Heartworm Disease in Dogs

Symptoms of heartworm infection vary significantly depending on the severity of infection. The severity of infection has four stages:

Stage 1 (mild) infections do not show any symptoms.

Stage 2 (moderate) infections show only a cough.

Stage 3 (severe) infections have difficulty breathing, unwillingness to exercise, and can have fluid accumulation within the abdomen (ascites). Additional signs of kidney damage, like excessive urination, are often present.

Stage 4 infections have caval syndrome, which is an emergency. Caval syndrome results from worms preventing the heart from beating. Dogs with caval syndrome have pale gums, a rapid heart rate, and can suddenly collapse. Dogs with emergency symptoms should be transported to a veterinary hospital immediately.

Pet parents who keep their dogs on regular, year-round heartworm prevention as recommended by a veterinarian do not have to worry about heartworm disease, but should keep up with routine testing as advised by their vet.

Cases of heartworm have been documented in every U.S. state, but this parasite is most abundant in the southeastern United States and along the Mississippi River Valley.

Most dogs with mild to moderate heartworm infections have a good prognosis with appropriate treatment. Severe infections can cause heart failure, kidney disease, liver disease, and difficulty breathing, which are all associated with a poorer prognosis.

Rarely, heartworm infection can cause caval syndrome, where the blood flow through the heart is blocked by a high number of adult worms. Caval syndrome is an emergency. Dogs with pale gums and a rapid heart rate, or dogs that have collapsed suddenly require immediate medical attention.

Heartworm disease is a parasitic infection caused by the roundworm species Dirofilaria immitis, which is spread through the bite of infected mosquitoes.

The severity of symptoms depends on how large the population of parasites in the bloodstream prior to treatment.

Annual testing is used to screen healthy dogs for heartworm disease. It takes six months from the time a dog is infected until it tests positive, so early, annual identification of positive dogs improves treatment outcomes.

Dogs with heartworm infection usually require some or all of the following diagnostics to determine the best treatment:

• Physical examination
• Antigen testing
• Detection of microfilariae
• Blood work
• Diagnostic imaging: X-rays or ultrasound can help determine how developed the infection is

The specific treatment protocol depends on the severity of the disease. A combination of antiparasitic medications designed to target specific stages of the heartworm life cycle are usually recommended. Injections of adulticide (adult-targeting) are given over several months, while preventatives to target the larval stages and minimize further spread are given on an ongoing basis.

Note: there are no “natural” or herbal medications proven to be effective against heartworm.

Complications during heartworm treatment are common and most dogs experience moderate to severe pain, lethargy, and appetite loss after each injection of adulticide. Exercise restriction is recommended for at least six months following injections, at which time the dog is retested to see if all worms have been eliminated.

A unique feature of heartworms is they have a symbiotic relationship with the bacteria species Wolbachia. As heartworms die off during treatment, these bacteria are released into the bloodstream and cause inflammation. Antibiotics are usually included as part of heartworm treatment as a proactive measure in anticipation of the expected inflammatory response to Wolbachia.

Dogs with caval syndrome caused by advanced heartworm disease require immediate surgical removal of the parasites, followed by a heartworm treatment protocol.

Dogs who have developed secondary conditions like kidney or liver disease will require additional treatment as determined by the attending veterinarian.

Heartworm is contagious to other dogs, cats, ferrets, and several wild-animal species, but not directly. A mosquito becomes infected when it picks up the parasite from an infected host and then passes it to another host 2-6 weeks later.

Heartworm disease is preventable. Year-round prevention for dogs throughout the United States is strongly recommended, starting as early as 6-8 weeks of age. Several medication combinations are available, and many are also preventatives for other parasite species.

Managing mosquito populations by using bug spray and removing standing water sources can also reduce transmission of disease. Do not use products containing DEET on pets.

It is also recommended that dogs in high-risk areas be tested once or twice a year for heartworm, even if they are on preventative medication.

Dogs in endemic regions are commonly exposed to heartworm. Veterinary clinics in highly endemic areas such as the Mississippi River Valley and Gulf Coast diagnose hundreds of cases of heartworm disease in dogs every year.

• Antibiotics
• Anti-inflammatories
• Repeated adulticide injections
• Heartworm prevention
• Exercise restriction
• Repeated testing