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View Full Version : My Cindy had a heart murmur and i would like some advice please



lincolnsmommy
25th August 2012, 03:47 PM
I have girl cavalier called Cindy, she is a rescue dog so unsure of her age but would guess over 8 years. We took her to the vet for her booster who told us she had a grade 4 heart murmur. She is now on heart meds but have been told this will not stop the problem only slow it down but that it will kill her in the end :( Apparently grade 4 is very bad.
Could anyone please give me advice on this. How bad is grade 4? What does it mean?

She had 24 teeth removed yesturday due to infections in her gums and holes in her teeth (problems we are sorting which she has had since we got her like her weight)Shes very drowsy today bless her.

I have been told im not allowed on another cavalier forum as Cindy is not a "show dog". I hope members on this forum will help me as shes still my baby wether shes a show dog or not :(

Thanks in advance

My cindy
http://i313.photobucket.com/albums/ll363/lincolnsmom_2008/cindy.jpg

RodRussell
25th August 2012, 04:31 PM
I have girl cavalier called Cindy, she is a rescue dog so unsure of her age but would guess over 8 years. We took her to the vet for her booster who told us she had a grade 4 heart murmur. She is now on heart meds but have been told this will not stop the problem only slow it down but that it will kill her in the end :( Apparently grade 4 is very bad.
Could anyone please give me advice on this. How bad is grade 4? What does it mean?

Dear Lincolnsmommy: Mitral valve disease (MVD) in cavaliers is progressive, meaning it gets worse as time goes by. For some dogs, that progression is a slow process, but for others, it can be rapid. The grading system is from 1 to 6, with grade 6 being the worst. A grade 4 is not "bad" in and of itself, but it indicates that Cindy's valve disorder has gotten worse.

One thing to keep in mind is the many general practice vets have not been trained enough in measuring the grades of heart murmurs to accurately classify the grades. So, Cindy's vet could be wrong about the grade 4. Veterinary cardiologists and internal medicine specialists are trained to do a better job of grading murmurs.

There is a webpage on this subject -- http://cavalierhealth.org/mitral_valve_disease.htm -- that discusses it all in much more detail. Here is a link directly to a discussion on grades of murmurs: http://cavalierhealth.org/mitral_valve_disease.htm#Grades

Could you tell us more about Cindy's medications? What they are and how much per day? Where do you live? In the US, UK, Canada, or where else? I ask that because in the US and Canada, I can tell you if there are any veterinary cardiologists nearby who could examine Cindy and make sure her heart diagnosis is correct.

I am a little concerned about the fact she has been prescribed medications, if she really does have a grade 4 murmur. There is a set of guidelines, called a Consensus Statement, published by a panel of cardiologists who do not recommend prescribing medications to dogs with mitral valve disease unless they show symptoms of congestive heart failure and/or have significant enlaregement of their hearts. You may find the Consensus Statement here: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf

If I were in your position, I would take a copy to my vet and ask him if he already has read it or not, and if he has not, to question whether Cindy needs heart medication if all he knows is that she has a grade 4 murmur. My family got our first cavalier in 1969, so we've had the breed for over 40 years. All but three of our cavaliers have had murmurs as high as grade 4 (the highest is grade 6), and none of them were prescribed any heart medications until they reached grade 6.

I have found that some general practice vets are a little to quick to prescribe heart medications, and they end up doing so too early in the progression of MVD. Some such medications may lose their effectiveness if prescibed too early in that process. That is why, although we now have a cavalier with a grade 4 murmur, he is not taking any medications. He is being given supplements (see http://cavalierhealth.org/mitral_valve_disease.htm#---_supplements).

lincolnsmommy
25th August 2012, 04:55 PM
Thanks so much for that info. The vet didnt seem confident when grading. She said she will grade it a 4 but another vet may grade another so we will never know as everyon thinks differently. We have been given Cardisure 5mg x 14.0. give 0.5 tablet 2 times daily. We have not given them to her yet as they vet has said she doesnt know wether she needs them but we can have them to try. The vet said she will put her on something else after but not sure what medication that will be.

