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timclayton
28th November 2013, 09:46 PM
My little Chesney is now just 6yrs old. I'm a dermatologist but underwent general medical training. Tonight I could detect a systolic murmur when I auscultated his chest. I have never picked it up before. I am very worried that this may be significant. I will contact the VET tomorrow and try and get him seen next week. I know that murmurs are very common in this breed and he is asymptomatic at present but I am very worried. Any further info would be helpful. He is otherwise fit and well and in the past he did suffer haemorrhagic gastroenteritis and responded very well to treatment. He is not overweight, has 1/2 tray of nature diet every day and milky biscuits as treats and he gets regular excerise, despite the dark nights.

Sydneys Mom
28th November 2013, 11:27 PM
Sorry you've heard a murmur. Unfortunately, this is very common in this wonderful breed. Contacting your vet is a good first step, but I would ask your vet for a referral to a cardiologist. They are the best to diagnose and treat heart problems. A cardiologist will most likely take an xray to see if the heart is enlarged and may also take a sonogram.

Let us know what your vet says. It's great that you are on top of this. This is the best you can do for Chesney.

RodRussell
29th November 2013, 12:22 AM
By age 6 years, statistics indicate that 60+% of all cavaliers will have a mitral valve murmur. Just about everything I know about MVD in the CKCS is contained in this article -- http://cavalierhealth.org/mitral_valve_disease.htm -- and its related links.

Kate H
30th November 2013, 02:29 AM
My Oliver was also diagnosed with a murmur when he was 6. He's now 12 years old, has a grade 3 murmur but no symptoms at all. Symptoms don't usually start appearing until the murmur becomes a grade 5, and like Oliver, Chesney may live a good long life without getting anywhere near a grade 5. All you can do is what you are doing - keep him fit and a good weight, but a visit to a cardiologist would be a good idea, so that you know exactly what is going on.

Kate, Oliver and Aled

timclayton
2nd December 2013, 04:14 PM
My Oliver was also diagnosed with a murmur when he was 6. He's now 12 years old, has a grade 3 murmur but no symptoms at all. Symptoms don't usually start appearing until the murmur becomes a grade 5, and like Oliver, Chesney may live a good long life without getting anywhere near a grade 5. All you can do is what you are doing - keep him fit and a good weight, but a visit to a cardiologist would be a good idea, so that you know exactly what is going on.

Kate, Oliver and Aled
Thank you for all of your comments. The VET agreed that Chesney has a grade 1/2 murmur, she offered two options, leave alone and regular check up or start a calcium channel antagonist to reduce the load on his heart. Opted for the tablets and regular check ups, he's been prescribed vetmedin 2.5mg bd. I am very anxious but trying to remain positive.

RodRussell
3rd December 2013, 02:00 PM
The VET agreed that Chesney has a grade 1/2 murmur ... he's been prescribed vetmedin 2.5mg bd. ...

I am a little stunned that a dog with a grade 1 to 2 murmur has been prescribed Vetmedin. I would NEVER give my dogs Vetmedin if they only had grade 2 murmurs and no symptoms. I consider the prescribing of Vetmedin to dogs at that stage of mitral valve disease to border upon veterinary malpractice.

In the US, the federal government's Food & Drug Administration has approved Vetmedin (generic name: pimobendan) ONLY for dogs in congestive heart failure, mainly because the drug has been shown the potential for doing more damage than good for dogs whose heart muscles are healthy enough to pump sufficiently. On the containers of the Vetmedin in the US is this WARNING: "Vetmedin should not be given in cases of hypertrophic cardiomyopathy, aortic stenosis, or any other clinical condition where an augmentation of cardiac output is inappropriate for functional or anatomical reasons. ... Warnings: Only for use in dogs with clinical evidence of heart failure." See more about Vetmedin's unintended consequences and side effects at http://www.cavalierhealth.org/mitral_valve_disease.htm#A_Few_Words

timclayton
3rd December 2013, 06:08 PM
I am a little stunned that a dog with a grade 1 to 2 murmur has been prescribed Vetmedin. I would NEVER give my dogs Vetmedin if they only had grade 2 murmurs and no symptoms. I consider the prescribing of Vetmedin to dogs at that stage of mitral valve disease to border upon veterinary malpractice.

