Why I take more dogs off of heart meds than I start - Mini Lecture on MMVD in Small Dogs
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- Опубліковано 14 бер 2023
- Discussion of heart murmurs and coughing in small breed dogs, consistent with myxomatous mitral valve disease. Diagnosis, monitoring, and treatment are covered, in addition to when NOT to treat, and my frustration with how commonly dogs are treated unnecessarily for MMVD and congestive heart failure.
I brought our little 9 year old dog (Yorki/Maltese) into our regular vet clinic because I saw a cyst on her toe. She got a different vet that day. The vet announced to me that she heard a heart murmur. They did an x-ray and sent our dog home on Elanapril and Lasix. Immediately, our once "healthy" dog was sick and laying on the floor, all day long. I got her seen by a vet cardiologist. The wait to get her seen was a few. months, but the cardiologist's office did notify me immediately (upon receiving her medical record) to discontinue the Elanapril and Lasix. (She had never needed it). After she was seen by the cardiologist, she was put on pimobendan. Initially, our little dog seemed to "get heart problems" after starting pimobendan (which we had her on for two months). Local vet advised us to discontinue it and just let "things ride out" for our little dog, i.e., no meds at all. And so, I went to yet another cardiologist who talked about the great benefit of pimobendan and advised starting her at a lowered dose. We are finishing one month of a lowered dose ... which our dog can tolerate ... and truthfully, our dog seems much better. IN THE BEGINNING, THOUGH, she had zero heart symptoms. She had a Grade IV murmur which our local vet did not notice or diagnose. Sorry for long story. We are now deciding on whether or. not to pursue the TEER procedure in the not-too-distant future. Our dog is stage 2 of the mitral valve disease. We really, really don't know what to do. The surgery is no longer considered experimental but it is new. Doctor, do you have any advice?
I'm so sorry you're going through all of this with your little girl! I'm assuming the cardiologist diagnosed her with stage B2 of mitral disease, since that tends to be the indication for starting pimobendan (though my personal opinion is it can probably be reserved for patients with at least moderate heart enlargement). I'm glad the medication seems to help her, and I'm very glad that the Lasix and enalapril were discontinued. I have not yet had a patient undergo the TEER procedure, so I cannot speak from personal experience and I would of course defer to the expert advice of your cardiologist, but here are my thoughts: A) Most of these dogs never progress to congestive heart failure, so it may be worth monitoring her progression for a while to get an idea on how rapidly or not the disease is advancing. Patients are candidates for the procedure up to early/mid stage C (patients with congestive heart failure that can be controlled with medication), so waiting shouldn't change eligibility, and you could wait to see if she is getting into later stage B2 when anesthesia risk is still fairly low, but the likelihood that the procedure will be of long-term benefit is more obvious. B) She is fairly young for her breed, so if there is evidence of fairly significant heart enlargement, there is likely significant survival benefit from the procedure and so may be worth the risk and financial expense. C) Since the procedure is fairly new and there is limited published data on long-term complications and survival times (what I can find shows a majority are alive at 9 months which is good, but it would be nice to see what the overall survival rate is to know how much better it is than medical management, though I would think there is significant improvement), I would personally want to make sure the potential benefit significantly outweighed the potential risks. i.e. I would pursue the procedure if my pet had a significant risk of progressing to heart failure, but probably not otherwise.
I hope this is helpful. Again, I'm not a cardiologist - just a general practitioner with an interest in cardiology (among way too many other things!). The bottom line for me is to assess the risk of progression to heart failure and use that to guide you decision on how to treat.
Thank you for all the good information! It’s good to know what’s actually happening with our dogs & the meds they give that sometimes are not needed!
Thank you..from all the information you are giving i see my vet is doing the right thing for my boy. 16 year old yorkie with an x-ray and we see his heart is enlarged now. My vet put him on the meds you prescribe. Thank you for reassuring me he is doing right for my little boy Benji !! I also kiss him all day long !! Lol I know his time is running out. For now he is pretty active
Take videos
Alternatively, don't take videos and be super in the moment.
I was trying to make a suggestion but realized it came off as telling you what to do. Idk you dog but they sound lovely
Thank you so much for your video. I hope it gets more views. My dog went through the exact process you describe, the vet ordered an ultrasound (I think that’s what you’re calling an ‘echo’ ?), confirmed mitral valve disease and put her on full dose of Vetmedin. She was immediately experiencing swings between hyperactivity and fatigue and I could tell she was unhappy, so I took the dose down to 1.25mg (one quarter of the full 5mg recommended dose). One year later she had another ultrasound and her left atrium had improved! I continued with the 1.25mg dose even though the vet said I should be giving that twice a day (so, double that dose), and another year later the vet wants another ultrasound. Meanwhile, the 15 yr old dog is deteriorating faster than I expect, in other ways, not heart failure symptoms, eg. Losing muscle mass, stiff joints, going deaf, slightly blind, having random bouts of diarrhoea/vomiting. Then I heard drugs can mess up their gut bacteria. Then I finally start researching Vetmedin and see all the people commenting that it made their dog sick! And I start to wonder if it’s the cause of her deterioration. I have taken her off Vetmedin two weeks ago and she is obviously happier. Bounding around the house, interacting more, etc. I am now giving her hawthorn tincture, minerals & electrolytes, and about to try DMSO for her arthritis.
Thanks for your comment! Unfortunately I’ve seen too many cases similar to this. I don’t know what it is, but I think too many of us hear a murmur and instantly get anxious about her failure, when it’s actually more often than not going to never develop. When I examine a 12 year old small dog and DON’T hear a murmur it’s almost more surprising than if I do! Pimobendan is definitely a drug with a place in the management of heart disease. The data pretty clearly show that it improves survival for the dogs that need it, but many of them don’t, and they just get subjected to potential (albeit not super common) side effects and their owners get subjected to the unnecessary expense of treatment. I’m so glad your dog is doing better off the meds, and I wouldn’t be surprised at all of the heart disease never becomes a clinically relevant problem for her.
@@taylorwardwelldvm8100 Thank you so much for taking the time to reply. I can confirm that 3 weeks on and she is even more active and happier. Taking her off Vetmedin is the best thing I’ve done.
Thank you
Great video, thank you.
Glad you liked it!
I've come to realize that I unintentionally contributed to my dog's passing (who was turning 16 this year) by reducing his heart medication (Vetmedim, a Blood Pressure med and diuretic more than a month ago, out of concern for his kidneys, despite him not showing signs of worsening kidney function like increased thirst. I received advice from the pet pharmacist indicating that he was on double the dosage (5mg) instead of 2.5 mg for his age. However, when I consulted with the regular vet, he mentioned that he could be on up to 5mg. Another vet agreed to lower it to 2.5mg. Additionally, I lowered his diuretics because I thought it would help with his kidneys.
A month or so later, fast forward to a week ago, he started to have breathing problems and made loud distressing noises. This occurred after he got excited over a treat, and initially, I thought he was just having troubles getting the treat down, but that wasn't the case. I took him to the Vet ER, where they initially checked his oxygen levels and said they were normal and didn't detect fluid in his chest. They suspected it was neurological and sent me home with Gabapentin. He wasn't coughing which I know is a symptom of fluid in the lungs. And he was good up until the treat.
However, upon returning home, he couldn't walk properly and laid on the floor, sleeping, but I noticed his heart rate was high, 50 bpm while sleeping, occasionally waking up and he yelled . I took him back to the Vet ER, and after some scans (not an X-ray), they observed blue lines in his lungs, indicating fluid in the lungs, and placed him in an oxygen tank. Following an examination (without X-rays or other tests), they presented three options: a) to give him diuretics and take him home, hoping for the best, b) keep him in an oxygen tank with medication and conduct tests, with no certainty of recovery, which could cost thousands of dollars ($2000 to $4000 or more), or c) euthanasia. They mentioned that the medication could potentially harm his kidney and liver. I reluctantly chose the last option.