We are very confused and overwelmed by it all. Thanks for all your help

Forgot to mention im in the UK:)

sunshinekisses
25th August 2012, 05:19 PM
Cindy is a beautiful girl, thank you for rescuing. My rescue/rehomed boy is almost nine with a grade 3 murmur. He does not require meds yet so I haven't had to worry about that. I would think her murmur must be worrisome to the vet to prescribe meds. My old boy is just slow at most things but sometimes it is hard to know if it is his arthritis or his heart that is slowing him down. We also had to remove some of his teeth due to decay when he was rehomed to us. You will be surprised how quickly she will learn to eat without her teeth. :)

Karlin
25th August 2012, 06:05 PM
The vet didnt seem confident when grading. She said she will grade it a 4 but another vet may grade another so we will never know as everyon thinks differently.

I think as a priority, you should arrange to see a board-certified cardiologist. :) They can give you a definite grade -- it isn't quite as subjective as your vet describes; grading accurately requires expertise most vets won't have so they are guessing to a degree.

IMHO, you really really do not want to work solely with a vet who is so unsure about giving medications and designing an adequate treatment plan for this common heart issue in the breed. Almost 100% of cavaliers will eventually have MVD and the treatment approach is pretty well understood. HOWEVER vets are not specialists and thus often misgrade murmurs and also far too often start treatment too early -- which can hasten an earlier death! I agree with Rod on this -- all vets I have encountered prescribe meds too early, if you read what cardiologists recommend.

You really do need to know the grade -- which a cardiologist can tell you accurately in 5 minutes of listening to the heart -- plus they can give you all sorts of further detail and tell you definitely whether your lovely rescue girl needs to start now on medications or wait. A grade 4 is often too early for many cases of MVD.

Someone may be able to have the link to hand for certified cardios in the UK or receommend someone in your region. Please note that if money is tight, you can at the very least simply get an auscultation (listening by stethoscope) by a cardio and this will be worth every penny and is not generally very costly (about the same as a vet visit). Further tests may be recommended but you can decide if and when to do them if the cost is problematical.

There's another current thread on MVD resources in the MVD/SM forum but in general you can find tons of info at www.cavalierhealth.org. I see Rod (who runs the site) has given you a detailed reply already. :)

It is a shame any forum would not give help to someone with an ill cavalier simply because they don't have a show dog. :x

Karlin
25th August 2012, 06:17 PM
Just a PS -- in the UK & Ireland vets and cardiologists sometimes use a 5-grade scale for murmurs and not a 6 grade scale. So the worst is sometimes a grade 5.

Here's a good explanatory page from a UK vets:

http://www.southillvets.co.uk/svs/factsheets/101-heart-murmurs.html

Sydneys Mom
25th August 2012, 06:40 PM
I agree 100% with what everyone has said so I won't repeat it. The best thing you can do, besides seeing a cardiologist, is readeverything you can about MVD and learn the signs of your dog when she may be in distress.

Good luck and let us know how she's doing.

Nicki
25th August 2012, 10:15 PM
Firstly welcome to the forum, Cindy is lovely.

I'm sorry you are dealing with so many health issues, you might find this website helpful - it is in easy to understand language http://www.cavaliermatters.org/

Your vet would need to refer you to a cardiologist but you can find your nearest one here http://www.bsavaportal.com/vcs/Information/HeartTesting/Dopplerechocardiographyexamination.aspx


It's very worrying that your vet does not seem at all sure about heart conditions, if you are not able to visit a cardiologist then please try to see a different vet more experienced with dealing with heart issues. You can search for vets here http://findavet.rcvs.org.uk/home/ I think you can search for specialities, some vets have extra training in their chosen interests.


I'm shocked at this

I have been told im not allowed on another cavalier forum as Cindy is not a "show dog". I hope members on this forum will help me as shes still my baby wether shes a show dog or not


You are most welcome here we enjoy hearing about everyone's Cavaliers and we try to help EVERYONE - all Cavaliers are special, poor Cindy obviously had a difficult life and it's wonderful that she is in a loving home where she will be cared for now.