In the US, the federal government's Food & Drug Administration has approved Vetmedin (generic name: pimobendan) ONLY for dogs in congestive heart failure, mainly because the drug has been shown the potential for doing more damage than good for dogs whose heart muscles are healthy enough to pump sufficiently. On the containers of the Vetmedin in the US is this WARNING: "Vetmedin should not be given in cases of hypertrophic cardiomyopathy, aortic stenosis, or any other clinical condition where an augmentation of cardiac output is inappropriate for functional or anatomical reasons. ... Warnings: Only for use in dogs with clinical evidence of heart failure." See more about Vetmedin's unintended consequences and side effects at http://www.cavalierhealth.org/mitral_valve_disease.htm#A_Few_Words

Hi Rod I did read the link yesterday and emailed my VET.

She replied: We treat lots of dogs with heart disease,especially cavaliers as it is so prevalent within the breed. There are arguments for and against treatment of dogs at Chesney's stage. I don't think that the vetmedin will worsen his heart disease,however I don't want to put him in medication that we aren't comfortable with. I am quite happy to monitor his murmur every 3 months and then to start treatment at a point where the murmur becomes louder,or he begins to show signs of congestive heart failure,such as coughing or exercise intolerance. He may stay stable like he is for a couple of years yet. As long as we keep a regular check on him,we will be fine to delay the start of any treatment. I honestly don't want you to be worried,so I think the best plan may be to hold off on the treatment but initiate it as soon as his condition worsens. Like I said we have used this drug in lots of dogs and it is very effective at alleviating signs and slowing progression of disease.

So I have decided to wait and have regular reviews. I think Chesney's vet is a very good practioner and she understands that I am an anxious doctor/owner/person. I am grateful for all the comments on this thread.

Karlin
3rd December 2013, 06:16 PM
I'm also so sorry to hear you have detected a murmur but like others would note it is very, very common in the breed (sadly) and the majority of cavaliers would have a murmur by this age. The good thing is it is low grade. It is very hard to predict how it will develop -- many dogs do not have them worsen at all or much, while others can deteriorate more quickly. There are many things you can do right now -- make sure your cavalier is trim and fit as any excess weight places pressure on the heart; give CoQ12 and fish oils, etc -- all detailed on Rod's links.

Would echo Rod's concerns, too. For some reason, vets seem to not keep up with developments on the MVD front and tend to just start giving meds as soon as a murmur is detected but this is not only not necessary, but can cause greater, faster deterioration. Vetmedin is actually one of the very LAST drugs given for MVD, when the dog is clearly in congestive heart failure (to such a degree that respiration accelerates -- taking resting respiratory rate is actually a much better guideline for owners to judge whether their dog needs to be on certain meds in the MVD arsenal). Rod's links are very good and he has an excellent document with the agreed care protocol at various stages from cardiologists. And there's another recent thread here with discussion on heart management.

Best practice is to have your cavalier checked by a board-certified cardiologist.

Do a search on heart/MVD discussions here and you'll get tons of detailed care info especially from posts by Pat.

RodRussell
3rd December 2013, 06:30 PM
I am glad you are going to hold off on the Vetmedin. A group of 36 cardiologists from all over the world presently are conducting a study of 360 dogs with mitral valve disease (but not congestive heart failure -- CHF) to determine if Vetmedin is safe for dogs before CHF. The study started last year and is designed to be completed in 2015. So, we are two years away from even knowing if it is safe to give Vetmedin to dogs not in CHF.

I am just dumbfounded that any veterinarian would even give a cavalier owner the option to give his or her dog Vetmedin. I know of cavaliers that have died from the premature taking of Vetmedin. I suspect it is all sales and marketing talk by the manufacture's salesmen. I have spoken with a few vets who confirmed that Vetmedin's salesmen are touting it for all stages of MVD.

My bottom line is to never let a non-specialist (cardiologist or internal medicine) prescribe any heart medications.

Karlin
3rd December 2013, 06:31 PM
This is from another thread> Generally you do not start meds til resting resp rate is greater than 30/min.

PS your vet really should read the cardiologist's recommendations (Rod's document). While many vets continue to say that results are uncertain and (sigh) then prescribe a quite expensive medication that they supply, 'just in case', actually cardiologists feel the evidence pretty much weighs out starting vetmedin in particular, before the dog is in CHF. And there are studies that indicate it can cause actual damage. At best, starting meds early is a waste of money and exposes the dog to unnecessary meds. But as one of my vets says: starting them too early means you lose tools far earlier in your arsenal and have to move more quickly to higher doses and more meds. And they can potentially cause damage.