Looking back, I feel that I should have administered the diuretics right away to prevent further fluid buildup, but it seemed like it was too late. When they took him out of the oxygen chambers to bring him to me for my final goodbyes, he was yelling as if he was in pain most likely because of the fluid. I feel that all this was caused by me, and I regret not leaving his medications alone. After researching maybe he had Pleural effusions and it would have required a lot of tests I presume.
I’m so sorry you had to go through that. It’s awful seeing our pets decline, and heart failure is a particularly nasty disease.
While I see many dogs on heart meds that they don’t need, when they are actually necessary they are VERY important. I tell my clients that the diuretic is hard on the kidneys, and that we will probably see kidney injury as we increase the dose. But I also tell them that I don’t really care what happens to the kidneys, because your kidneys don’t matter if you can’t breathe. We try to be as judicious with dosing as we can, but in the end for owning on your own fluid will kill you a lot faster than kidney disease will.
@@taylorwardwelldvm8100 do you think that me reducing the diuretic would have caused what he had? I wonder if I was able save him if we gave him that intravenously from the start. But I guess without doing tests the vet wouldn’t know what he had. I also gave him CBD oil at night for his joint pain because he would make loud moans finding comfort. But other than that he was his usual self.
Forgive yourself. You are still a great pet parent and did the best you could...You really did your best.
Good video! I appreciate your approach (in the tradition of "All Creatures Great and Small" as I recall the book). I would be interested in hearing your thoughts about large dogs - any especially unique considerations and how you might approach their treatment differently, noting that the size makes expensive drugs even more out of reach for many dog owners.
Thank you! And it’s a good point that you make about large dogs. Since the list of heart diseases that larger breeds tend to get is more variable, I do generally recommend an echo for those dogs. If it’s mitral disease I manage it the same way, but may recommend more frequent chest rads at least at first because some of those dogs progress more rapidly. If it’s DCM, I’ll recommend pimobendan for DCM if clients can afford it, because there is some limited data that it prolongs survival and one would expect a positive inotrope to be helpful in that condition, but the benefit is not definitive so I definitely tell clients that and try to appropriately manage their expectations.
Great video. My vet gave my healthy shih tzu heart meds for a cough. He's not taking them. I looked up the meds, one med prescribed was eye drops, looked it up, one side effect was high blood pressure. I didn't think he needed that. Visit was over 500$. He's not taking any the meds. Paid for them and can't return them.
Hmm, I wonder what the eyedrop med was? Did they do any diagnostics? I suspect at least X-rays given the cost total of the visit. There are many things that can cause a cough, and some need treated while others are self limiting. Hard to say how he should or shouldn’t be treated without knowing what was found, but many causes for cough are not an emergency to treat.
My 16 year old dachshund boy Louie was diagnosed with heart disease last June and put on Pimobendan, Enalapril, and furosemide. It made him feel much better for a month and then he started getting lethargic, weak backend, and finicky eating. After some research I figured it was the furosemide and I took him off it. I started giving him dandelion leaf / root tincture hoping it could replace furosemide. Since then it’s been an ebb and flow of feeling okay, then slowly feeling worse, taking furosemide to feel better, then kidney values climb and I take him off furosemide. I’m trying to find a natural alternative to furosemide because it really messes with him. Right now he’s on 10mg twice a day and it’s cleared him up (I bought a stethoscope to keep track). Now I’m thinking of backing off the furosemide to 10mg once a day. Do you know of an alternative to furosemide? I also give him the Five Leaf Pet Botanical kidney protocol and it really does heal the kidneys, but he still gets a bit sluggish from the furosemide (but nothing like initially without the kidney protocol). I’m researching homeopathy and hoping to find a diuretic replacement. Also, do you think I should discontinue the Enalapril? I’ve read it’s hard on the kidneys too and if it’s unnecessary I’d like to discontinue using it to have one less thing affecting his kidneys that way if we continue using furosemide at least we won’t be taxing his kidneys with Enalapril too.
Unfortunately, the best and most important medication in congestive heart failure is furosemide or some other loop diuretic. Given the weakness, it might be a good idea to have his electrolytes checked, as that class of medication can cause low potassium which results in weakness. It’s also possible that weakness is just related to heart failure. It’s also tough with the kidney issue, because it’s a balancing act between keeping the lasix dose high enough that a dog can breathe, but low enough that you minimize the insult on the kidneys. I often take the approach of telling my clients that I’m going to be as judicious as possible, but if I have to beat up the kidneys to let their pet not drown on their own fluid, so be it. Not being able to breathe will kill an animal a lot faster than kidney disease, and causes a much higher impact on quality of life. That said, kidney failure is also horrible, so we definitely want to avoid it if possible. If I’m worried about kidney damage and/or the patient isn’t tolerating it well, enalapril is the first drug I would discontinue (if I was even giving it in the first place, which I typically don’t).
@@taylorwardwelldvm8100 thank you so much for replying with all that info! Yesterday at 11am I gave Lou 10mg of furosemide and not again (I usually do another 10mg at 5pm) and he coughed through the first half of the night. But when I listened to his chest this morning I didn’t hear any crackles. I thought about doing once again today, but moving it to 5pm instead of 11am and see how he does. I did notice that he felt better, but of course with coughing. I think it would be great to discontinue the enalapril if that would ease up on his kidneys while still allowing for the furosemide twice daily (and with him hopefully feeling peppier). Do you know of a reliable way I could monitor his BP at home to be sure he’s doing okay without the enalapril? I’ve seen BP cuffs on Amazon for dogs and wondered if that would be a good choice. Thank you again!
Thank you! I'm SO hesitant to start the Pimobendan. I just feel like he doesn't need it yet- if ever. He barely has symptoms. RRR is fine. No fluid. BP is fine. He has one cough in the morning upon waking. He pants after walks but he's a brach face pekingese. I'm just at a loss at how fast they want to use the meds.
If his SRR is fine, then the cough is not due to his heart (with the caveat that if there is some decent heart enlargement it could be squishing some airways a bit and exacerbating an underlying reason for a cough). Much more likely that the cough is due to chronic bronchitis or mild tracheal collapse. I would get X-rays (or an echo if you want, but not necessary at this point as long as X-rays can be adequately interpreted) to see if there is any significant heart enlargement, then use that information to direct treatment with pimobendan.
Thank you for responding. Got another echo done with a cardiologist and his findings seem to be considerably worse than the mid December one. 83% regurgitation. Moderate severe B2. He went from 1.7 to 2.14 LA:AO in less than two months which seems crazy to me. He's literally fine. The initial vet looked at his heart X-ray and said the trachea didn't seem to be collapsed. We started on pimo today. And I'm pretty bummed about it.
I posted this reply twice with the reply button, it doesn't show up.
Thank you for your speedy reply. You said the Olive Leaf would likely hurt her? Everything I've read says that it is safe for dogs, and that it is good for a lot of things. I hoped it might strengthen her heart. I'd like to try it if it wouldn't hurt her or lower her blood pressure too much.
She's had a heart murmur for some years, maybe 5?, and has been getting progressively worse. When we took her to the vet in September and she had the first X-ray, we took her because she was coughing. They said her heart was enlarged and getting close to congestive heart failure. In December she was huffing a lot and seemed to be having trouble breathing. That's when they took another X-ray and she had fluid around her lungs, but not in her lungs and her heart is pressing against her trachea. Her breathing usually isn't fast. She seems to be trying to cough something up but I've never seen anything come up. I think she has trouble breathing because of her heart against her trachea. She doesn't eat good lately, I'm thinking it might be pressing against her esophagus as well. When she's outside walking around, she doesn't cough much.
