In the early stages of the disease, many dogs show few symptoms or no symptoms at all. The longer the infection persists, the more likely symptoms will develop. Active dogs, dogs heavily infected with heartworms, or those with other health problems often show pronounced clinical signs.
Signs of heartworm disease may include a mild persistent cough, reluctance to exercise, fatigue after moderate activity, decreased appetite, and weight loss. As heartworm disease progresses, pets may develop heart failure and the appearance of a swollen belly due to excess fluid in the abdomen. Dogs with large numbers of heartworms can develop a sudden blockages of blood flow within the heart leading to a life-threatening form of cardiovascular collapse. This is called caval syndrome, and is marked by a sudden onset of labored breathing, pale gums, and dark bloody or coffee-colored urine. Without prompt surgical removal of the heartworm blockage, few dogs survive.