"After reviewing the echo study I am not convinced your patient is in CHF. The presence or absence of CHF cannot be determined by echo. Physical exam, thoracic radiography and the SRR with a proven Lasix response if the SRR is elevated are much more accurate. The echo can readily assess the presence or absence and degree of cardiac pathology and verify the reason for murmur generation and provide info that is consistent or inconsistent with CHF but cannot tell you that CHF is definitely present.
The echo confirms the murmur in this patient is due to MR most likely associated with MMVD in the CKCS. However, the LA and LV size is not consistent with CHF.
I would have the owner log the SRR for 3-4 days and if <30/min stop the pimobendan and enalapril and begin to taper the Lasix dose lower and lower monitoring the SRR at each step.

Client education is important here as it is likely that this dog will go into CHF at some point in the future due to a worsening of the MMVD. Careful monitoring of the SRR will allow you to restart meds when the SRR begins to approach 30/min. No study to date has shown that early intervention with the drugs you are using is beneficial in either prolonging life or prolonging time to onset of CHF."

From this thread: http://www.cavaliertalk.com/forums/showthread.php?43665-very-bad-heart-issue-and-teeth-removal-(/page2

On the plus side: treatment for MVD is generally well understood (outside that 'too early' element from many vets) and there are several meds that help and can be introduced over time. That said: MVD can be distressing and challenging as it progresses (which is why regular monitoring is important and why using a cardio is best practice and can add months to years to a dog's life, compared to vet treatment alone) and it is an absolute tragedy that this breed has endemic early onset heart disease. It is so widespread that it affects the average lifespan for the breed quite severely -- a small breed like this should routinely live to 14-16 but average lifespan is variously estimated as 9-12 years.

I've recently taken two cavaliers into rescue that were both on an array of heart meds -- had them reassessed by two vets very good on hearts and both recommended taking them back off meds -- in one case, entirely, in the other, from taking three down to just one (frusemide). So, so common to find this is the case -- many vets start meds as soon as they hear a murmur and keep increasing them as the murmur gets stronger even though degree of murmur is not an indicator of when to give meds at all! I will get the two rescues into my cardio later this month.

Karlin
3rd December 2013, 06:51 PM
Cardio document: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf

timclayton
3rd December 2013, 09:53 PM
Cardio document: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf
appreciate all your comments. keeping my fingers crossed he remains well and off meds

Kate H
4th December 2013, 12:15 PM
I would echo what others have said - MVD drugs are given to deal with symptoms, so that the dog is kept as comfortable as possible, and to support the heart. No symptoms - no drugs are necessary. Symptoms don't usually appear until the heart reaches a Grade 4-5, congestive heart failure usually appears at around Grade 6. So your Cavalier is a long way off that and may never reach it. It's not a matter of, as your vet said, just keeping him going for a couple of years; your dog may have many years of more or less healthy, symptom-free life ahead of him, as my Oliver is still going strong after 6 years with a murmur and still only a grade 3 at 12 years old. I'm afraid it's all a bit of a lottery - some Cavaliers live for a long time with a mild murmur, others deteriorate quickly; I hope your boy is one of the former.

Kate, Oliver and Aled

timclayton
5th December 2013, 09:38 PM
I would echo what others have said - MVD drugs are given to deal with symptoms, so that the dog is kept as comfortable as possible, and to support the heart. No symptoms - no drugs are necessary. Symptoms don't usually appear until the heart reaches a Grade 4-5, congestive heart failure usually appears at around Grade 6. So your Cavalier is a long way off that and may never reach it. It's not a matter of, as your vet said, just keeping him going for a couple of years; your dog may have many years of more or less healthy, symptom-free life ahead of him, as my Oliver is still going strong after 6 years with a murmur and still only a grade 3 at 12 years old. I'm afraid it's all a bit of a lottery - some Cavaliers live for a long time with a mild murmur, others deteriorate quickly; I hope your boy is one of the former.

Kate, Oliver and Aled

I like you comment!