The Pimobendan was prescribed at a 2.5mg. pill in the A.M. and a half pill in the P.M. When we'd hold her, we could feel her heart pounding very hard. We tried cutting it to a half pill both times and it seems much better, she only weighs 12 lb. But she still coughs a lot.
I want you as my vet? Your not in Vegas by chance are you? Thanks for the video my dog just started vetmedin.not doing so well on it.
Thank you for making this video. I just lost my pomeranian due to CHF and AF, No one explained to me like you did. What symtpoms I should be wathcing for. I regreat every second that i do not know all these signs.
I’m so sorry to heart that. It’s such a sad disease. I’m glad you found this helpful.
Thank you Dr. Wardwell for your frank honesty! Do vets and cardiologists get a kickback from Big Pharma every time they prescribe Pimobendan? Is there a contest between vets to see who sells more Pimobendan 😂?
Jokes aside, are there side effects if you take dogs off Pimobendan cold turkey or do you have ween them off slowly? Asking for my dog that’s been on “heart skittles” 🍬 for 2 years now. Thank you 🙏
Cardiologists tell me you can stop pimobendan cold turkey without any known issues.
Dr. Wardwell, can you please make a video to explain the echo numbers? What they mean and what is normal? The echo numbers are very Greek to me. Thank you 🙏
Honestly I don’t know all of the normal values of the top of my head. I typically follow the cardiologist’s interpretation as to whether they are high, low, or normal. There are a lot of different things they measure, but the most important ones to me in monitoring/managing mitral disease are:
- left atrium to aorta ratio (LA:Ao). This is an objective measure of how enlarged the left atrium is (normal is somewhere around 1.2 i believe)
- Tricuspid regurgitation velocity (TR velocity). This is used to estimate the pressure in the pulmonary artery, and this diagnose pulmonary hypertension. The cutoff varies based on the doctor, but most cardiologists I know use a cutoff of around 3.2 m/s
Other values can be used to create a disease score, but the above are typically the most clinically relevant.
You are saying things I always suspected. My Chihuahua was put on Vetmedin 1.25 and Lasix 8 years ago he showed no sign of illness, discomfort or coughing. Last year he developed an occasional cough and the vet doubled the dose of Vetmedin. From then on he lost all energy. He recently developed ascites. The vet drained his abdomen and prescribed Cardalis (Benazepril) and Upcard (Torasemide) in place of the Lasix. His abdomen filled up again within 5 days. It was redone but the vet said there was no option but to continue with the Vetmedin, Cardalis and Upcard as there was no alternative and he would die very soon. He is 15 years old. When he was drained last week he was suddenly full on energy for a couple of days. If he only has days or weeks to live with this drug regime I wonder if I should stop the drugs. I hate that I force these drugs down his neck every day and may be killing him.
I’m so sorry to hear about your little old man. I hope that he is ok, or that he did well up to the end. It is possible for a dog to develop ascites (abdominal fluid) from heart failure, but it is not typical with left sided heart failure, which is the type the vast majority of small dogs will have. I wonder if he had a different condition causing the ascites. And to answer your question, in my own patient I would have discussed how easy or difficult it was to get the meds in, then decide the priority level of each drug and discuss whether we should just give the most important ones, or even discontinue. To your point, I think that trying to medicate a patient that resists it is not great for anyone when the prognosis is grave.
@@taylorwardwelldvm8100 Thank you for taking the time to reply. He died the week after I posted my message. I am sure he was over-medicated...the vet prescribed 40mg or Furosemide per day...he only weighed 3.8 kilos. I was prescribed 40mg of furosemide for a swollen leg and I weigh 75k....but he insisted it was the correct dose...I halved it anyway for the last few days when he stopped eating. 8 years on Vetmedin now seems to have been unnecessary and probably damaging...I wish I'd seen your video then. I feel bad for having forced it upon him for so long and he resisted always. I saw 4 different vets in the last 6 weeks of his life but they all backed each other up even though not one checked his heart with a stethoscope and just read his records.Thank you again. Keep up the good work.
I wonder if you are familiar with the new TEER procedure for dogs with MVD? Im considering this for my dog after her last echo which showed moderate to severe enlargement. She has already been on Pemo for about 2 yrs, then enalapril was added a year later and now following her most recent echo Spironolactone has been added. The Cardiologist has also said they dont feel comforable with ther going under anethesia for a teeth cleaning. That has me researching this more as I had hoped her MVD wouldnt have progressed with the first 2 meds.
TEER is a new procedure first introduced at Colorado Veterinary and is now available in several states. I have applied with the only center in my state, CA.
I appreciate your info about respiration, that is new to me and I will keep an eye on her as I have noticed she is out of breath quickly after playing around the house and coughs from excessive play or barking. Thx again, and I would love to hear your feedback about TEER.
I am familiar with TEER, but have never had a patient who had it performed. I know a cardiologist in the area, but not sure if he does the procedure.
I have read good things about the outcomes. The only downside I can see right now is how new it is - there are going to be very few out there who have done dozens of procedures, so operator experience is inherently modest. I’m not saying that’s bad - I successfully take on new procedures all the time. But that’s just a fact.
If I remember correctly, outcomes were better in stage 2 and early 3 patients, so that’s something to consider. All in all, congestive heart failure is progressive and fatal, and it’s a miserable disease when the meds stop working. If the TEER is available to you and you can afford the expense, the risk might be well worth it if you can potentially double (or likely more) her survival expectancy.
@@taylorwardwelldvm8100 Thank you for your reply. She is in the perfect stage for the procedure. Its at the vet hospital in Los Angeles, via referral from Colorado.
It is beyond any expense I ever imagined I would spend, but, I can take the money out of my retirement. I have found myself going back and forth on it nearly every day because she is 10 yrs old and essentially only has 5-10 yrs left at most anyway. I also could lose her in the actual procedure.
Ive had friends question it because she could possibly live another few years, although from what Ive read it could be quite awful in the end. But I dont know if I could live with myself if I dont do it.
Only a few weeks ago I had no idea TEER even existed. I literally stumbled across it here on youtube while up late feeling devastated by her fate and trying to learn everything I could to help her.
Ive considered a second opinion but there are so few performing the procedure Im not sure how I could arrange that before when she is scheduled for this Feb 14, Valentines Day.
At our TEER consult, in order to be considered good candidate, the dog’s left heart size needs to be larger than 14 mm (size of v-clamp is 14 mm).
I recently spoke with the cardiologist I know about it and his comment to me was that it seems like an interesting procedure, but that the criteria for patient selection seems fairly narrow, so it may not be an option for a lot of dogs.
