Heart Disease in Dogs
Disclaimer: I am not a veterinarian, nor do I have any formal training in any medical field. The information presented here is not meant to replace your vet's advice or prescribed medications, but only to suggest additional options to explore, based on your dog's condition.
Supplements recommended for dogs with heart disease include:
- Taurine is an amino acid that is good for the heart. Taurine deficiency may be linked to feeding certain lamb and rice diets, very low-protein diets, high-fiber diets, or vegetarian diets. Studies suggest that taurine supplementation may be helpful for dogs with heart failure even when no deficiency exists. Certain breeds of dogs have been found to develop dilated cardiomyopathy (DCM) that is linked to taurine deficiency. Affected breeds include the American Cocker Spaniel, Portuguese Water Dog, Newfoundland and Golden Retriever. Other breeds that may be affected include the Scottish Terrier, Border Collie, Doberman Pinscher, and potentially other large and giant breeds as well. It is less likely that DCM in the Doberman Pinscher and Boxer is related to taurine deficiency, though supplementation will not hurt. Give as much as 250 mg to a small dog, 500 mg to a medium dog and 750 mg to a large dog, twice a day. Taurine is best given on an empty stomach. Note that taurine is abundant in raw meat, particularly heart, but much is lost when the meat is cooked. You may want to add some meat and canned fish with bones (sardines, jack mackerel, pink salmon) to the diet if your dog suffers from heart disease. Cooking reduces taurine, so feed raw or cook lightly. Canned fish is high in sodium, so rinse before feeding. Vitamin B6 is needed for the conversion of taurine, so adding a B-complex vitamin supplement (better than supplementing B6 alone) is also a good idea. Lamb and rice diets may contribute to taurine deficiency, either due to the effect of rice or a lower availability of taurine in lamb.
- Carnitine is another amino acid that helps to keep the heart strong. Certain breeds, particularly Boxers, as well as Cocker Spaniels, Springer Spaniels, and Doberman Pinschers, may be affected by dilated cardiomyopathy (DCM) that is linked to carnitine deficiency, and improves when supplements are given. Even when there is sufficient carnitine in the diet and blood levels are normal, providing additional carnitine may improve cardiac function. For Boxers and Cocker Spaniels who have DCM, you can give as much as 20 to 45 mg per pound of body weight daily. For other breeds, or dogs who do not have DCM, you can give as much as 500 mg to a small dog, 1,000 mg to a medium dog and 2,000 mg to a large dog, twice a day, though less is OK (this supplement is expensive). The free form type is best; never use synthetic forms (D-Carnitine or DL-Carnitine), which can cause serious side effects. Note that carnitine is abundant in red meat (especially beef and lamb, with about 20-40 mg per ounce), with higher amounts in mutton, half as much in pork, and low amounts in poultry and organ meats. For senior dogs, a combination of L-Carnitine and Acetyl-L-Carnitine may work best; use together at the rate of 2-3 mg each per pound of body weight. All amino acid supplements are best given on an empty stomach.
- Arginine is another amino acid that may provide beneficial effects for dogs with CHF (congestive heart failure) by improving endothelial function and cardiac output, and may result in improved exercise tolerance and decreased dyspnea (shortness of breath). Give as much as 100 mg per pound of body weight daily.
- Fish oil such as salmon oil or EPA oil (not cod liver oil) provides the omega-3 fatty acids EPA and DHA that can be beneficial for heart disease. These omega-3 fatty acids reduce inflammation and improve cardiac cachexia (lean muscle loss/muscle wasting), and may help with anorexia (loss of appetite) and arrhythmias. Dogs with heart failure have lower concentrations of EPA and DHA in their blood. Give one 1,000 mg fish oil that contains 300 mg combined DHA and EPA per 10 pounds of body weight daily, preferably split into two doses, for dogs that are symptomatic (you can give half that amount to dogs before they show any symptoms, i.e. one gelcap per 20 lbs of body weight). If you are using more concentrated supplements that contain 500 mg combined EPA and DHA per gelcap, then give one gelcap per 16 pounds of body weight daily. Flax seed oil is not recommended, as the omega-3 fatty acid ALA it contains must be converted to EPA, which happens at a very low rate in dogs, if at all. Be sure to also give vitamin E whenever you supplement with oils: 50-200 mg daily or every other day, depending on the size of the dog (you can give higher amounts less often, if that is easier). Vitamin E is also good for the heart.
