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.

11 Comments

Filed under Congestive Heart Failure in Dogs

11 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

  3. Vivian

    My heart is broken about the loss of my dog to the same malaise. Please except my sincere condolences for your loss. Thank you foryou’re kind article to help us that are grieving. With sincere regards Vivian

  4. Hi Vivian,
    Thank you for your condolences and please accept mine.
    If my posting helped at all, that makes me feel like I accomplished what I had hoped to do, which is to help other dog owners whose dogs may suffer congestive heart failure.
    Just remembering back to Rocky’s passing, which was three years ago last Feb, makes me cry. How lucky we were to have had them, and all the love they brought, in our lives.
    Thanks very much for sharing, and again, I am very sorry for your loss.
    Gina

    • Vivian Malin

      Gina you did help me greatly. My Bobby was 13 1/2 years of fun and my treasured companion when I found out about his condition and they told me to use the medication Solalol not sure if I spelled it correctly he would slumped down to the ground and vomit at the time I really didn’t realize if it was the medicine but now reading your article it help me understand much more and with Bobby falling down suddenly I realize now he was having dizzy spells or fainting spell’s but luckily he would get up. I stopped using the medication because I thought it was making him very sick of course I feel guilty because maybe if I keep giving it to him he would’ve lived longer but my fear is that he wouldn’t live better but don’t wait on me is so heavy I can’t even function and I’m sure you you still can feel that pain he was playful all day long which was just last Monday, April 19 he always acted like a puppy he was running around taking shoes and slippers and pillows and his toys and running around the house he ate well that day and he even shared a hotdog with his grandmother. That evening he and I went to bed I got up to go to the bathroom and is he always does he comes over on my sideand we play our game is there any room for mommy and you have to go on your pillow on your side with your baby which is his toy and it happened so fast I heard him yell and I thought it was someone walking in the yardand his heart just stopped and I’ve never been the same thank you for listening

      Sent from my iPhone

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  5. Hi Vivian,
    I know the pain and you did not do anything wrong. It’s so hard to know what to do, and you did the best you could.
    Rocky was the same way in that he would recover from passing out and then seem normal and playful and I would think all is ok, but it wasn’t. With Rocky at the end, as you said, longer is not necessarily better, except for us because we still have them.
    But the first time he screamed as he was passing out, which was just two days before his death, we thought maybe he pulled something on the way down. But it became evident his condition was getting worse.
    I think you are lucky you did not have to have a vet come euthanize Bobby. Bobby died naturally and with congestive heart failure there is no cure.
    I had to euthanize Rocky and even though I absolutely know it was the right thing for Rocky, it wasn’t the right thing for me.
    I also had to put his non-biological sister, Luna to sleep last August. They had been rescued together. I have a post about her on my blog as well. I don’t know what had happened inside her and neither did the vet but she went downhill in one week and was having trouble breathing. And it felt equally as bad. It’s something I never want to have to do again, and, as a result will never get another dog because that’s how bad it made me feel.
    So please know you did the best you could and that Bobby is now out of pain and knows how much you love him. But I know the scream. I had never heard a dog scream before and it’s just awful to witness. Both Rocky and Bobby are out of pain and, who knows, maybe they are running and playing together somewhere in heaven, with Luna too, of course.
    All the best,
    Gina

    • Vivian Malin

      Gina you are my angel I was just crying my eyes out and saw your email thank you so much you are such a blessing and I did read about your sweet Luna on your blog and I’m so sorry and like you I could never have another dog because the pain is just too overwhelming. Blessings to you with a very grateful heart for reaching out to me again, Vivian Malin 508-340-9608