@@taylorwardwelldvm8100 very true! My poor dog did not qualify😭
My dog a mixed breed terrier 11 years had a weird hacking cough. After a walk i took him to the vet because it was going on for the whole morning. Doctor said enlargment of the left side of heart chf and fluid he fave me pemobendin 2x a day lasix cough drops another cough fluid (doxycycline)and a once every 24 hours. he has been seeming tired doesnt have increased thirst but his cough went away. I am making him dog food today and finding natural ways but am worried im doing more harm then good with all meds 😥
Hey man can you help me my dog developed a cough and it lasted for weeks he was treated for lung infection well it got better then came back then the the cough disappeared well he got bad off right after it dissappeared he got unresoosive to us n he got wrak we panicked we rush him to a er he was diagnosed with a stage 5 murmur never got the cause investigated but you could feel his heart beat he was given pimeodean lasix or flurosemide and another pill for heart contractions well he was on it 2 days n he had quit eating the second day he was axting like he was gonna die and his heart was goin crazy yesterdy after fuerosomide about 2 hours later he started breathing rapidly like a dog dying frim a fatal snakebite we stablilized him and ate and we vowed no more meds except a appetite stiumlant today he rose up walked around our house somewhat is more reaposive hes holding down raw eggs and goats milk and omega 3 fish oil land q10 today and hes even stringer should i continue to follow this route yhe vets wanted to put him down but ive also had vets tell me the same i adopted a small papi jack unbenounced to us wasant vaccinated for parvo she developed wildfire parviorous to where she was blowing blood out her nose bloody pools.of diarrhea i took her to the vet they wanted 1200 up front as the base cost estimation n said there was a 99 percent chance she would persih i bring her home guve her daily b12 and penicillin injections feed her goats milk and raw eggs and pedialyte it was day n night i slept about 3 hours the whole week she alsmost starved but out of love i made her eat about 10 12 years later shes still right here
My small 10 year old dog has had two episodes of cough at night then syncope within 6 months. Today had chest xrays and vet thought heart is slightly enlarged with a grade 4-5 murmur. This dog never coughs except these two episode 6 months apart. Has perfect breathing while sleeping and rarely pants even after short burts of running. Vet wants to start vetmedin but after watching your video and looking at the side effects im not sure especially since he has allergies to food and has had vomiting from anti inflammatory drugs. Do you think he needs these meds?
In my hands I probably wouldn’t start it with only slight heart enlargement. Technically there is a study that suggests it will prolong life in dogs with any degree of enlargement, but that study is pretty flawed and the cardiologists whose opinions I tend to follow don’t like to start it until there is AT LEAST moderate enlargement.
My dog was diagnosed with congested heart failure because he had a cough and had CHV for 2 years now and has been on Vetmedim but for some reason on high dosage, my dog is 10 lbs and on 2.5mg 2x day as well as a durietic and blood pressure med. Is there a way to tell on the X-ray if he has an enlarged heart? Apparently he has a level 4-5 heart murmur. I don't want to give him more meds than necessary.
It is definitely possible to identify an enlarged heart on X-rays, though it can be very dependent on the skill level of the person reading the images. It is easy to overinterpret heart size, especially in some small dogs. An echocardiogram will give the most detailed information on the size of various heart chambers, but is typically not necessary to diagnose degenerative mitral disease or heart failure (but is useful for certain complications of those conditions, such as pulmonary hypertension).
The following is not meant to criticize your vet - I am so far from perfect! - but to provide some additional education/insight to help you ask the right questions and better manage your pet’s care. With that in mind, some other thoughts I have are:
First, not that it’s that important as far as diagnosis goes, but a grade 4 murmur is usually very distinguishable from a grade 5. You can feel a grade 5 with your hand - a grade 4 you can’t. Occasionally you might wonder if maybe you’re feeling something very mild, so perhaps you call it a grade 4-5, but this is pretty uncommon.
Second, your dog is not in heart failure. Or at least he wasn’t at the time of the original diagnosis. Dogs with heart failure are usually very lucky to live a year. And in that time you will have to increase the furosemide dose several times because the failure gets worse. So a dog that has been on diuretics for “failure” for a couple of years, especially without increasing the dose repeatedly, was 100% misdiagnosed.
Third, while it’s still common practice by some, and the last consensus statement by the ACVIM did not reach a consensus on this topic (due to factors I don’t have time to discuss here), it is generally accepted by cardiologists that ACE inhibitors (enalapril, benazepril) are worthless in treating CHF. They probably don’t hurt, but it’s one more thing to buy and one more thing to shove down the poor animal’s throat, so I don’t encourage people to waste their time with it.
Fourth, regarding Vetmedin, I would be curious about the degree of heart enlargement before jumping to starting it. And while there is some room to increase the dose when necessary, I personally wouldn’t even consider a higher dose in a patient that wasn’t in failure. Again, it’s PROBABLY safe, but it’s an expensive drug, and the cardiologists I generally take advice from don’t necessarily recommend starting it until there is fairly significant heart enlargement, so that would be good to confirm.
If your dog was my patient, I would be recommending X-rays, then basing treatment off of those. If there was any question (or if it was not me reading the X-rays), I would send them it for a radiologist interpretation. I hope you can get things figured out for your little friend. Let us know what happens!
@@taylorwardwelldvm8100 Thank you so much for that information. As for his meds, for the 2 years he's been on them I've never had to increase the dosage like you mentioned nor did his condition get worse and my dog is 15, and it sounds about right because I know two other people whose dogs did have the same condition and the condition got worse over time and the meds had to be increased. I was told to reduce the diuretic because my dogs kidneys were getting worse. I have the X-rays from when he was initially diagnosed and also recent and from what I can tell his heart did not enlarge over time, but I'm no specialist. It's just so difficult to find a vet who knows about this without just prescribing meds. If I don't need to give him meds, I'd rather not and like you said Vetmedim is expensive, 100 pills for $100 but that's because I found a 'Pet Pharmacy' 45 mins away from me otherwise vets are charging $140 to $180 for them. I've had the experience with using different vets and from my experience it's all about the money and less about really helping dogs. I understand vets have overhead etc but it's become outrageous how much money they charge and add things that is not necessary.
May I ask how your dog is doing? My whole world fell apart today, and truthfully I’m terrified.
First ide like to say thank you for this video. Alot of important information to consider.
My yorkie-poo, 9 years old, has been diagnosed with a grade 4/6 heart murmur..(i can hear it myself when i put my ear on his chest) he has shown 0 clinical signs of any heart issue. Still a very active dog who eats and drinks alot of water. Can play for hours with incredible steady breathing and can also go on very long hot walks, without issue in the previous summer. (Now it's winter)
The vet did 1 xray on his chest and identified an enlargement, but she didnt say what level of enlargement. She recommended Vetmedin(pimobendan) and i purchased it at the moment... but i am reluctant to give it before i do more research. In Quebec, it can take up to 4-6 months to see a cardiologist, and i want the specialist's opinion before i start any potential debilitating medications. He's doing very well right now and I'm not sure what to do..
Do dogs that show no sign of heart issues need to be started on pimobendan? She said it's a preventative measure.
Pimobendan does have a protective benefit, that is true. But the question is: “what is the likelihood that THIS dog is going to develop heart failure?” If an animal is never going to develop a condition for which it is taking a preventative medication, then they might as well be taking Skittles. That’s why I follow the recommendation to start pimobendan when there is at least moderate heart enlargement. Those patients are much more likely to be on the path to heart failure, so pimobendan is likely going to provide a survival benefit for them. It’s not wrong to start it now, but I would personally be curious what degree of enlargement they think is there. You could always ask if they are able to send the Xray(s) for review by a radiologist to see if there’s agreement that there is heart enlargement, and to see what qualifier they use to describe it.
@@taylorwardwelldvm8100 understood, I do have the xray so I'll have to find a radiologist who will agree to analyze it without a full 100$ consultation fee. I see measurement lines around the heart, I don't have the image without the lines. Thank you for the response. I sent an email for them to describe the degree of heart enlargement, although it is his first xray so I'm not sure if they need a previous image to compare what is abnormal.
