Congestive Heart Failure in Dogs and the Use of Sotalol

rocky from TyRocky

I originally wrote this blog in December 2012. I posted it and then pulled it  as I was afraid that it would jinx something, such as Rocky’s life.  Rocky passed away on February 11, 2013, and I do feel that there may be other dog owners who can benefit from knowing our experience regarding Sotalol.

Whoever is in charge of allowing dogs to have congestive heart failure does not have a heart.

My dog Rocky, a boxer mix, had congestive heart failure. Although he is a mix, his mom was a pure breed boxer, and boxers tend to have heart disease. I rescued him 13 years ago. Last April, on a visit to my mom’s home in Indian Wells, California, Rocky started acting nervous. We had visited my mom’s many times, so the next day when his breathing seemed too fast while he was at rest, I took him to a nearby vet, who ran an EKG and told me Rocky had a dangerous cardiac condition. He said his blood pressure was very high and Rocky was started on blood pressure medication.

As soon as we arrived back in Los Angeles, I took Rocky to a vet I knew well. He said Rocky had nothing wrong with his heart. I followed up with a cardiologist who agreed.  They both said now Rocky’s blood pressure was too low.

Was the vet in the desert a quack?

A week later, he started coughing. Back to the vet we went. We were told kennel cough. But the cough persisted. Rocky was put on even stronger antibiotics.

He kept coughing.

Then disaster struck. While on a walk only a few minutes from home, Rocky began to cough and passed out. He urinated as he collapsed, and it appeared he was dying, which I think he was. Luckily my son was with me. He ran home to get a car. Just before he returned, Rocky’s breathing picked-up and he slowly came back to life. This same scenario happened the next day after breakfast.

After the second collapse, we saw an internist at the same large veterinary clinic, since the cardiologist only works on Tuesdays and Wednesdays. We were there for 6 hours. The vet ran every test imaginable and put Rocky on many medications, adding new antibiotics for the cough. On Tuesday we finally saw the cardiologist again, who diagnosed Rocky with congestive heart failure (CHF). The bill for these two visits added up to thousands of dollars.

After getting the correct diagnosis and correct cardiac medication, Rocky was doing as well as could be expected-until last week. On December 7th, Rocky wanted to go out around 2 am. Once outside, he ended up collapsing like he had when this started. Only this time he also started shaking and overall it was a worse type of collapse.  As a result, in an email, his cardiologist suggested I increase his anti-arrhythmic medication, Sotalol. So I followed her suggestion.

This brings us to last week. Last Monday to be precise, one week after increasing the Sotalol. He seemed fine other than his coughing had increased.  As I put his leash on him, he became excited about going on the walk and collapsed and urinated. He recovered.

But  it got so much  worse. He began to collapse repeatedly:

  • Wednesday morning, two days later, he woke as usual at 7 am. But he didn’t make it out of my bedroom. He collapsed and urinated.
  • Wednesday afternoon he collapsed
  • Thursday 1:30 am he collapsed and urinated
  • Thursday at 9:30 am, he collapsed

He had stopped eating as well.

I emailed his cardiologist to ask what criteria she suggests for euthanasia, and I also asked her to confirm that the increased Sotalol is not a possible reason for this sudden decline.

Her response surprised me. The usual tone of compassion was absent. Instead she told me that unless I bring him in for an EKG and lung x-ray, there was no way to know what was going on. She said that if I do not bring him in, I should euthanize him.

I was stunned by her response. I wasn’t sure if the car ride would kill him, but I knew it would be close. But the question about the increased Sotalol had not been answered. I went online and you can read it for yourself at this site http://www.drugs.com/pro/sotalol.html or you can read the text from the link here:

Congestive Heart Failure

Sympathetic stimulation is necessary in supporting circulatory function in congestive heart failure, and beta-blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. In patients who have congestive heart failure controlled by digitalis and/or diuretics, Sotalol should be administered cautiously. Both digitalis and Sotalol slow AV conduction. As with all beta-blockers, caution is advised when initiating therapy in patients with any evidence of left ventricular dysfunction. In premarketing studies, new or worsened congestive heart failure (CHF) occurred in 3.3% (n = 3257) of patients and led to discontinuation in approximately 1% of patients receiving Sotalol. The incidence was higher in patients presenting with sustained ventricular tachycardia/fibrillation (4.6%, n = 1363), or a prior history of heart failure (7.3%, n = 696). Based on a lifetable analysis, the one-year incidence of new or worsened CHF was 3% in patients without a prior history and 10% in patients with a prior history of CHF. NYHA Classification was also closely associated to the incidence of new or worsened heart failure while receiving Sotalol (1.8% in 1395 Class I patients, 4.9% in 1254 Class II patients and 6.1% in 278 Class III or IV patients).