Brian M
25th August 2012, 10:33 PM
Hello lincolnsmummy

You got told you were not welcome as your little girl is not a showdog ,HUF there blxxxx loss and our gain and to me its plain to see shes a Cavalier
so thats all she needs to be to very wellcome here ,the cheeky ignorant so and so .We are all more than happy to help from people like me with four girls
to ex show people like our Margaret who has a massive amount of knowledge then there's Karlin ,Nicki ,Tania and zillions of others and also our Rod with
his own superb site www.cavalierhealth.org and Tanis www.cavaliermatters.co.uk and loads more to help ,assist and advise so glad to see you here .

Best wishes

Brian m and
Poppy ,Daisy ,Rosie and Lily
The FlowerCavs

Brian M
25th August 2012, 10:43 PM
Hi

My Daisy is a recently diagnosed grade 4 but her cardio said no meds until she reaches CHF .So I keep her on
a very low sodium diet give her certain supplements and treat her as my normal Daisy with no limit on her
exercise ,while she is here I want her to enjoy life and me to enjoy her and even then her Cardio said when
she does reach CHF with careful management by him we could get another 20 months out of her yet.

So any serious deterioration may be a long way away yet ,he even commented that hes been thinking that
the general comment of all Cavalier having a murmur by the age of 5 that it possibly might be lifted to age 7.

Surely that shows some progression that with care and support by all our babies might just be living that bit
longer ,we will wait and see .

Take Care

Brian

karen baker
25th August 2012, 11:12 PM
cindy is beautiful!!!!!! I,am sure you will get lots of advice from this forum, and support, as far as i,am concerned all the cavaliers and other d ogs on this forum are "show dogs" Karen Ruby and Sadie x

Kate H
25th August 2012, 11:38 PM
Hi Chez

Glad you finally made it onto this forum! As Karlin says, a useful first step can be simply to get a cardiologist to use his special stethescope on Cindy, which will give you an accurate grade. I don't know whereabouts you live in the UK, but there is Cavalier Club organised health clinic in Leicestershire on 29 September open to any Cavalier - more information in the Events sub-forum of the General Cavalier Chat and Discussion section here. If you are elsewhere in the UK, you can find a list of forthcoming health clinics on the Cavalier Club website - I've forgotten the website address, but google 'Cavalier Club UK' and you should get there, then on the home page click on Health Clinics from the list of topics on the right hand side. Most of the heart checks at these clinics are done by Simon Swift, one of the leading heart researchers at Liverpool University; he is a really nice, friendly person and besides giving you an accurate grade will be able to tell you (and through you your vet) whether Cindy should be on medication or not.

I don't think Cardisure is actually a heart medication in the sense of directly treating a heart problem - it contains a high dose of the basic ingredients of Omega 3 and can possibly help slow the progression of MVD. This may be why your vet suggested it - Simon Swift said the same to me when my Aled's murmur went from a 2 to a 3. You can get the equivalent amount of Omega 3 from ordinary capsules at a much cheaper price! Aled (who is 5 years old) has a Grade 3 murmur possibly edging to 4, but with keeping him fit, watching his weight and also giving him Omega 3 every day, his murmur hasn't got worse over the last 3 years. I take him to one of the health clinics every year just for Simon to give him a quick check so that I know whether he's staying stable.

Kate, Oliver and Aled

Pat
26th August 2012, 02:14 AM
Tablets for dogs - Pimobendan

Cardisure® Flavoured 1.25 mg
Cardisure® Flavoured 2.5 mg
Cardisure® Flavoured 5 mg
Cardisure® Flavoured 10 mg


MARKETING AUTHORISATION HOLDER
Eurovet Animal Health BV, Handelsweg 25, 5531 AE Bladel, The Netherlands

DISTRIBUTOR
Eurovet Animal Health Ltd, Compass House,Vision Park, Chivers Way, Histon, Cambridge, CB24 9AD, UK

NAME OF THE VETERINARY MEDICINAL PRODUCT
Cardisure® Flavoured 1.25 mg tablets for dogs, Pimobendan
Cardisure® Flavoured 2.5 mg tablets for dogs, Pimobendan
Cardisure® Flavoured 5 mg tablets for dogs, Pimobendan
Cardisure® Flavoured 10 mg tablets for dogs, Pimobendan