Hi First i want to say thank you for the video, my miniature pinscher born 2013, 11years old started having syncope out of no where , i took him to the vet while she was trying to take his temperature he had another episode she said "thats good she can see whats exactly happening to him" , they put him in a oxygen tank, she came back and told me "hes doing good he snapped right out of the syncope episode he was having" also before him fainting when she listened to his heart she said it sounds like theres fluid, she said "a whoosh" sound she hears, told me shes going to do a X-ray, after doing the X-Ray and showing me the picture on the computer she said his air way valves looked clear, and his heart is normal she pointed next to his heart saying that spot should be dark which is good, and his lungs didn't look like there was any white she said, but after they sent me home with Furosemide 50mg/ml Oral Give 0.16ML by mouth every 12 hours (twice daily) until recheck. & she also gave me Vetmedin/Pimbendan 1.25mg capsules(28 capsul) Give 1 capsule by mouth every 12 hours (twice daily) until recheck. I tired to give him the Vetmedin capsule but he just spit it out and bite it down so i didn't give it to him. He still hasn't had it at all. But i did give him one does Furosemide of 0.16ML by mouth at 4pm so now im waiting 12 hours to give him it again. My question is Should i try to start him on the Vetmedin or just give him the Furosemide for now and see how he does, to be honest i dont want to give him meds he doesn't need for the rest of his life if thats the case, because they told me this is going to be a lifetime thing. As of now he's laying in bed and making small coughing noise here and there. I just wanna know how my energetic best friend that would be jumpy and fast, eating and drinking normal last week turns into all out of no where no im being told he's gonna need meds 2 a days for the rest of his life doesn't seem right to me :(
I was Listening to his heart right now it sounds like a washing machine very fast too
Can you clarify something for me please? What was the medicine that brings if from 7 to 0.2 In the section with ace inhibitors I missed a few things. My dachshunds is on bp meds it did help his breathing. He has mitral valve disease. His heart is enlarged moderatly at this point. His breaths per min where just going up up up until he started the bp meds and then his breaths per min leveled out and are now staying between 22 -32. Maybe a different med would be better. Thank you so much!!
I was just giving an example of a different disease where ACE inhibitors are used, and how they are inferior to different medications in that disease as well. Blood pressure meds can definitely be helpful in some cases of mitral disease, but if blood pressure is the issue, I reach for something like amlodipine as it will do a MUCH better job of lowering blood pressure than an ACE inhibitor. If it’s helping, definitely keep doing it, but I think you should always feel free to question your vet about anything. I personally prefer my clients to be as informed as possible, and sometimes they bring up a good point which helps me treat the pet better.
My dog Benny got an echo in Jan 2023 as per my vets advice (she said he had mumur) - the findings of the echo were: The left ventricular wall thicknesses and chamber dimensions are normal. The systolic function is normal with a
fractional shortening of 44.3%. The left atrium is normal in size (LA/Ao 1.1) based on right parasternal short amd
long axis images. There is a mild to moderate, eccentrically directed jet of mitral regurgitation present with mild
thickening and prolapse of the anterior mitral valve leaflet. The aortic flow profile and velocity are normal. Aortic
valve appears normal with no regurgitation noted.
The right ventricle is subjectively normal in size and function. The right atrium is subjectively normal in size. The
tricuspid valve is normal in appearance and there is trivial regurgitation present. The pulmonary flow profile and
velocity are normal. The pulmonary valve appears normal with no regurgitation noted. There are no overt cardiac
masses noted. There is no pericardial effusion present.
Echo measurements:
LA/Ao (Swedish): 1.1 (normal
Feb 2024 Echo Report - Clinical History - grade 3/6 mumur, asymptomatic. Echocardiographic Findings: There is mild left atrial dilation (LA 27.7 mm). The mitral valve leaflets are mildly thickened and exhibit mild systolic prolapse. A mild to moderate jet of eccentric mitral regurgitation is present. There is borderline mild left ventricular dilation (LVIDd 26.4 mm; LVIDs 15.8 mm). Left ventricular systolic function (FS 40%) is normal. The aorta and aortic valve are normal. Right atrial (RA 18.3 mm) and right ventricular dimensions are normal. The tricuspid valve is normal. The pulmonary artery and pulmonic valve are normal. No shunting lesions are visualized. No pericardial effusion or cardiac masses are seen. ECG: Sinus rhythm. Assessment/Recommendations: Degenerative mitral valve disease. This examination demonstrates mild to moderate regurgitation of blood across Benny's mitral valve resulting from degenerative valve disease. Secondary to his regurgitation, Benny has mild dilation of his left atrium and borderline mild dilation of his left ventricle, though his left ventricular systolic function is well-preserved. As only mild left atrial dilation is present, Benny's current risk for the development of clinical signs secondary to his mitral valve disease, such as coughing, exercise intolerance, syncope and laboured breathing, appears to be relatively low, though careful monitoring for these signs is recommended going forward. I recommend starting Benny on pimobendan (2.5 mg am, 1.25 mg pm), as this medication should help to slow the progression of his mitral valve disease. A recheck echocardiogram is recommended in 9 months. Thoracic radiographs are recommended if Benny experiences respiratory clinical signs.
Benny is a small jack russel terrier mix. 14.8 lbs. He is very active (we take at least 3 walks a day). He does not really cough except very occasionally. Pretty infrequently. After watching your video, I am wondering if he needs to go on Pimobendan at this point in time. My problem is that I was not able to speak to the cardiologist directly after this most recent echo. I didn't even get to speak to my vet (long story) - but another vet at the clinic we go to, called us with the results and basically just read the results out to me. Didn't feel like I was getting a lot of info. So just looking for some insight that perhaps you can provide. Thanks for putting out such good info and thanks in advance for your time!
Well, the second report (at least as provided here) does not give the LA/Ao, only the absolute LA diameter. Assuming the Ao diameter is the same in the two studies, the new LA/Ao is about 1.2, so still normal. This is why absolute values in some cases are annoying. 27.7mm might be above ‘normal’ for one reference, but that reference value is based on an average of a lot of different dogs of a lot of different breeds. It’s probably much more accurate to compare two structures in the same animal and how they compare to one another over time, which is what the LA/Ao does. Given this, I would argue that there’s not good evidence that there’s left atrial enlargement, or at best it’s very mild. I don’t think I would let this sway my thinking that this patient is at significant risk of developing heart failure any time soon. Personally I would want to see more of a trend, and ideally more significant enlargement before thinking he would benefit greatly from the meds.
And I wouldn’t worry about a cough. Cough is not a common symptom of heart failure except for really bad failure. Cough is a reflex triggered by irritation of the trachea and bronchi. These are more upper airway structures, whereas pulmonary edema cause by heart failure is an alveolar (lower airway) problem. Benny almost certainly has no idea his heart is anything but normal, and I wouldn’t waste much time worrying about closely monitoring for any symptoms. Of course, if something big changes you will notice and get him checked out. I would get a recheck echo at the indicated interval (because then you can continue to compare apples to apples), and see what kind of trend there is.
⁰0@@lemondrop13100
My dog has mild regurgitation n doctors put him on so many meds .. should we give him so many meds at this stage ?
My 8-year-old Maltese was diagnosed with a heart murmur stage 2. Was initially prescribed 1 1/2 of the 2.5 bid. Without an xray or echo cardiogram. Had a second opinion and that Vet referred me to see a cardiologist and confirmed diagnosis. Cardiologist Rx 1.25 bid. Lasix 3mg and bp meds. She is only 7 lbs. What is the correct dose. She is lethargic . She had more energy before the medication. I took her in for coughing and gagging. I need advice. Thank You.
That’s very abnormal for a dog to be in heart failure (thus need lasix) with only a grade 2 heart murmur. Did the cardiologist do any imaging? The dose for lasix has a very, very wide range, as it’s based on what is needed to control the accumulation of fluid. She is currently getting 1mg/kg, which is not a huge dose.
I have a 5lb. shi tzu. The vet said he has a 5/6 heart murmur. He has no symptoms. He now gets liquid pimobendan 2.5mg. He gets .5ml 2X a day. It costs $80 per month canadian.
The question as to whether he really needs this medication really depends on if he has any significant heart enlargement. To determine this requires some form of imaging. In a patient with no symptoms I prefer to take X-rays, though echocardiogram is also an option (just generally more expensive). If he has no or very mild heart enlargement, then the medication is probably not going to be helping a whole lot at this point and is probably just costing you money. If there is moderate to severe enlargement, then there's a good chance that the medication will prolong his life, so it's probably worth the cost.
