Cause of cough is often fluid in the lungs.

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Baby is 15 ½ years old. The tiny mixed-breed dog has started slowing after an extremely active life.

Baby has also been coughing, almost like she was choking and to the point where she nearly collapses. Pauline took Baby to the veterinarian, who diagnosed congestive heart failure.

Baby was put on three medications. The first is a diuretic to help pull fluid out of her lungs and help stop the coughing. (A radiograph showed fluid in Baby’s lungs.) The other two are to help her heart pump stronger and more efficiently. Cough suppressant tablets were also prescribed.

Pauline worries about Baby’s persistent cough. She realizes Baby is toward the end of her life and wants to make her as comfortable as possible, so she’s asking if there is something more to be done about the cough.

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Congestive heart failure can certainly manifest with coughing. The cause of the cough is often fluid in the lungs that results from back pressure in the blood vessels coming from the lungs to the heart. This back pressure results in leakage of fluid from the vessels into the lungs. The body’s response is to cough to try to get rid of it. The diuretic will help remove fluid through the kidneys and out in the urine. However, Baby is still coughing. It may be that there is still fluid accumulating in the lungs. Another radiograph would determine if this is the case. Then, the problem can be addressed by adding another diuretic to the drug regimen or increasing the amount of furosemide given.

The other distinct possibility for Baby’s continued cough involves one of the changes within the heart that can occur with congestive heart failure. Because of the back pressure that occurs within the right side of the heart with congestive heart failure, one of the four chambers of the heart, the right atrium, will enlarge over time. When it gets large enough, it will impinge on one of the breathing tubes, a main stem bronchus, which supplies air to the lung. This impingement irritates the bronchus and causes the cough response. This is what I suspect is causing Baby’s persistent cough. Unfortunately, there is no direct way to eliminate this cause.

Baby already is on the proper medications to help her heart function better and slow the increase in the size of her right atrium. Cough suppressants can help with a cough associated with main stem bronchus impingement, but there is no direct way to eliminate that type of cough. There are several types of cough suppressants that can be tried.

Have Baby re-evaluated to determine the definitive cause for her continued cough and what can be done to help her. I would suggest she have an echocardiogram, which will allow a detailed look at how her heart is functioning and measurements of the chambers of the heart.

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