      Sent from my iPhone

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  6. Hi everybody, I brought my dog, a 10.5 y/o miniature schnauzer to Emergency the last week of March due to increased resting respiratory rate and not eating, mild diarrhea. I wanted a blood panel taken to ascertain if she had some underlying problem, such as pancreatitis or? Other than the above mentioned symptoms, she was bouncy and happy. Intern doc also did an ultra sound and reported she had a grade 3-4 heart murmur (grades are 1-6), but no heart drugs were prescribed at that time, but she should be seen again in another 6 months for further analysis. She was prescribed an antibiotic for diarrhea. After midnite on April 16, Riley respiratory rate was really ramping up and she seemed extremely restless. I took her temp and it was below normal. I raced her to a different Emergency Vet and as we approached the glass doors, she collapsed as though she was having a gran mal seizure. A tech saw us, I’m screaming, and he grabbed her and raced her in. PRE-DIAGNOSIS: Congestive Heart Failure. I will make a long story short… Once revived, she was place in an oxygenated kennel compartment with an IV and was given diuretics to get rid of all the fluid build-up around the lungs. I could see her about 4 a.m. I agreed to have the Cardiologist come in on Sunday for more precise tests involving the heart. I slept in my car until 7:30 am and went back in to see Riley at that time and pay a very, very large estimated emergency bill. The cardiologist would be in at 4:00 pm. I went home to shower and change clothes.
    FINAL DIAGNOSIS: Congestive Heart Failure and Degenerative Valve Disease, and a slight arrythmia. btw, A dog “COUGHING” is a very strong indication that there is heart disease. The strange thing with Riley is that she exhibited no coughing ever during her life, which is quite bizarre… she’s with me almost 24/7. Anyway, I took Riley home at 7:00 pm with the following medications:
    VETMEDIN (heart pill), Salix (diuretic/water pill) given a.m. and p.m. For the first week it was necessary to ‘force-feed’ using a plastic syringe, a wet dog food because Riley’s appetite wasn’t the greatest. I also gave her good chicken breast, cooked lean hamburger, or anything else that might tempt her to eat. I also gave her a Tablespoon of pure pumpkin and Tablespoon of low fat plain yogurt for digestive purpose. She doesn’t really like it, but she tolerated it. She was soon have NORMAL poops! On the 24th of April, her normal appetite really picked up! Went back for a follow-up app’t on April 25th and Riley was looking good. More tests, EKG, etc. She was also prescribed a low dosage 2.5 mg blood pressure med Benazapril to be given at night and a Potassium Gel tsp in morning and night. I do not have a crystal ball. All I know is that she is doing pretty damn well and going crazy at the dog park! All could fall apart tomorrow, but we are living for the day! Unless I missed it somewhere, I did not read that anyone had been prescribed Vetmedin or a diuretic, which is pretty much the norm for canine congestive heart failure? I do know an acquaintance who is also giving Sotolol along with those meds. The only thing I can add to my story is that if you receive a prescription for your pet and it is working… STOP REFILLING the medication AT THE VET!! They are charging 4 to 5+ times more than an on-line PET PHARMACY! The vet charged me $2.12 for each Vetmedin 1.25mg pill (fairly standard dose). The California Pet Pharmacy charges me $.67 per pill. Walgreens even charged me more for the blood pressure med! Get your “life long” prescription meds transferred by your Vet to an on-line Pet Pharmacy so we can STOP THE PROFITEERING by them. I had not found out about this, this Emerg. Vet Clinic was just going to continue to take me to the cleaners $$$! Pills can also be halved or quartered, too!!

    My heart goes out to all who have suffered the loss of their beloved pet or possibly ‘misdiagnosed’ by a vet who just didn’t know or didn’t refer to a Specialist.

  7. Hi Laurie,
    Thanks very much for your comments regarding my posting on Congestive Heart Failure in Dogs! Yes, I couldn’t agree more about the cost of medications from veterinarians. In fact, my neighborhood “human” non-chain pharmacy was cheaper than the veterinarian’s price. It took me a month or two to figure it out, but once I did, I also used an online Pet Pharmacy. It may have been 1800-Petmeds but it’s been awhile.
    Also, it’s not just for dogs with Congestive Heart Failure. Luna, Rocky’s sister, had arthritis and took a non-steroid inflammatory medication that I purchased online for much less than it cost at the vet. EVERYONE SHOULD BUY PET MEDICATION ONLINE!
    Rocky was also on Vetmidin as well as Lasix, a diuretic. The internist veterinarian had also suggested he be put in an oxygenated kennel, but I declined. The veterinarian had acted like it was animal cruelty if I didn’t hospitalize Rocky. But I felt Rocky would be most comfortable at home. Worrying that I should have put him in the oxygenated kennel, I used count his resting breaths per minute. I’d wake in the middle of the night and count. Or while watching tv in the evening, I would turn the sound down and check his breathing. That same vet said she saw “something” on his pancreas and that scared the heck out of me. That fear of something wrong with his pancreas lasted until he passed.
    And people reading this whose dogs have congestive heart failure may find it helpful to know that if the vet wants to do yet another EKG, you can ask to have them bring the EKG machine in the examining room, so you can comfort your dog. Or you may ask to accompany your dog into the room in which they want to do the EKG. Rocky became more ill each time we were at the vets, and so I began to insist on such things and they permitted it.
    I am very glad Riley is doing well. And it is great he is not coughing.
    Thanks again for your comment, and I hope Riley continues to do well! With a mom like you, I am sure he will. I hope your post about your experience plus the information regarding purchasing pet medications online will help others!
    GIna

  8. Thank so much for this! My 11+year old mixed breed has congestive heart failure and an arrhythmia and is on a good cocktail of medication (Lasix, Enalapril, spironolactone, vetmedin) for his CHF but was just started on Sotolol for the arrhythmia. He’s been doing ok but recently collapsed. I had just read this and was pretty sure the cause was due to the arrhythmia, which the vet confirmed, but I would have been sooo much more worried / terrified if I hadn’t read this and suspected the cause.

    Also, for anyone in this situation, if you can get your prescriptions at Costco, do so. THey now fill common pet prescriptions, including Vetmedin and they are MUCH cheaper , especially if you can afford to do a 3 month refill at once. Your dog is automatically put on the Rx card for a discount on everything. I’ve also heard that for human prescriptions you use Targets Rx card.

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