Do dogs feel pain with congestive heart failure?

A: Dogs can experience pain with congestive heart failure due to symptoms such as heavy breathing, fluid accumulation, arrhythmias, blood clots, and organ damage. Each dog will respond differently, your vet will include pain management treatment if necessary. 

Q: Can dogs recover from congestive heart failure?

A: CHF in dogs can be managed in the early stages.  Congestive heart failure in dogs is often a chronic and progressive condition so early detection, medical intervention, and lifestyle modifications can help in controlling the disease and prolonging the dog’s life.

Q: How can I help my dog with congestive heart failure?

A: You can work closely with vets as soon as the first signs occur. You can adjust diet, home environment, exercise types, etc. 

Please read our: How to Comfort a Dog with Congestive Heart Failure