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 your dog but they sound lovely

Just love on him while you can! I’m glad to hear you are providing him great care

Thank you for your comment!

​@@taylorwardwelldvm8100echo £700

Glad to hear you avoided the unnecessary meds! Definitely get that X-ray. And have it read by a radiologist or cardiologist if you can. It’s very common to overinterpret the heart size on little dogs like a papillon.

@@taylorwardwelldvm8100 thank you for your reply. Much appreciated 🙏

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.

Hi! SO grateful for this post. I have a Bichon Poodle mix and I kept him off pimo bc his heart murmer was low grade for the first 7 years i had him. But hen he had a hypothermia moment and collapsed in the snow in 2022 and developed seizures after that. Prior to that he ran like a white lightning streak across the grass and never got tired! I was having his teeth cleaned when needed for years since I got him bc he has always had a prob with warts and rotting teeth and he would cough when they created bacteria he would swallow and it taxed his heart or lungs or something…bc after the dental he no linger coughed and bounced back with full energy again…although i brushed his teeth etc. YES, i did not know that peas and lentils and grains would mess him up so I got him off of that a few years back…BUT after the seizures they upped his pimo, made me put him on it, after an echo… he kept having seizures on med that was not working from the heart doc so his new vet after we moved put him on the enalopril and the seizures stopped. He also pur him on phenobarb after ant fire ant bite that brought his seizures back. ( Puppy has had a very rough last 1 1/2 yrs and it makes me cry to write this) HOWEVER, vet refused to do a dental bc of his heart etc and the new meds took a way all his vitality and his teeth got worse and broke so i had to go find another vet who would do the dental but they had to schedule him out over three to four weeks on Amoxacillan and an increased dose of Phenobarbital from a quarter a tab i was doing every three days to half a tab every day. They did bloodwork prior to dental and it was all good but then the vet pulls out on the dental the day before bc his heart is way more enlarged and liver having problems. So now Pup can not have a dental for his teeth and has MORE drugs than are good for him…he was recently starting to not want to eat anymore BUT he will eat his food out of my hand?? He has an appetite. I am giving him moist natures logic kibble and clean cooked chicken breast. I am at a complete loss at this point. I tried to quit his meds but that night he got distressed and his heart seemed to be pounding too much so i gave them to him and he was able to settle down. I ran out of money on all this…the last vet that might do his dental I mentioned now is requiring me to get another echo and liver test for a grand so they can up his meds again and a dental is off the table now. I joined an annual care plan for the dental and am giving them 150 a month and all they did was harm Pup and charge me for a maintenance care plan i cant use anymore. So, can you please advise anything that will help Pup. I saw his ray, his heart is enlarged NOW.. it was slight before but it is a lot now, after the seizures I guess. Unless the meds did it? I want him off Pheno, Analopril and vet med or drastically reduced if possible. I found a holistic doctor who will see him for 89.00 for 30 mins on a zoom and thinks she can help but wow… i need a free completely effective plan for pup at his point bc I lost my Care credit card from all this and I am already paying the 150 plus the meds and his dog food. And i still think he needs dental work:0. Thank you for any help! Ps, his murmer is 6/7 now

​@@brmm48 please understand the importance of mixing healthy carbs like rice, ground flaxseed, chia or quinoa in with your dogs meats. Can add Taurine & Quercetin for heart health & at least one healthy veggie & fruit/berry. For the teeth you can buy powdered chlorophyll to put on the food or just add rosemary or parsley & a probiotic. This along with occasional fasting & keeping dog's temperaturature & stress levels regulated will help.

@@hahna77 thank you thank you! I have some of these things.. will get the rest soon.. Pup thanks you;)

@@COMMANDER-ONE I hope you’re doing it doing ok now. It’s so tough with those symptoms because there are so, so many conditions that can cause that kind of a breathing pattern, from any kind of lower airway condition , to pain, to some kinds of abdominal problems. If it keeps occurring I would have him checked out

@@taylorwardwelldvm8100 I had a reminder to ask his veterinarian if antibiotics would be appropriate for his really bad breath and subsequent plaque on his teeth. He ended up getting antibiotics after a barrage of testing and he feels a lot better now and his breath does not smell bad like it did. I’m not sure , what the cause was for the reasons you stated. I just know it cost me around $1000.! thanks for your comments

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.

How did you take your dog off? Slowly or abruptly?

@@juliamullins8145 Abruptly.

Im starting hawthorn berry tincture today. Drops in her water, & also made x in wet food. Hopefully she won’t notice.

@@TammyTimeMovies thank you 😊 I have a whole list of topics I want to make videos on - I just need to get time to start doing them!

@@franceslynch8815 you’re welcome - thank you!

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.

No worries!

