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Thread: Recently diagnosed grade 3 murmur

  1. #1
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    Question Recently diagnosed grade 3 murmur

    My 8 year old Bentley has just been diagnosed with a grade 3 murmur. I'm just devastated and so sad. He also has symptoms of Cushings, altho no actual diagnosis yet (he has all the symtoms however, as well as a nasty skin infection, on meds for the skin issue), we will be going back to the vet for tests.

    Can anyone provide me with some good advice/information for treatment/supportive care for a heart murmur? Does Lasix (furosemide) help at all?
    ~Renee, Bentley & Bailey & Maddie

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    Is Bently being seen by a cardiologist? Here's a list of certified cardiologist by state, if one is not listed close to you try calling one maybe they can refer you to one in your area. http://www.cavalierhealth.com/Cardio...ick_on_a_state Also do so clicking around on that site for more info on MVD.
    Melissa
    "If you don't own a dog, at least one, there is not necessarily anything wrong with you, but there may be something wrong with your life."
    -Roger Caras

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    Quote Originally Posted by Remali View Post
    ... Can anyone provide me with some good advice/information for treatment/supportive care for a heart murmur? Does Lasix (furosemide) help at all?
    There are supplements which I think are helpful to cavaliers with MVD, but Lasix is a prescribed drug and not something that a dog owner should give her dog without the advice of a vet, preferably a cardiologist or other internal medicine specialist.

    Here is a list of supplements which I find to be helpful: http://www.cavalierhealth.org/diets....ac_Supplements
    Rod Russell

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    Thank you. We have not seen a cardiologist yet, not sure if one is close, although I do know there is one about an hour and a half away. Trouble is Bentley doesn't really enjoy car rides much any more now that he doesn't feel well.

    The vet did prescribe Lasix for him, I am just wondering whether or not it has much of a success rate in treating the issues.

    Thank you for the information and links.... going to check them out right now.
    ~Renee, Bentley & Bailey & Maddie

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    He should definitely not be on medications unless he is actually in heart failure, generally. Too many vets stick cavaliers on meds far too early, which can actually shorten, not lengthen, their life. Lasix is often one of the last meds they go on -- at a point when they are retaining water due to heart failure and this is causing breathing difficulties.

    Rod has a list of board certified cardiologists at www.cavalierhealth.org. It's a good idea to have him checked by a cardiologist and get on a proper treatment regime. Pat has many times posted recommendations on how to proceed -- if you search on MVD for previous threads and for previous posts by Pat you will get tons of information.

    If he is very unwell due to his heart (though perhaps it is the Cushings?) and he's only on Lasix then that is also not a good treatment approach and would really emphasise the need for a more professional assessment from a cardiologist.

    Given other health issues I'd think the relatively short car journey would be worth it to get his heart at least, properly assessed. Most dogs are most comfortable traveling in a crate and nervous or poor travelers benefit by placing a dark cloth over the crate so it is enclosed and calming. Soothing music is helpful too.
    Karlin
    Cavaliers: Jaspar Lily Tansy Libby Mindy
    In memory: Lucy Leo
    Cavalier SM Information site:www.smcavaliers.com

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    A board certified cardiologist is holding a low-cost heart exam clinic in West Bend, Wisconsin on June 29. Details at http://www.cavalierhealth.org/health...#West_Bend,_WI

    Otherwise, here is a list of cardiologists in Wisconsin: http://www.cavalierhealth.org/Cardio...htm#Wisconsin_
    Rod Russell

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    This could be a complicated situation, so Ill try to make some helpful points without writing a book.

    First of all a heart murmur is only a sound, and it is only a symptom. It is NOT a disease or a diagnosis. The important thing to determine is what heart disease Bentley has and what is the stage of his disease. (Stage of heart disease is not the same thing as grade of murmur. This misconception is widespread.)

    Normally we assume that middle-aged and senior Cavaliers have degenerative valvular disease (endocardiosis or MVD). However, you say that Bentley most likely has Cushings. Untreated Cushings can cause heart failure. Blood clots in the lungs can also result from Cushings, and this can cause severe pulmonary hypertension (from a pulmonary thromboembolism). PH symptoms (difficulty breathing) are similar to the symptoms of heart failure, but the treatment is very different. Lasix can make PH worse. Cushings also frequently causes general hypertension. It is really optimal to have a specialist treat dogs with heart disease and Cushings.