- CoQ10 (Coenzyme Q10) is an antioxidant that may be beneficial for dogs with heart disease, particularly DCM. Give 1 mg (or more) per pound of body weight daily, divided into two doses. Q-Gel or a comparable oil form should be used, it is much more bioavailable than the dry form.
- Other supplements that may be helpful include B-Complex vitamins (B-50 for larger dogs, or break in half or quarters for smaller dogs), Selenium (about 1/2 mcg per pound of body weight daily), Vitamin C (250 to 500 mg twice a day), Vitamin E (1 to 2 IUs per pound of body weight daily, or you can give higher doses less often), and Garlic (one minced clove for a large dog, half for a medium dog and 1/4 for a small dog). Other antioxidants may also be helpful. Lasix can cause deficiencies of magnesium (which has also been linked to mitral valve disease) and potassium.
- D-ribose (alpha-D-ribofuranoside), a type of sugar, has been shown to help with congestive heart failure, as from late-stage mitral valve disease (MVD), a form of heart disease that is one cause of heart murmurs. D-ribose improves ventilation efficiency and may strengthen the heart as well. Products include Sedona Labs Corvalen Ribose and Pure Encapsulations Ribose. See D-ribose aids advanced ischemic heart failure patients (human study) and Mitral Valve Disease and the Cavalier King Charles Spaniel for more information. I could not find reliable information on dosage, but one person said she was giving her 25-pound dog 850 mg of D-ribose twice daily.
Diets for dogs with heart disease should be high in protein, particularly meat, which supplies amino acids that are good for the heart and helps to preserve lean body mass. Beef heart and other heart meats may be particularly beneficial. The amount of fat in the diet may need to be increased for dogs with cardiac cachexia (muscle wasting), or decreased for dogs that are overweight, but should remain moderate rather than low. Carbohydrates should also be reduced for dogs that need to lose weight. See the section on Senior and Overweight Dogs for more information on how best to achieve weight loss.
Sodium should be moderately restricted in early stages of heart disease, and more severely restricted in late stages (severe restriction may actually be harmful in early stages). The use of ACE inhibitors such as Enalapril or Benazepril reduce the need for severe sodium restriction. With early stage heart disease, avoid feeding diets that have over 100 mg of sodium per100 kcals. With mild to moderate heart disease, sodium should be restricted to 50-80 mg/100 kcals in the main diet, and with advanced heart disease, sodium should be less than 50 mg/100 kcals. At all stages, avoid treats and table scraps that are high in sodium, such as baby food, pickled foods, bread, pizza, condiments (e.g., ketchup, soy sauce), lunch meats and cold cuts (e.g., ham, corned beef, salami, sausages, bacon, hot dogs), most cheeses, processed foods (e.g., potato mixes, rice mixes, macaroni and cheese), canned vegetables (unless "no salt added"), and snack foods (e.g., potato chips, packaged popcorn, crackers). See Healthy Diet Tips for Pets with Heart Disease for more information.
Pills can be given in pieces of fresh fruit, "no salt added" peanut butter, raw or cooked meat (without salt), or low-sodium canned food. You could also use Pill Pockets -- the smell is very enticing, and you can pinch off just enough to cover the pill, making each one last a long time (I used to think they were too expensive because I thought you had to use a whole pill pocket each time you gave pills). I'm not sure how much sodium they contain, but you can use very small pieces to lessen that concern. Note that Pill Pockets are now available in a Duck and Pea Allergy Formula for dogs with food allergies.
