13th May 2011, 02:21 AM
Cavalier DOB 1st Aug 1996 with mild atrium increase an concurrent kidney issues
Misha was diagnosed with MVD on 9/18/2007. He is currently asymptomatic. I just saw that Pat indicated treatment as soon as heart size increased. I was wondering if anyone had thoughts on this since Misha also has renal insufficiency currently. See below for official vet report:
Echocardiogram: There is evidence of mildly progressive disease based on a mild increase in left atrium size, which is considered mildly enlarged. The mitral valve was moderately thickened consistent with endocardiosis. There is a mild eccentric jet of mitral regurgitation. Normal aorta, right atrium, right ventricle and pulmonary artery. The tricuspid valve is thickened with a mild eccentric jet of tricuspid regurgitation without evidence of significant PH. Normal left ventricular systolic function. Delayed left ventricular relaxation without an increase in filling pressure.
ECG: Sinus arrhythmia with a wandering pacemaker and heart rate ranging from 50-120bpm.
Prognosis: Misha's cardiac disease is mild and currently well compensated...
13th May 2011, 05:55 AM
Almost midnight and I have to get up at 5 am so this will be short and not super coherent.
I'd have to think about this and discuss pros and cons with cardiologist - I wouldn't automatically treat with ACE inhibitor at this point. I would treat with ACE inhibitor when cardiac remodeling and cardiomegaly are significant (not mild) but before overt CHF. Then if/when overt CHF ensues, I'd add furosemide and then probably pimobendan sooner rather than saving as a rescue drug. I would likely not treat with very mild changes as Misha has esp. considering his current age and fragile status. 15 years ago I started early treatment with several Cavaliers in middle age (5-6) and they did well and lived to be 14 and over 16 respectively. But the medication decision was made in the mid-90's - a different time and different situation. Conversely, in 2006 when I had a littermate of one of those boys who was 15, I did not start an ACE-I even when she had moderate heart enlargement because she had early kidney disease. Another shih tzu at 15 with a similar heart status we also did not start early treatment because she had a kidney removed at the age of 1. (These two girls died of intestinal lymphoma and pulmonary hypertension secondary to pulmonary embolus respectively so neither died of heart failure or of kidney failure.) Cardiologist and I were reluctant in both cases because of compromised kidney function. On the other hand, there are some good studies (Harriet has posted these in yahoo CHF and kidney groups) showing that ACE-I's can actually be renal protective due to increased perfusion of kidneys. Gregory Grauer (kidney guru) at AVMA gave some elaborate presentations indicating that enalapril and other ACE inhibitors are very unlikely to cause azotemia. But not sure I'd take the risk with a geriatric dog with very mild cardiac changes.
Bottom line - things change and what I did 15 years ago I might not do today. I'd look at each case rather than use a "one size fits all" plan. All of those decisions back in the 90's were made with my cardiologist, and I'd make future decisions with him and I'd certainly have a strong leaning toward his recommendations.
What does the cardiologist recommend about treatment at this point? Also, I'm curious about what he says about the wandering pacemaker - any treatment recommendations for that? Just how often does Misha have the bradycardia episodes and are there symptoms such as syncope when that happens?
On another subject - I saw your post and Mandy's post about ubiquinol versus CoQ-10 and we should post about that over here. I'm going to make the change for my dogs - esp. now with the Puritan's Pride sale going on since there is quite a price difference.
14th May 2011, 11:56 PM
The cardiologist was very pleased with his heart and said no treatment needed at this time, but to continue rechecks. They said once a year is fine, but I wonder if I should increase that to 6 month intervals.
Cardiologist also said the ECG was actually normal and nothing to worry about.
Unfortunately, he saw general practice, cardiologist and opthamologist same day so I was a bit shell shocked with all the vets and their students.
15th May 2011, 06:03 PM
Can someone post a link here to the CoQ thread? That will probably interest many people but am not sure what the original thread was.
In memory: Lucy
16th May 2011, 12:34 AM
16th May 2011, 12:38 AM
Thanks! I'd just found it and am sure others wlil want to have a look too.
In memory: Lucy