Nutrition for Dogs with Heart Disease

My dog was just diagnosed with congestive heart failure. How did his heart disease happen?

Heart disease in general, and congestive heart failure (CHF) in particular, are fairly common diseases in dogs. The most common acquired heart abnormality (differentiated from a heart abnormality the dog is born with) is chronic valvular disease. The valves deteriorate and become stiff, allowing blood to flow backward as the heart beats. Over time this can lead to the vascular congestion, as suggested by the name of the disease.

A second cause for congestive heart failure in dogs is dilated cardiomyopathy in which the heart muscle thins, dilates, and can no longer beat effectively enough to move blood.

Hypertension (high blood pressure) may be a contributor to heart disease and CHF, so checking the blood pressure of any dog suspected of having heart disease is a good idea.

While there is no definitive answer to the question "How did my dog develop CHF?" it is worth noting that approximately one-third of dogs over the age of 10 have some level of cardiovascular disease. Also, small dogs are more often affected than larger dogs. With so many dogs at risk of developing heart disease in old age, it makes sense to consider ways in which nutrition may play a role in keeping these dogs as healthy and comfortable as possible.

I have always fed my dog food from the grocery store. Now that he has CHF, aer there changes that I should make with his food to help him?

The first step toward determining the best nutrient profile to feed your dog with CHF is to work with your veterinarian to determine what, if any, other medical conditions might be present in your dog. For instance, hypothyroidism, chronic kidney disease, and obesity are common in older dogs. Any, or all of these conditions may be present and would benefit from good nutritional choices. The key to success is understanding which disease takes precedence.

Hypothyroidism is diagnosed by simple blood tests and managed using daily, lifetime medication. Hypothyroidism can also contribute to weight gain and obesity, reinforcing the need to test for this disease. It is important, when embarking on canine weight loss, to use a nutrient profile that has been proven to promote weight loss AND body remodeling: burning fat and building/maintaining muscle. Diets that promote this include Hill's® Prescription Diet® r/d®, Hill's® Prescription Diet® Metabolic Canine, Royal Canin® Canine Satiety® Support Weight Management, Royal Canin® Canine Calorie Control, Purina® Pro Plan Veterinary Diets® OM Overweight Management®, and Rayne Clinical Nutrition™ Healthy Reduction-MCS™. Your veterinarian can make a specific evidence-based recommendation. Chronic kidney disease (CKD) is the most common disease in dogs over the age of eight, so it often occurs in conjunction with heart disease. There are specific therapeutic nutrient profiles that have been proven to support dogs with CKD and CHF. These are veterinary-exclusive formulations (see article “Nutrition for Dogs with Chronic Kidney Disease”). Work with your veterinarian to choose the most appropriate food for your dog.

For heart failure patients in particular, there are some key nutritional factors to consider. CHF is associated with retention of sodium, chloride, and water, making the salt (sodium chloride) content of the dog's food very important in disease management. The sodium intake for a dog with CHF should be restricted to 0.08% - 0.25% on a dry matter (DM) basis, and chloride should be restricted to 0.12% - 0.38% (DM). While a lower sodium chloride content in a dog's food will not prevent heart disease, at the first sign of heart disease, foods should be chosen with sodium and chloride levels within the recommended restrictive ranges. It may be appropriate to consider using distilled water if the household water has more than 150ppm of sodium.

Are there any other nutritional concerns besides salt content that can benefit my dog with CHF?

In addition to sodium and chloride, there are other nutritional considerations that can benefit dogs with CHF. Your veterinarian can help you choose specific nutritional formulations that meet these recommendations.

• Phosphorus. Phosphorus is a concern in those dogs who also have kidney disease. Phosphorus should be restricted to 0.2% - 0.52% DM.
• Potassium. Potassium serum levels should be monitored in the dog, but a good dietary level of potassium to start with is 0.4% - 0.52% DM. Supplementation may actually be necessary if your dog is on certain diuretics. 
• Omega-3 fatty acids. The omega-3 fatty acids EPA and DHA may help to stabilize heart muscle cells. Your veterinarian can help you to choose an omega-3 fatty acids supplement with good bioavailability, meaning that it is easily absorbed by the body. Unfortunately, no optimal dose for the dog with CHF has yet been determined.

Overall, the best nutritional plan for a dog with CHF is a therapeutic nutrient profile formulated with controlled levels of sodium and chloride that has been demonstrated in clinical studies to be helpful. Home cooking creates great risk of an improperly balanced ration as well as inadvertently high levels of sodium (many human foods contain well-hidden sodium). Some balanced diets include Royal Canin® Veterinary Diet Canine Cardiac, Rayne Clinical Nutrition™ Restrict-CKD™, or Hill's® Prescription Diet® h/d®.  Your veterinarian will help you determine the most appropriate nutrient profile at each stage of your dog's heart disease progression.