To summarize the above statement, if someone has congestive heart failure it can get a lot worse from taking Solalol.

So I cut Rocky’s dose back to what it had originally been and he has stopped collapsing and has almost completely stopped coughing. Today is Sunday, Dec. 23, and he just finished eating his normal full dinner. I don’t have final answer as to if all of this has been caused by the increased medication.  After all, he did collapse prior to any change in medication. So it’s not a clear cut situation. Yet, the vet’s response should have stated that , yes, it is possible the sudden decline could be caused by the increased Sotalol.

Afterword: As stated above, Rocky passed away on February 11. Clearly his condition worsened, but equally clearly is the fact that by increasing the Sotalol, he had became much worse very quickly due to the drug. By reducing the dose back to what it had been, he had another good month, and as my son said, one good hour with Rocky is worth it.  Toward the end of January, the cough worsened again and he progressively became worse until he had to be euthanized. I will miss him forever.

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2 Comments

Filed under Congestive Heart Failure in Dogs

2 responses to “Congestive Heart Failure in Dogs and the Use of Sotalol

  1. Alicia

    Thank you for writing this up. My little Jack-Dachsie mix has been having similar symptoms before being diagnosed with CHF– the collapsing and urinating. The first vet I saw told me he must have a brain lesion as nothing showed up in his blood tests. However, the next day he was clearly in respiratory distress and was then diagnosed with a severe murmur and heart failure. He is on more than Sotolol but it clearly makes him weaker as his heart rate is now under 100 but he is comfortable. He does have a need for Sotolol as his heart rate is so erratic and fast and did not respond to Lidocaine.. I know he is not meant to be with me much longer and my heart aches. Thank you again for posting. I think these drugs are last resort to conditions that otherwise take the lives of many breeds.

  2. Hooray for the Internet for communicating condition like the Boxer story. I have a Boxer, he’s 9.5 years. He’s a indoor dog, but like to go for rides and run as fast as he can in the back yard. Boxers have genetic heart conditions. My little fellow fell over on our morning from V Tact.

    Both V-Fib and V-tach are serious, immediately life threatening heart rhythms. In V-Fib, the heart is just sitting there quivering. It’s not pumping blood and the treatment is immediate defibrillation. In V-Tach, the patient may or may not have a pulse. Even if they do have a pulse, they are not getting good blood flow to vital organs and V-Tach can quickly deteriorate into V-Fib. The treatment for V-tach is to first assess if the patient has a pulse or if they are symptomatic. If they are not symptomatic, then the rhythm can be treated with meds. If they are pulseless or symptomatic, the treatment is the same as it is for V-fib, immediate defibrillation.

    My wife and I brought hime to the Emergence Vet clinic. There the Vet gave Lidocaine to regulate his V Tact – it did then they did a unsound to see how his heart was functioning. The heart had a slightly lower EF (ejection fraction) but another medical problem found was his spleen had irregularities that could end his life and the Vet said that 90% of this condition was CA. They did a splenectomy and found no CA. So we were relived. Three weeks after the surgery he collapsed on the kitchen floor. We live in a two story house the kitchen is on the second level. I had a right shoulder injury so I was a concerned with carrying him downstairs to the truck. He stopped breathing so I pressed on his rib cage several times and saw that his breath was being forced out his lungs and it seem that his diagram was pulling air in. In a few minutes he became conscious but still did not get up. I called a friend to carry him to the truck. When my friend knocked on the door the little fellow came to his feet and rushed to the door. My friend carried him down the stairs to be on the safe side. The Vet keep him for 5 days with EKG monitoring while he was there they said he arrested and they revived him. He’s on meds, Sotalol is one of them – he seems to be OK for now.

    Dog and other animals are Balls to the Wall. If a doc told me I had a heart condition so don’t run any marathons I won’t, when animals feel good they go for it. May be we should be more like them – it’s better to burn out than to fade away. T

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