As an aside (so I can check his dose), are you saying that the liquid medication contains 2.5mg/mL?
My dog is a 8 year old Maltese , weighing 15-16 lb . He does have an enlarged heart which I learned after being diagnosed with a heart murmur and going to a heart specialist and echo exam. . I did notice he would cough like he was coughing up something in his throat. So now he is on 3 meds twice a day but no fluid in the lungs yet. I want to do the best for him. Are you saying that the meds might not be the right thing? He is a great dog and great companion. Thank you.
If you took him to a cardiologist I would be inclined to think the treatment is appropriate for his case, but hard to say without more info about the echo findings / meds.
Hello Dr. I have a King Charles Cavalier who has been on Vetmedin for awhile. She has a 6 grade heart murmur. But she does fine. Like she sleeps a lot but she’s 11. Her heart was I think a 12. Normal I believe is 10.7. But she has no fluid etc. no panting. I give her harthorne berry, tuarine L Cartinine and CO10. It’s all in a chew. Is it possible she won’t go into CHF
The measurement you were given is called a vertebral heart score (VHS). It is a way to roughly estimate whether there is general heart enlargement, but it’s not particularly accurate, and most cardiologists and radiologists don’t really use it much. I’d say it’s more helpful for ruling out heart enlargement than confirming it. What would be more helpful is to know if there’s significant enlargement of the left atrium. Dogs that exhibit a high degree of left atrial enlargement are much more likely to develop CHF. So my initial answer is that it’s hard to say with the info I currently have.
The general answer to this question is: yes, it’s possible she won’t develop heart failure. It is definitely possible to have degenerative mitral disease that remains compensated for the animal’s life. That said, CKCs are definitely a high risk breed for this disease, and anecdotally I think they tend to have faster progression of disease than other breeds. But who knows, she doesn’t have to follow any kind of trend. I would ask your doc about her left atrial size, and if they aren’t confident saying much about that, you can always ask them to send the X-rays for review by a radiologist. This service is usually not too expensive in most places, and most clinics should have access to a teleradiology service.
Thanks for the quick response. I’ll do some digging and see if the left or not. Is a 12 significant large or like how you grade rhat I guess. I believe normal range is 10.5
A 12 is not particularly impressive. 10.6 is the average for CKCs according to one study, with a standard deviation of 0.5. If you go out two standard deviations to include 95% of animals, that makes the high end of the range 11.6, so 12 is not that impressive. And like I said, there are many experts that don’t put a whole ton of value on the VHS in the first place. I would be much more curious whether the left atrium appears subjectively enlarged on the radiographs.
Ok. Thanks sir. I’ll check when she goes back next week and see what area is enlarged. They’ll be closed tomorrow.
I should be able to find out which chamber or side of the heart might be enlarged. Would that VHS core of 12 cause any strain on the dogs swallowing ability etc. she had 3 loose teeth pulled. She wasn’t put under due to the heart situation. I know it’s been over a week and half. She will just swallow a lot of times and then it’s too big so she gags the food or supplement up. Then tries to eat it again. Like harder foods. Basically regurgitating. Smaller foods or wet she doesn’t have an issue. Thanks
Ace inhibitor for my 15 year old made her sincope incidents much less frequent and intense.
Interesting. There are really no causes of syncope that should respond to an ACE inhibitor, so I wonder if there was something else underlying? In any case, I’m cases like this I like to remember my school’s neurologist who loved the saying “never say never, always avoid always.” Who knows - every individual is an individual and could respond differently to any medication. I’m just glad it seemed to help!
@@taylorwardwelldvm8100 ace inhibitors are one of the medications prescribed for dogs with heart failure and degenerative mitral valve disease which I would think are the most general causes of syncope in old dogs. See how Kingsdale Animal clinic explains this.
Exactly the same for my 15 year old miniature French poodle.
My baby boy is 13 years old and has an enlarged heart and has all symptoms, the coughing and he has had one fainting spell a few months ago… he has high anxiety 😬 and cushions. I have not started him on pimobendan 2.5mg, take half tablet every 12 hours. because the doctor said his heart murmur was like a two we did x-rays and she showed me. He had a large tart which I’m not a doctor. I cannot tell. Now, just like you said she’s trying to get me to spend money on an echocardiogram. I’ve spent thousands and thousands of dollars on a Cushing test and now all heart test. he does cough he does pant he will also cough if like you wake him up and disturb him, he snores…. I think I need to go get a second opinion. I do not want to start him on this medication if it’s going to hurt him.
I’m sorry you and your little man are dealing with all of this. My first thought is that with a soft murmur (you were told it is a grade 2 out of 6?), heart enlargement is very unlikely. The thing that DOES make me a little worried is the fainting episode. There are a number of potential causes for fainting (or syncope, as doctors call it), with pulmonary hypertension being a fairly common one. Pulmonary hypertension is high blood pressure in the lungs and can occur for a number of reasons. While congestive heart failure is certainly one potential cause, that seems unlikely in this case if the murmur is soft, and I would think that Cushing’s disease is much more likely to be playing a role. If that’s true, then pimobendan is not indicated. If you can show that pulmonary hypertension is present (with an echocardiogram), then sildenafil would be the recommended treatment.
I would see if you can get the X-rays sent out for review by a radiologist. Most facilities (at least here in the US) can do this easily. There are a lot of teleradiology groups, and it is usually very reasonably priced to get a second opinion from a specialist.
thank you! I have never had a fur baby that I’ve had such a strong connection with. Thank you for taking your time to write me back I appreciate it more than you know. Rowdy goes to Banfield pet Hospital. This will be the secound doctor he has seen in a 3 year span. The first doctor said it was Cushing.
The excessive thirst always being hungry. He has a spot missing on his tail where the hair is missing. He is very anxious my little anxiety ridden, baby. They tested him for cushions. His cortisol levels were high during the test. His adrenal worked qproperly? Lol it’s been a long time but as she said, that does not mean that he does not have cushions they wanted to retest but before his scheduled appointment Rowdy would not stop crying and basically screaming. We had to rush him to the animal hospital. And he was sent home with a bunch of medication for I believe gastritis again this was a horrible experience watching him in so much pain… the doctor at the pet hospital did use the ultrasound and seen that he had a growth on his liver which I told her could that be Cushing’s and she said yes it could also be fatty tissue we would just have to watch the growth. I had Doctor Bosa at Banfield get a hold of the doctor at the pet hospital and they both decided and confirmed he had cushions without a positive result on the Cushing test. I did not start medication because I was scared. Doctor said that it was OK. We will just monitor him. She put Rowdy on trazodone for the anxiety and Galliprant for his arthritis and his back legs. Long story short. Lol fast forward about two years later Rowdy see a new doctor at Banfield. We took him in because he would have these little trimmer episodes and they would last from anywhere between 15 to 30 minutes. we took him in she checked him over. She said he has a heart murmur and graded it. We took x-rays. She came back into the room and showed me his heart was enlarged and Rowdy had a growth, but she could not see when it was located because of the heart being in the way, so We sent them off to radiology to figure out where the growth was located.( mind you she just told me he had 2 months to a year to live she came in had my husband take our 8 year old out of the room to deliver this information to me. I was in shock I’m like I am just here because he’s having tremors like what the heck is going on. we get the results back from radiology and it’s inconclusive on where the growth is. I proceeded to tell her about the pet hospital and she said oh that makes a lot of sense with the cushions diagnosis. By the way, this was not the doctors fault for not knowing about the Cushing. I guess it was not properly documented down. She takes the two months to a year off the table. And we go about our daily lives. The last visit here is what I wrote down so I remember exactly what happened. Sorry, I copied cut it and pasted from my notes .
latest )
Vomiting - after he wakes up and he will in the evening time, but mostly in the morning id say.