    The first thing that I would recommend is that you have appropriate tests for Cushings done asap so that you have an accurate diagnosis and can decide on treatment for Cushings.

    http://www.vetmed.wsu.edu/cliented/cushings.aspx

    http://www.kateconnick.com/library/cushingsdisease.html

    It may be that Bentley has concurrent Cushings and MVD. Cushings can make MVD worse, so you really want to control and treat both diseases. I would probably want a board certified internal medicine specialist (cardiologist would be my second choice) rather than a GP vet to give a diagnosis and treatment plan for the best possible outcome. Determining the best treatment plan for Cushings, esp. with concurrent heart disease, can be tricky as there are several medication options. Id have chest x-rays, full blood chemistry, a blood pressure test, and possibly an echocardiogram done after the tests for Cushings.

    I presume that Bentley has symptoms since your vet has already prescribed Lasix. A short course of Lasix alone is sometimes done to see if the symptoms resolve (called treating empirically) in order to try to confirm a diagnosis, but Lasix alone is never appropriate treatment for heart failure. If there are symptoms of difficult breathing that do not improve with Lasix, Id be very concerned about pulmonary hypertension.

    Frankly, I wouldnt worry at all about supplements at this point as you have more important things to determine and on which to spend your money. You need to determine appropriate drug treatment first without worrying about adding other things like supplements into the mix. If the tests for Cushings are negative, you can focus sooner on the MVD with supplements, etc.

    http://veterinarycalendar.dvm360.com....jsp?id=724749

    Copied from above link: Hypertension is relatively common (50% or greater) though with the lack of blood pressure monitoring devices in many practices it often goes undiagnosed. Pulmonary thromboembolism, recurrent (often asymptomatic) urinary tract infections, proteinuria, pancreatitis, pulmonary mineralization, and calcium oxalate urolithiasis are also often frequently seen with Cushing's disease. Recently it has been noted that many dogs with hyperadrenocortism are hypoxic, whether or not they have mineralization of the lung parenchyma. This can be a serious consequence, leading to distress as well as excess strain on the right side of the heart. Some of the clinical problems caused by Cushing's disease are more bothersome than dangerous. Other clinical problems are life threatening such as thromboembolism or pancreatitis. Still other clinical problems can aggravate other disorders that the patient may have, such as is the case if hypertension is present in a dog with underlying heart disease. This is not an uncommon scenario since older dogs tend to have Cushing's as well as valvular heart disease. Hypertension in a dog with valvular problems can be a factor that leads to more rapid progression of the heart problem as well as difficulties in treating heart failure if it occurs.

    Pat
    Pat B
    Atlanta, GA

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    Hi Remaili, sorry to hear about Bentley. I know the shock we feel on getting news that our dogs have murmurs. My Pippin was at the vets two years ago for a routine check up and my vet found a grade 2 murmur but also thought his heart wasn't right but wasn't sure what was up.

    She did some tests and an doppler scan and ecg of his heart the following week. Pippin was started on vetmedin although he was not in heart failure due to the results of the tests and not the sound of the murmur.
    DJ was found to have a grade 2 murmur on his recent routine visit to my vet but she is not starting him on any meds and feels he doesn't require tests yet but we will keep an eye on him.

    When Pippin was first diagnosed People told me he needed to see a cardiologist and shouldn't be on meds. I was happy for my vet to look after him. Pippin has done well on meds and is only starting to get a little worse now but is not bad and will have another scan in my vets soon. The practice I go to is very good and do refer to specialists if they feel it is needed. Maybe if the trip to a cardiologist is inconvenient and maybe not ideal for Bentley you could ask your vet if a local place do ecg or scans. I'm sure your vet knows what he/she is doing but voice your concerns about meds with your vet as they are the ones who know and have seen Bentley and if you are happy with them that's fine, if you are not satisfied maybe consider changing vets.

    I hope you get the answers to your concerns and Bentley is doing ok. Take care.
    Gus(blenhiem) Pippin(tri) DJ(ruby)

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    Our Shih Tzu was diagnosed with low grade heart murmur, put on Enalapril, and lived for several more years. I continued to distance walk him often and he died of old age a week after his 16th birthday.

    I don't know about Cushings, but the people here at CT will know and have wonderful support for you.

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