STATEMENT OF THE ACTIVE SUBSTANCE(S) AND OTHER INGREDIENT(S)
Active substance: Pimobendan
Cardisure® 1.25 mg tablets: Each tablet contains 1.25 mg pimobendan.
Cardisure® 2.5 mg tablets: Each tablet contains 2.5 mg pimobendan.
Cardisure® 5 mg tablets: Each tablet contains 5 mg pimobendan.
Cardisure® 10 mg tablets: Each tablet contains 10 mg pimobendan

INDICATION(S)
For the treatment of canine congestive heart failure originating from valvular insufficiency (mitral and/or tricuspid regurgitation) or dilated cardiomyopathy.

CONTRAINDICATIONS
Do not use in cases of hypertrophic cardiomyopathies or clinical conditions where an augmentation of cardiac output is not possible for functional or anatomical reasons (e.g. aortic stenosis).

ADVERSE REACTIONS
A moderate positive chronotropic effect and vomiting may occur in rare cases. However, these effects are dose-dependent and may be avoided by reducing the dose in these cases. In rare cases transient diarrhoea, anorexia or lethargy have been observed. If you notice any serious effects or other effects not mentioned in this leaflet, please inform your veterinary surgeon. Although a relationship with pimobendan has not been clearly established, in very rare cases, effects on primary haemostasis (petechia on mucous membranes, subcutaneous haemorrhage) may be observed during treatment. These signs disappear when the treatment is withdrawn. In rare cases, an increase in mitral valve regurgitation has been observed during chronic pimobendan treatment in dogs with mitral valve disease. Monitoring of cardiac function and morphology is recommended in animals treated with pimobendan.

Pat
26th August 2012, 02:24 AM
What is Cardiguard®?
Specifically designed for dogs, Cardiguard® is a highly concentrated, easy-to-dose nutritional supplement that gives your dog the Omega-3 fatty acids that can help support heart health. Cardiguard® provides your dog with non-drug heart support both in early and more advanced stages of heart disease.


I hate these #@&** marketing departments!!

Pat
26th August 2012, 03:00 AM
I've posted about this many times in many forums over many years.

No cardiologist (and this goes even more for a GP vet) should be prescribing medications based on ONLY auscultation - murmur grade. The murmur grade tells you absolutely nothing about whether a dog needs to be on medication. The only value of knowing a murmur grade is that it is a sign (or clue) that tells you when to get a cardiac workup - radiographs and/or echocardiogram - so that an accurate diagnosis of the stage of the disease can be made. It is a serious sign if the murmur grade rapidly and/or suddenly increases - and you would absolutely want diagnostic tests done in that case versus a murmur grade that slowly increases over the years.

The decision to prescribe meds is made based on test results and symptoms, not on the grade of a murmur. Chest x-rays give you important (and objective) information about heart size, presence of fluid in the lungs, condition of great vessels, and whether there is heart enlargement compressing the main airway. Echocardiogram gives you EXACT heart chamber measurements, exact measurement of backflow velocity (regurgitation from the valve), tells you the condition of the valve/s (for example, prolapsed, flail leaflets, ruptured chords) and gives other information such as the presence of pulmonary hypertension. It also gives you an objective measurement of contractility (the pumping strength of the heart). (This is also called fractional shortening.)

Chest x-rays are not very expensive, echocardiograms are more expensive. If cost was an issue, I'd at least monitor progression of disease with chest x-rays every six months to twelve months. Echos generally don't need to be done that often. If I absolutely had no money for any diagnostic tests, I would not start meds until there were overt symptoms of heart failure (cough, fainting, exercise intolerance, shortness of breath, etc.).

For a middle aged dog with a low grade murmur, I'd start with a baseline chest x-ray. By the time the grade gets to about a III or IV (Roman numerals are used, not Arabic numbers - and I couldn't tell you why!), I'd ideally like to do x-rays and an echocardiogram if I can. If my dog had symptoms, I'd always want to do a full work-up including blood chemistry.