Snoring like crazy
Coughing and wheezing (in sleep or if he is touched and or picked up sometimes.
tremors (last for for short time and he can have one and then not another for weeks) I do not know what it is we call them episodes. 😔
Unsteady on feet ( back legs are riddled with arthritis)
excessive urination.
Always wanting to lick us and will lick all you legs and arms .
Smacking his tongue a lot like dry mouth
excessive drinking water
Breathing weird (galliprant maybe?)
Coughing like a seal
Does not like sleeping under blanket (almost a year now)
Like to lay on cold surfaces ( never has he done this)
DONT KNOW WHAT THIS WAS.
( don’t know if it was a seizure of fainting spell, or he had had a greeny lodged in his throat. )
EVENT. (So scary)
I gave Rowdy his daily medications and greenie. Then we laid back in bed, (which is his favorite thing to do….) he was
Laying on the bed beside me about 10 minutes later he Jumps up like something is wrong... Proceeds to throw up, but catches most of it in his mouth...he tries to go down his doggie stairs but does not, he turns around, and seems like he is choking on something... Rowdy goes to the other side of the bed ( he's in a panic ) almost falls off bed he catches him self Lands on his side and just lays there. About 20 seconds i start to shake him gently and rub him while I blow into his nose ( idk what I'm doing ) he finally coughs and I pick him hm up hold him and he finally relaxes into me about 2 minutes later. he gives me kisses and I take him outside.…. I called vet told me if it happens again to bring home in. It never happened again. I believe whatever this was occurred on Feb 3rd. I believe he had chocked on a piece of greenie that I had just given him 15 minutes prior to whatever this was?
Does an enlarged heart with a grade 4 murmur mean heart failure?
No, not necessarily. Depending on the severity of the enlargement it could mean that progression to heart failure is a significant possibility, but it doesn’t in and of itself confer a diagnosis of heart failure. Heart failure is defined as heart insufficiency that results in the accumulation of fluids - typically pulmonary edema (fluid in the lungs) in the case of mitral disease / left sided heart failure.
So I took my Chihuahua of 15 years old 4 pounds to a Cardiologist because of cough. The cardiologist found Mild degenerative valve disease (mitral and tricuspid valves), ACVIM stage B1- No medication needed. Also, he found Moderate Pulmonary Hypertension and possible high blood pressure and he suggested to see a Internal Medicine Vet which we did. He prescribed Lomotil for the suspected chronic bronchitis and Sildenafil every 8 hours for the Pulmonary hypertension. I am wondering if my dog will need heart medication as well or the Sildenafil will be enough at this stage. Also, is every 8 hours Sildenafil over medicated for Moderate PHT? Sildenafil is 20 mg and her dose is 1/4 of the pill every 8 hours.
Thank you so much for this video and for caring.
While it’s impossible to predict with certainty, I think there’s a good possibility that your dog will not need heart meds because at 15years old if the mitral disease is so mild there’s a good chance it will not progress enough to ever cause a problem.
The pulmonary hypertension is probably secondary to the respiratory disease, and that is being treated appropriately in my mind. Every 8 hours is a reasonable frequency for sildenafil, though sometimes you can taper it to 12 hours once everything is controlled. You could always discuss this with the internist.
Our 13 year old, 12 lb. dog has a heart murmur, her heart is now enlarged. She's taking 5 mg. of enalapril, 20 mg. of furosemide, and we added Pimobendan a few days ago.
We want to give her Olive Leaf Extract for her heart, it's said to lower blood pressure and they say to check with the vet if the dog is on medications. We asked the vet, they know nothing about the Olive Leaf Extract. We're hoping the Olive Leaf Extract will help her, she's coughing a lot. Her X-ray shows her heart is pressing against her trachea, and she had fluid around her lungs before she got the furosemide added.
From what I've seen on the internet, 5 mg. of enalapril is pretty much the maximum dose for her size. And you say enalapril is useless for this. I'm thinking of cutting the enalapril in half and add some Olive Leaf Extract instead. I see 1/4 tsp. of Olive Leaf Extract is a dose for a small dog, should I cut this amount in half as well, and give her the half dose of enalapril with it? I'd like to get her off the enalapril and give her the Olive Leaf Extract instead, if I could be sure I wouldn't hurt her condition. Please advise.
**Her first X-ray last September was sent out to have her vertebrae measured in relation to her heart and it was determined that she was borderline for the Pimobendan at that time. Her other X-ray in December, her heart hadn't gotten any worse.
There are days to suggest trust Olive leaf extract helps lower LDL (so-called ‘bad cholesterol’), but atherosclerosis does not appear to be a problem in domestic pet species, so I’m not sure of the cardiac benefit in dogs. It is a potent antioxidant, but again I’m not sure that will significantly impact heart disease (but likely would hurt). If she truly has congestive heart failure, then pimobendan is indicated. What’s odd to me is that you report her heart is only now getting significantly enlarged. Typically, dogs with congestive heart failure (which is present if there was actually fluid in the lungs) already have significant enlargement with a few exceptions, so I am a bit dubious of the congestive heart failure diagnosis (but obviously I haven’t seen her, so perhaps it’s accurate). She’s on quite an aggressive dose of furosemide, so I would hope that diagnosis is accurate for her to be receiving that. What were her symptoms that led to that diagnosis? Cough is typically not a clinical sign of heart failure. As for enalapril, while I’m not convinced that studies really show a major survival benefit, it might Be of some benefit once a patient is in heart failure, though it’s the first medication I would discontinue if she’s having any problems with meds.
@@taylorwardwelldvm8100
Thank you for your speedy reply. You said the Olive Leaf would likely hurt her? Everything I've read says that it is safe for dogs, and that it is good for a lot of things. I hoped it might strengthen her heart. I'd like to try it if it wouldn't hurt her or lower her blood pressure too much.
She's had a heart murmur for some years, maybe 5?, and has been getting progressively worse. When we took her to the vet in September and she had the first X-ray, we took her because she was coughing. They said her heart was enlarged and getting close to congestive heart failure. In December she was huffing a lot and seemed to be having trouble breathing. That's when they took another X-ray and she had fluid around her lungs, but not in her lungs and her heart is pressing against her trachea. Her breathing usually isn't fast. She seems to be trying to cough something up but I've never seen anything come up. I think she has trouble breathing because of her heart against her trachea. She doesn't eat good lately, I'm thinking it might be pressing against her esophagus as well. When she's outside walking around, she doesn't cough much.
The Pimobendan was prescribed at a 2.5mg. pill in the A.M. and a half pill in the P.M. When we'd hold her, we could feel her heart pounding very hard. We tried cutting it to a half pill both times and it seems much better, she only weighs 12 lb. But she still coughs a lot.
@@taylorwardwelldvm8100 Thank you for your speedy reply. You said the Olive Leaf would likely hurt her? Everything I've read says that it is safe for dogs, and that it is good for a lot of things. I hoped it might strengthen her heart. I'd like to try it if it wouldn't hurt her or lower her blood pressure too much.
She's had a heart murmur for some years, maybe 5?, and has been getting progressively worse. When we took her to the vet in September and she had the first X-ray, we took her because she was coughing. They said her heart was enlarged and getting close to congestive heart failure. In December she was huffing a lot and seemed to be having trouble breathing. That's when they took another X-ray and she had fluid around her lungs, but not in her lungs and her heart is pressing against her trachea. Her breathing usually isn't fast. She seems to be trying to cough something up but I've never seen anything come up. I think she has trouble breathing because of her heart against her trachea. She doesn't eat good lately, I'm thinking it might be pressing against her esophagus as well. When she's outside walking around, she doesn't cough much.
