congestive heart failiure misdiagnosis vs lung trouble

[boubou64]

Hello, new to this forum
I do not know what to think now, we thought our little Mitsy had conjestive heart failure but turns out that her main problem right now is her right lung.
I would like your input as what you think
We have an 11 year old (in november) female chihuahua that's been the perfect picture of health all of her life other than a slightly colapsed trachea due to her previous owner (of 6 months time) using a colar.
In the last year, she's developped coughing in the morning, or evening, restlessness. We went to our vet and he told us she had a heart murmur (which we knew of but it was not severe until just recently). We did an ultrasound at the local general vet practice and xrays and the vet put our Mitsy on vetmedin and lasix. The lasix helped the coughing but her breathing rate has dramatically increased in the last month. enough for us to feel alarmed. The vet increased the lasix, no more coughing but yet, she still struggles for air. she has lost appetite and last night she kept her head up in the air. We went to emerg and lasix shot was given and we then drove her to a vet hospital in Ottawa. She was on oxygen. She saw the cardiologist and he did chest xrays, echocardiogram, blood pressure, bloodwork and urinalysis. His diadnosis today was: Severe mitral regurgitation at risk for congestive heart failure. Right lung consolidation, possibly bronchopneumonia or mucus entrapment.

The cardiologist also looked at the original xrays taken one year ago from our vet and is very uncomfortable with Mitsy being on Lasix, he says she isn't into congestive heart failure. Her valve is diseasy, there is a severe murmur but not congestive heart failure. I wish we had gone to him in the first place.
Now, I was wondering why if Mitsy was on lasix, the cough would go away, but yet, she was still breathing really fast and sometimes hard.
Also, she has NO trouble sleeping on her side or her stomach, that's never been an issue. Her coughing is not the weezing type, more like a dry ackkkk gag type that stops when done. She does cough after excitement and running or hot humid weather (we control that now).
Meds for Mitsy (8 lbs) now:
Fortekor ACE inhibitor
Norvasc calcium channel blocker for high blood pressure
spiroton diuretic
vemedin
theo bronchodilator
clavamox antibiotics
flovent
salbutamol

Mitsy was released back to us today (so happy!) with all these meds.
She's always been really good at taking the vetmedin but now her appetite is lacking and I have to force the meds down her troath, I do no like doing that. Do you have any recommendation, tricks as a nicer way to administer the pills? crush them? mix them with favorite treat?

[lindapalm]

I've always had luck with pill pockets for my dog, but no way for our cats. If that doesn't work, try wrapping the pill in a piece of pre sliced cheese.

[boubou64]

thanks, we tried that, and baloney but she's a smart little one, once she figures out there is meds, she won't take it.
thinking about pulverising the meds, putting them into water and syringe it down her throat would be easiest. Will talk to vet see if that is acceptable.

[MaxaLisa]

I know that managing the meds in these cases can be really difficult. I had a girl with heart disease, but she never went into congestive heart failure (CHF).

I don't really understand what is going on with your girl, but I'll just pass on a few things that were told to me. My girl was treated by a local cardiologist, and also had an eval with the local vet school cardiologist.

My girl's murmur got a little better when she was treated with clavamox for a different infection, so I would make sure that there is no infection in the body, teeth, etc...... Personally, if they think that there is a risk of infectious bacterial pneumonia, I would want to treat that, since only good things ever happened to my dog on antibiotics. But I know that pneumonia can be non-bacterial also.

Many cardios use no meds at all until the the dog is in CHF, unless some situation comes up. The university cardio followed this rule. The cardio that we used did start my girl on an ACE inhibitor early (enalapril), and it was a good thing. I believe that ACE inhibitors can affect appetite, but perhaps all the others can too.

Vetmedin will strengthen the heartbeat, and if used too soon in heart disease, *may* cause the disease to progress faster, which is why it's usually reserved for when the dog has reached CHF.

You may not be able to point to one med that is causing a problem, since they are all working in concert with each other. Since they say your dog is at high risk of going into CHF, I'm sure that is why they have given you the cocktail of meds that is being given.

You probably have googled a bunch, but I like these two articles:
https://docs.google.com/file/d/0B2fU...hl=en_US&pli=1
https://docs.google.com/file/d/0B2fU...hl=en_US&pli=1

My girl was on doxycycline a lot, and she did have a ruptured tendon in her heart, but it might have been the doxy that kept her from going into CHF:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367668/

[MaxaLisa]

Oh, the one other thing I know is that the heart and lungs do not like moisture and fluid in the body, but the kidneys love moisture and fluid. So it's an eternal balance between trying to keep the heart as healthy as possible, and trying to keep the kidneys as healthy as possible. Also, kidney values are supposed to be checked about 7-10 days after starting an ACEi, but I'm guessing that that was done.

[boubou64]

This is so tough! Last night, she started breathig hard Again with her head up. Gave her meds and she settled down. Today, started doing it again but too early for meds. Finally gave her them and she isn't settling down. 1 hour after meds she vomitted hope most of them stayed in.
Went to hospital with her and they don't really want to take her (they will but ) they prefer if I took her back to Ottawa where cardio is which os 3 hours away. I can't drive back and forth to Ottawa every 2 days. Llast time cardio said she was fine to go home. Today was 2.5 days on antibiotics for lungs and the other meds. Just added a medication to increase appetite. She is not in heart failure yet. Vet says breathing really high (90) but good oxygen. Still!
What am I to do? I am stresse out. I watch her day and night.

[boubou64]

Anyone have dogs trouble with fast breathing and they eventually settle down???

[MaxaLisa]

I would call the cardio and explain what is going on, and see if maybe they can recognize the issue over the phone. They should be familiar with the meds and the reactions. Most vets will do a phone consult with a pet that is being given newly prescribed meds.

I would trust your instincts and follow up on this.