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).