The Pimobendan was prescribed at a 2.5mg. pill in the A.M. and a half pill in the P.M. When we'd hold her, we could feel her heart pounding very hard. We tried cutting it to a half pill both times and it seems much better, she only weighs 12 lb. But she still coughs a lot.
What is the name of the drug for PLE? Please and thank you 🙏
For PLE (protein losing enteropathy)? I wonder if you’re thinking of prednisone. PLE is essentially a version of inflammatory bowel disease, which can be managed a number of ways. The common therapies involve hypoallergenic or highly digestible diets, steroids (eg prednisone), chlorambucil (a chemo drug), other immunosuppressive medications (eg cyclosporine), vitamin B 12 supplementation, vitamin B 6 supplementation, and antibiotics. Often I can manage patients with just diet or diet plus steroids, but every case is a little different and requires a bit of trial and error.
Dr Wardeell, where are you located?
I’m in Boise, Idaho, USA
When we come for our Rick's family reunion in Rexburg Idaho I may bring my 5 lb Chihuahua to see you. After listening to your video I think that what she has is maybe a trachea problem instead of any kind of heart problems. She's got Boundless Energy and just lightly coughs intermittently. She's very thin and I make all of her dog food, and she walks about a mile and a half every day with my husband. I felt very relieved after listening to your advice. We lost our 12 year old Chihuahua 2 years ago to heart failure and I just didn't want to Repeat Performance if I could do anything. Thank you!!!!
@@pamelaricks2083 well I’d be happy to see you if it works out! I’m at Viking Veterinary Hospital if you do end up wanting to find me 😊
My dog has a heart murmur stage 6. She’s been on holistic meds for the past 4 years. We recently decided to put her on pimobendan per the vets request. She has been on it for a little over a week and she is extremely anxious and coughing even more than normal now. Can I lower her dose to get her off of the medication ?
I wanted to add she has always had a normal respiratory rate. She’s fine in the car. Traveling etc. She also doesn’t hang any fluid in her lungs. She has a cough that could be related to something else as well that has gotten worse since moving back to Florida and sounds just like the dog respiratory virus that has been going around. Her blood tests were all fine. Can we take her off meds and keep her on holistic ? Her heart was enlarged with no change until this past X-ray. However the vet said she could’ve been breathing out bc the heart seemed enlarged on both sides not just the usual left.
So the two big questions are:
1) Is there at least moderate enlargement of the left atrium?
and 2) If there is, is there evidence of congestive heart failure (best evaluated by monitoring the sleeping respiration rate).
If there is significant enlargement of the heart, pimobendan will likely increase your dog's lifespan. If there is evidence of congestive heart failure, you need to add furosemide (or another diuretic, like torsemide) to the treatment. If neither case is true, then you don't really need to do anything except monitor. Left sided heart enlargement is relatively easy to identify on X-rays if you are experienced at interpreting them. If you have any question, you could always ask your vet to send the X-rays for review by a radiologist (the fee is usually rather small for this). Counting the respiration rate is only necessary if there are significant clinical signs of heart disease, or if there is significant heart enlargement. It is free and easy - just count the number of breaths she takes in one minute while sound asleep. Less that 20 is great, more than 30 is concerning. In the middle - just monitor for a trend.
So the left side has been slightly enlarged. It stayed the same for the past 4 years - we recently got new X-rays and the heart showed enlargement but the vet said it could’ve been because she was breathing out at the time. It looked bigger on both sides - is that common or usually just the left so the xray could be wrong ? Her respiratory rate has been fine as well as NO fluid ever heard in her lungs. She has been on all holistic meds up until now. She was coughing more than normal so we took her in and the pimobendan was recommended. However we think the cough could be related to the respiratory virus that is spreading. I’m reaching out to you bc I’ve had really no help - for the past four years even if my dog has an earache or a stomach ache, the vet always tries to immediately treat her heart. I get that the heart is an underlying issue because it did show signs of enlargement however, I have been treating her with holistic medicine. The only new alarming thing was the cough since moving from Colorado back to Florida. It almost started immediately with the move. She has been on the pimobendan for over a week now and her cough has significantly gotten worse and more frequent. I’m scared she’s having negative side effects of it and would’ve been better treating the cough for the virus. Not heart med.
It is unusual to have right-sided heart enlargement with mitral disease unless it’s very advanced, so I do wonder if the X-ray is a bit misleading. Hard to say of course without seeing it, but that wouldn’t be super common.
It’s great that her respirations are normal. That essentially rules out congestive heart failure at this time. Unfortunately, you can rarely hear fluid in the lungs until there’s a very significant amount, so the respiration rate is important.
As for the cough, there are many, many potential reasons for a cough in an older, small breed dog, including tracheal issues, chronic inflammatory airway issues (bronchitis), heart enlargement pushing on the airways and tickling them, infectious causes, etc. Heart failure is usually very low on my list of explanations for a cough. A virus is definitely a potential cause for a cough. Viral tracheobronchitis in dogs is generally self-limiting, so it will go away on its own regardless of what you do. If there’s a bacterial component, dogs will often get pretty sick (runny nose/eyes, fever, lethargic, not eating, etc). So it’s usually pretty obvious if a dog has an infectious cough because they either get much better or much worse over a week or so.
It is possible the pimobendan is causing lethargy. The most common side effect is GI upset, but lethargy does sometimes occur. It’s also possible that there is something else going on coincident with the start of the meds. The bottom line is that if the heart is not AT LEAST moderately enlarged then it is very very unlikely to be the cause of the cough, especially if the respiration rate is normal. If you are unsure and want more confirmation about the heart size, the murmur, etc, you could consider an echocardiogram. Though I don’t often order them for these dogs, sometimes they can be helpful for clarifying the more equivocal results.
Im heatbroken after seeing a beloved dog die in front of me after being dosed with vetmedin .i am angry with myself for not checking up on this shit before .
I know about the benefits for younger cavaliers with an early murmurs and an enlarged hearts. But I suggest that cavaliers from "good heart lines"=no murmur and no prolapse until 8- 10 years do NOT benefit from Pimobendan. I was persuaded to put two such ladies at 12 and 13 (both heart clear until 10 years) on pimobendan. Their mother lived to 16 years and 7 months old and did not die from heart failure. The daughters lasted around 6 months each on Pimobendan, and both had horrible deaths, falling down screaming from litterally broken hearts, directly into serious heart failure and put down the same day or the day after.
I'd VERY much prefer the slower process without the pimobendan (even if it would mean a shorter life, but in my case I am sure Pimobendan shortened their lives.) Never again.
I agree that I wouldn’t put a cavalier on pimobendan just because of its breed. I would only consider it if it met my typical criterion of at least moderate atrial enlargement.
@@taylorwardwelldvm8100 even if it was a 12 year old?
The study did not include older dogs, only younger dogs with early onset disease. The older dogs who are heart clear for a long time and with the that amount of atrial enlargement but no symptoms of heart failure at 12-13 yo, might actually be more sensitive to the medication and die a premature death instead, compared to without medication.
I suppose it’s possible an animal could live longer without it. We only have data that suggests it prolongs survival (and it’s the only thing known to), but that doesn’t mean it doesn’t have the potential to cause problems in some individuals. That said, I think that generally it’s a very safe and likely beneficial medication in advanced mitral disease. Probably the patients that seem to get worse on the meds are worsening despite the medication, and not because of it. That would be my guess, anyway.
Sorry Dr Wardwell, I went to copy your email address and deleted your comment by mistake, could you please give me your email address again re: online consult about my dog's heart murmer. Thank you.
Taylorwardwelldvm@gmail.com
@afrodite9801 do not listen to this quack.. you should be consulting with a pet cardiologist who will give you the correct information. he knows nothing and is spreading a lot of misinformation.