Potassium needs may be increased, if you are giving digoxin or diuretics, or decreased, if you are treating with ACE inhibitors such as Enalapril, or with spironolactone. Monitor blood potassium levels and make adjustments as needed.
Note that many prescription cardiac diets are high in potassium, which may be inappropriate depending on the medications being used. Some prescription diets are also low in protein, which is always inappropriate for dogs with heart disease. If you are feeding a prescription diet for heart disease, you can improve the quality of the diet by adding high-protein animal-source foods such as meat, eggs and dairy, but be careful not to add foods that are high in sodium, such as cottage cheese and canned fish. Note that prescription diets are not usually necessary unless needed to reduce sodium in later stages of heart disease. This can also be done by feeding a homemade diet. See Balancing a Homemade Diet for more information. You can look up the amount of sodium in various foods on the USDA Nutrient Database.
If your dog does not want to eat, try feeding multiple small meals, and offer different foods. It's more important that your dog eat something than that he eat the best foods for his condition. Foods that are higher in protein and fat are likely to be the most palatable.
See the following for more info on diet and supplements for dogs with heart disease:
- Canine Heart Disease and Nutrition and The Role of Diet in the Treatment of Heart Disease
- Nutritional Therapy in the Treatment of Heart Disease in Dogs
- ACT with SPEED
- Nutritional Modulation of Cardiac Disease
- Review on Nutritional Management of Cardiac Disorders in Canines
- Dilated Cardiomyopathy (DCM) Treatment for Rapid Heart Beat
- CHF Supplements
- Natural Support for Heart Problems in Dogs & Cats
- New treatments for congestive heart failure
- Nutritional Therapy of Heart Disease
- What Supplements Should I Give My Dog with Heart Disease
- Cardiovascular Disorders and Heart Healthy Diet
- Dietary Taurine Deficiency and Dilated Cardiomyopathy in Dogs (pages 6-7)
Foods that are natural diuretics include celery, parsley, watermelon and dandelion leaf. You can also get dandelion leaf tinctures (using the leaf, rather than the root). Dandelion helps replace the potassium that is lost with diuretics. You can feed bananas and apples to help with potassium loss if you are giving diuretics, such as lasix, or you can get potassium pills if your dog develops hypokalemia (low potassium). Side effects of lack of potassium are nausea, vomiting, muscle weakness, listlessness and rapid heart beat.
Hawthorne berry is also sometimes recommended, but it may potentiate (increase the effects of) digitalis and other positive inotropic drugs and cardiotonic glycosides, so be sure to ask your vet before using it. When supplementing with herbs, I prefer to use tinctures that are made specifically for dogs, so that the dosage will be correct. Brands that I trust include Animal Apawthecary (see Hawthorn Plus and Senior Blend), Azmira Holistic Animal Care, and Tasha's Herbs for Dogs and Cats.
Another supplement I've seen recommended for heart problems in humans, including cardiac failure, hypertension, angina, endocarditis, pericarditis and edema, is the Ayurvedic herb Terminalia Arjuna. Arjuna seems to work by improving cardiac muscle function and the pumping activity of the heart. Arjuna also benefits cardiomyopathy, or weakening of the lower muscles of the heart. The commonly recommended human dosage is 500mg three times a day, adjust accordingly for the size of your dog (large dog would get adult human dosage, medium dog half the adult dosage, small dog 1/4 the dosage). This herb is one of the ingredients in Bio-Cardio from Thorne Research, which contains all of the above recommended herbal supplements along with a few others. Thorne Research products are often recommended by veterinarians.
Dilated Cardiomyopathy (DCM) can occur in both dogs and cats if the diet is deficient in taurine . This problem has been discovered in a number of dogs being fed commercial dog foods. See Nutrition and Congestive Heart Failure for more information. Adding fresh, raw meat to the diet would help counteract the potential for deficiency. See Commercial Dog Foods and Adding Fresh Foods to a Commercial Diet for more information on a good diet for your dog. Also see Taurine for a chart of the taurine content in different foods (note how much it decreases when the foods are cooked). Cocker Spaniels, Golden Retrievers and Newfoundlands are some of the breeds that are prone to Dilated Cardiomyopathy that may be related to taurine deficiency.
