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
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
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
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
For the treatment of canine congestive heart failure originating from valvular insufficiency (mitral and/or tricuspid regurgitation) or dilated cardiomyopathy.
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).
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.
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!!
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.
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.
Originally Posted by lincolnsmommy
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. :)
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!
Originally Posted by lincolnsmommy
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.
Originally Posted by lincolnsmommy
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.