My personal preference is to start an ACE inhibitor (enalapril) when there are significant changes in heart size and functioning but before there are overt symptoms of heart failure. When symptoms start, I add furosemide. As the disease progresses, I'll add pimobendan. There are quite a few other medications that can be added when these drugs fail to control symptoms. This method allows me to start one med at a time so I can measure positive effects and possible side effects for each drug. If you start two or three meds at the same time, you don't know which med is causing improvements or side effects. As I said, this is MY personal preference, but it is supported in the ACVIM consensus paper that Rod mentioned and my cardiologist also supports this. However, each case is different and I would explore other options for a unique situation.

Most cardiologists will simply say "no medications needed" for a middle aged dog with no symptoms and a low to medium grade murmur, and they (rightly) won't push a client to do tests in this common situation.

Deciding to start meds based on only a grade of a murmur (no symptoms or tests) is like throwing a dart at a target in the dark. Maybe you'll get it right; probably you'll miss; hopefully you won't accidentally kill someone.

Pat

MomObvious
26th August 2012, 03:36 AM
I have been told im not allowed on another cavalier forum as Cindy is not a "show dog". I hope members on this forum will help me as shes still my baby wether shes a show dog or not :(

What a bunch of SNOBS :mad: There is a ton of great info and "experts" on cavalier health (you will be pointed in the right direction- a vet is the only true expert) and many many personal experiences from people who love cavaliers all cavaliers. Not only that you will receive support from people who love their dogs like children.

I agree with the advice you have been given by others. I have nothing to add just want to add my support and I hope you get your little one straight quickly. :)

Emkaybee
26th August 2012, 07:28 AM
I have girl cavalier called Cindy, she is a rescue dog so unsure of her age but would guess over 8 years. We took her to the vet for her booster who told us she had a grade 4 heart murmur. She is now on heart meds but have been told this will not stop the problem only slow it down but that it will kill her in the end :( Apparently grade 4 is very bad.
Could anyone please give me advice on this. How bad is grade 4? What does it mean?

She had 24 teeth removed yesturday due to infections in her gums and holes in her teeth (problems we are sorting which she has had since we got her like her weight)Shes very drowsy today bless her.

I have been told im not allowed on another cavalier forum as Cindy is not a "show dog". I hope members on this forum will help me as shes still my baby wether shes a show dog or not :(

Thanks in advance

My cindy
http://i313.photobucket.com/albums/ll363/lincolnsmom_2008/cindy.jpg
I can't imagine someone or some forum being unwilling to help you because she's not a show dog! How silly and frustrating! I think you've gotten lots of good info already. I'll just second the idea of seeing a cardiologist. If your dog is at stage 4, it's too early for meds. She has a very sweet face!

RodRussell
26th August 2012, 04:34 PM
... We have been given Cardisure 5mg x 14.0. give 0.5 tablet 2 times daily. We have not given them to her yet as they vet has said she doesnt know wether she needs them but we can have them to try. The vet said she will put her on something else after but not sure what medication that will be. ...

I missed the Cardisure mention before, until after I read Pat Beman's post about it. Yes, Cardisure is the same as Vetmedin, both are pimobendan. I would never give pimo to my dog upon the prescription of a general vet who only auscultated my dog with a stethoscope. Her doing so borders on malpractice. At the early stage of a typical Grade 4, without any symptoms, pimo more than likely would do much more harm than any good at all.

Pat's post about cardio exams deserves a special place on this list.

Pimo should be given only if the dog is in congestive heart failure (CHF), and in some cases -- including one of my dogs -- pimo is not even appropriate at earlier stages of CHF, in fact, it can be deadly. The premature ingestion of pimo can accelerate some dogs' MVD, turning a slowly progressing disease into nearly instant death. That is why I am so opposed to the EPIC Trial going on right now. I believe it is irresponsible of any cardiologist to talk any owner into allowing his/her cavalier to be used as a lab rat for the dangerously premature giving of pimo to the owner's dog.

Incidentally, the EPIC Trial is financially underwritten by the manufacturer of Vetmedin, so the cardiologists who are talking owners into using their cavaliers as guinea pigs are being paid by Vetmedin to do so. Their advice thereby suddenly becomes un-objective and a shameful conflict of interest.

I repeat, Pat's post about cardio exams deserves a special place on this list.