I sometimes wish I had never have listened to his heart! he is my best friend

timclayton
23rd April 2014, 07:39 AM
Met some other cavaliers and their owners on the beach on holiday yesterday. They advised me that two of their previous cavaliers had murmurs and didnt live beyond six. They had a lovely 8 yrs old tricolour with a mild murmur. They asked me to look out for increased respiratory rate. Typical me I came in that evening after a great day in the beach and he was breathing fast. I had a very quick listen with my ear and his murmur is louder than before probably grade 5, it was still a grade 2/3 when he had his vaccination a month or two ago. Now I am desperately worried. I think I will have to go back to the vet and get him on the vetmedin, I'm wondering if I have left it too late. To everyone else in my family he is the same dog but I know now that he is a ticking time bomb and that I need to switch the timer off or slow it down. Any advise would be great, I am very worried.... Should, never have got chatting to those owners, should never have listened to his chest with my ear.....

Kate H
24th April 2014, 11:33 AM
Hi Tim

Definitely not listened with your ear! Even with a stethoscope, some vets can't accurately interpret the level of a murmur. It would be pretty unusual to jump from a 2/3 to a 5 in a couple of months, unless there was some additional heart problem. Before you go back to your vet, take your dog to a cardiologist for a thorough examination (you may need to ask your vet for a referral) - I can't emphasise this enough. You wouldn't expect your local doctor to treat you for a serious heart problem - he/she will refer you to a heart specialist. In the same way, 'local doctor' vets are not heart specialists. And other things than heart can cause rapid breathing - Was it a hot day? Is he overweight? Was air quality poor? Or a simple question - was he thirsty (very easy when out for the day to forget to offer water regularly)? And it isn't just increased rapid breathing that is a symptom of a worsening heart problem - you also need to look at coughing, reluctance to exercise, and a few other things. You can learn the proper way to monitor your dog's breathing rate (not just looking from the outside!) - I think there's an app you can use - someone else can tell you about it.

If you're not doing it already, there is some evidence that Omega 3 (as liquid or capsules) and Co Enzyme Q10 given daily can slow down the progression of a heart murmur. Readily available at health shops or online from somewhere like Simply Supplements.

I hope a new day has calmed your panic a bit - get that cardiologist appointment and take it from there :thmbsup:

Kate, Oliver and Aled

timclayton
24th April 2014, 10:36 PM
Hi Tim

Definitely not listened with your ear! Even with a stethoscope, some vets can't accurately interpret the level of a murmur. It would be pretty unusual to jump from a 2/3 to a 5 in a couple of months, unless there was some additional heart problem. Before you go back to your vet, take your dog to a cardiologist for a thorough examination (you may need to ask your vet for a referral) - I can't emphasise this enough. You wouldn't expect your local doctor to treat you for a serious heart problem - he/she will refer you to a heart specialist. In the same way, 'local doctor' vets are not heart specialists. And other things than heart can cause rapid breathing - Was it a hot day? Is he overweight? Was air quality poor? Or a simple question - was he thirsty (very easy when out for the day to forget to offer water regularly)? And it isn't just increased rapid breathing that is a symptom of a worsening heart problem - you also need to look at coughing, reluctance to exercise, and a few other things. You can learn the proper way to monitor your dog's breathing rate (not just looking from the outside!) - I think there's an app you can use - someone else can tell you about it.

If you're not doing it already, there is some evidence that Omega 3 (as liquid or capsules) and Co Enzyme Q10 given daily can slow down the progression of a heart murmur. Readily available at health shops or online from somewhere like Simply Supplements.

I hope a new day has calmed your panic a bit - get that cardiologist appointment and take it from there :thmbsup:

Kate, Oliver and Aled
Thanks. Kate for your reply. It has been hot here and he has been on the beach etc, doing more than normal. Yes I listened with my ear! It was the fact it was heard all over the chest that made me suspect that actually this was a more significant murmur. I live in Manchester so not sure of any cardiologists there. Chesney himself has been eating and drinking as normal, not coughing and playing in the sea etc. I think yesterday when we had a quieter day, usually at home he has plenty of sleep during the day, his respiratory rate settled down.

i will try and book him in for a cardiologist review when we get home.

he is my best friend and I think being a doctor makes me the worst patient and a little knowledge can be a problem when my whole medical training is geared toward detecting abnormality etc. Our local vet is understanding about all this so I may ho back to her first and then discuss cardio logical assessment and echo.


feel a bit more relaxed now

thanks again for your reply

Margaret C
25th April 2014, 09:24 AM
Your vet will be able to recommend a Cardiologist but there is also information on this website: http://www.bsavaportal.com/vcs/Information/HeartTesting.aspx .

Our little dogs are so precious to us that it is easy to panic. I think it will be reassuring for you to know that Chesney is being seen by a heart specialist.