That morning, Roxy went in to her regular veterinarian for not feeling well. Bloodwork and x-rays were performed, but nothing obvious was found – there was maybe one area on her x-ray that the veterinarian thought might be early pneumonia. So, they sent her home with antibiotics and instructions to keep a close eye on her. Later that night, Roxy started coughing repeatedly and seemed to have trouble breathing.
When she came into Bishop Ranch Veterinary Center, Roxy's gums were pale – as white as a sheet of paper. She was struggling to breathe and coughing up red (blood)-tinged foam.
She was immediately placed on oxygen support. Listening to her lungs, I immediately heard crackles. Let's say you're stepping on a piece of bubble wrap – those pops are what we hear with crackles. My highest concern immediately became fluid accumulation in the lungs. Crackles can be heard with a few different things: fluid in the lungs (seen with heart failure), infection within the lungs (pneumonia), or inflammation within the lungs (bronchitis or asthma). X-rays help us to distinguish which of these we are dealing with.
On her exam, Roxy had a very loud heart murmur, an abnormal sound we hear when we listen to the heart. It indicates blood flow moving in the wrong direction, and often indicates underlying heart disease. Hearing both a heart murmur and crackles, my leading diagnosis at this point was heart failure.
Heart failure is a condition when the heart is no longer pumping blood appropriately. There are 4 chambers in the heart. Between the chambers are doorways, which we call valves. The valves open and close as the heart pumps which controls the flow of blood. In some dogs, with age, these valves stop working as well as they should. They are unable to close completely and therefore do not form a good seal. This allows blood to move in the wrong direction, which creates the sound we hear with a heart murmur. As more and more blood moves in the wrong direction, it backs up, eventually causing increased blood pressure in the blood vessels in the lungs. As the pressure builds, fluid can then leak into the lungs – a condition that we call pulmonary edema.
Suspecting this, I recommended x-rays. Understandably, Roxy's owners were hesitant to move forward with another set of x-rays, as they had just performed them that morning at their regular veterinarian's office. I explained that an x-ray could change quickly, even over the course of a few hours. It was clear that Roxy was not the same dog she was earlier that morning. Her owners agreed to move forward.
Roxy's x-ray had changed – drastically. Her lungs were almost completely filled with fluid. She was diagnosed with heart failure.
There are many reasons for why a pet can suddenly go into heart failure. The most common reason is if they have a ruptured chordae tendineae. The valves in the heart are operated by chords (called chordae tendineae), which are easiest to imagine as strings, attached to the heart wall. The strings will tense and relax as the heart beats to help the valves open and close. Let's imagine one or multiple of these strings breaks. If they break, then you suddenly lose control of the valve. This leaves the doorway wide open - all of a sudden blood can flood and overload the heart, and lungs. Often this will cause a sudden and dramatic heart failure.
Roxy was placed in oxygen support overnight while we gave her medications to: 1) help her heart to pump more effectively and 2) drain the fluid out of her lungs. Roxy thankfully made a rapid improvement overnight, and by the following morning she was breathing comfortably off oxygen support. Her x-rays also looked significantly better (see below). We were able to transition her over to oral medications and she was home with her owners that same day.
Roxy's story is a valuable one, as it demonstrates how quickly things can change. Thankfully, her owners brought her in quickly and we were able to get her treated immediately. She's a fighter and continues to do well at home.