See the following sites for more specific information:
- Dilated Cardiomyopathy in Dogs (see page 2)
- Dilated Cardiomyopathy
- Dilated Cardiomyopathy (DCM) in Dobermans
- Dilated Cardiomyopathy: a daunting disease of the heart
- General Information About Dilated Cardiomyopathy in Doberman Pinschers
- Dietary Taurine Deficiency and Dilated Cardiomyopathy in Dogs (see page 6)
- Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy
A study published in 2012 found that a relatively new medication for heart disease, Pimobendan (see below), prolonged the time to onset of clinical symptoms and extended survival significantly when given to Doberman Pinschers with pre-clinical DCM (dogs with enlarged hearts but no clinical signs of heart disease). More info:
- Efficacy of Pimobendan in the Prevention of Congestive Heart Failure or Sudden Death in Doberman Pinschers with Preclinical Dilated Cardiomyopathy (The PROTECT Study)
- To Screen or Not to Screen (for DCM): That is the Question
There is a new medication approved in 2007 called Vetmedin (pimobendan), which can increase quality of life for dogs suffering from congestive heart failure related to either dilated cardiomyopathy (DCM) or mitral valve disease, and can lead to significant improvement in clinical signs and improved survival times. A study published in 2012 found that pimobendan delayed progression and significantly improved survival rates in Dobermans with DCM when given even before clinical signs were seen. More info:
- Pimobendan (Vetmedin)
- Pimobendan (Vetmedin®) (click Close Window on the popup)
- RVC researcher helps to lead pioneering study offering new hope to owners of dogs with fatal heart disease
- Pimobendan Can Prolong Lives Of Dogs With Heart Failure Up To Nine Months, Study Says
- Pimobendan: Understanding its cardiac effects in dogs with myocardial disease
- Efficacy of Pimobendan in the Prevention of Congestive Heart Failure or Sudden Death in Doberman Pinschers with Preclinical Dilated Cardiomyopathy (The PROTECT Study)
CEVA Animal Health claims that "dogs suffering from heart failure are 3 times less likely to see their health deteriorate or die due to heart failure (the risk of death alone being 9 times reduced) when spironolactone is combined with benazepril [an ACE inhibitor], compared to benazepril alone." CEVA has created a combined medication called Cardalis, but it has not yet been released in the U.S. You can still ask your vet about giving both supplements separately. More info: Spironolactone: A promising adjunctive therapy for myxomatous mitral valve disease
There is a new blood test available for detecting heart disease in dogs. The Cardiopet proBNP Test from IDEXX Labs detects the results of early heart disease from various causes, so it can be used as a screening test, or to help differentiate whether symptoms such as coughing might be caused by heart problems, and to help determine the severity of existing heart disease. The same methodology has been used for humans as well. See the followingfor more info:
- NT pro-BNP (N terminal pro-BNP)
- Biomarkers in the diagnosis of canine heart disease
- The Utility of NT-proBNP Assay to Detect Occult DCM and Predict Survival in Dobermans
- Blood Test for Heart Disease (click on Natriuretic Peptides)
There is a new DNA test available for detecting a mutation that causes cardiomyopathy in Boxers. It's done with a cheek swab and costs around $70. See the following for more info:
- New genetic test is a breakthrough for Boxers — and people, too
- Vet cardiologist discovers gene for heart disease
- Genetic Mutation Testing Service for Boxer Dog's Arrhythmogenic Right Ventricular Cardiomyopathy
For more information on heart disease in dogs, see the following:
- Veterinary Heart Institute
- Veterinary Clinical Cardiology
- Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease
- Old Dogs with Murmurs