I think that’s a great mindset

Thank you for your comment. It does sound like your girl meets the criteria that I follow to start pimobendan. There is definitely debate, but I personally do not use benazepril unless dogs are in congestive heart failure (if at all). Did the cardiologist recommend sildenafil (Viagra)? It is used to treat pulmonary hypertension, and I think probably well warranted here. As far as the coughing, if there is any present (which it sounds like you’re not really seeing) it’s probably related to something like tracheal irritation (tracheal collapse and/or the left atrium putting pressure on the trachea) or chronic bronchitis - ie old dog things +/- some tangential heart involvement, but not heart failure. There’s not usually much that needs to be done for these types of cough except a cough suppressant if the cough is frequent. To clarify the diagnoses: 1) Chronic degenerative valve disease of the type of heart disease little dogs get. As the heat valve gets old it can develop degenerative changes/abnormal thickening that result in the valve no longer creating a tight seal like it’s supposed to. Blood leaking through that little gap in the seal is what we hear as a murmur. When there is no heart enlargement we call out Stage B. When there is enlargement of the left atrium of the heart we call it Stage B2. Stage C is heart failure that responds to meds. Stage D is failure which is refractory to treatment. 2) Pulmonary hypertension is high blood pressure in the arteries of the lungs. It can be the result of heart disease, and it can lead to issues such as fainting. 3+) I suspect the other diagnoses are fairly straightforward. For what it’s worth (a whole different can of worms - maybe another lecture topic one day…) it takes some fairly specific and significant blood work findings to get me excited about liver values in an old dog. Feel free to share and I’m happy to give my thoughts if you’re interested. I promise I don’t ignore all problems!!! I just get annoyed at things being over treated or aggressively worked up when it’s unlikely to change anything.

​@@taylorwardwelldvm8100 Thank you kindly for your thoughtful reply. I have started her on the pimobendan 5mg (1/2 tab 2-times daily) but I am not starting the benazepril. No, I did not speak with the cardiologist he only did the echo and passed along his findings to my vet. No mention of sildenafil. I was handed these two drugs with little information from the tech. I did review myself and found pimobendan best on an empty stomach, so... However, now I wonder how am I going to inquire about the sildenafil without upsetting egos? So I really don't know how to broach the subject. I did read where benzaepril helps kidney, but is that just re-stating that it helps with the hypertension? Her BUN was 33 mg/dl on May 15th, they did do a idexx chem 17 clip (in house) the day of the echo, I just don't have a copy of those results yet. I think they were concerned about her kidney function, and I have been told that crummy teeth can cause kidney problems so that is the reason for a dental. The concern over her liver values was mine, and only because the vet report I got when she was turned over to me as a foster showed ALT and ALKP were high. I wanted a re-check because it was a year later and she is a senior. Oh, I do have a digital copy of the echo report. I feel like you are in the dark here a lot, but your efforts to assist are just wonderful for me. Thank you again! By the way, she is a rescue, who at 12 yrs old was in a shelter due to a fire in her home. No name, no claim, no idea. She was adopted and less than a year later her adoptive parent passed. We have her now as a foster, she is so very sweet, just a tad overweight.

@@taylorwardwelldvm8100 Dr. Wardwell, thank you so much for your consideration and thoughts. I have started her on the pimobendan 5mg (1/2 tab 2 times a day). I am not giving her the benazepril. Oh, and I never spoke with the cardiologist, my vet likely did and got the echo results (I have them digitally too) There was no discussion of any of the drugs given and definitely nothing regarding sildenafil, which does sound really worth exploring. The thing is I find it difficult to broach this subject with my vet. I often feel like I am not being listened to and I don’t feel I dare question this. The day of the echo it was nearly 95 degrees outside (heat wave that week) with high humidity. When we arrived at the vet’s to check in we were told they were having people wait out in their cars and a tech would come get the dog. We weren’t prepared for this, and being obedient clients we took our dog outdoors, but waited under an umbrella at a picnic table. We do not have a vehicle with AC. It was hot, we were hot. After 15 or so minutes a tech came out to get the dog and told us to go into the reception area. Not more than 20 minutes after that I was handed the dog and the rx's by a tech with almost zero information shared on the drugs, diagnosis or much else. I finally spoke with my vet 3 days later (weekend) on the phone. He stated he was unhappy that we were made to wait outdoors; he wasn’t in the office that day, but that the echo, observations etc would not be affected. I find this hard to believe, but I have nothing to judge this by except she was panting heavily. Meanwhile over the weekend I had plenty of time to read and try to self educate. I looked into the drugs on my own and discovered that pimobendan is best given on an empty stomach. I agree with your coughing assessment. It really isn't an issue. The only reason the liver levels were mentioned likely, is that was the reason I initially set up an appointment for her. It had been over a year since her last check up (5/2023) and at that time her ALP and ALT were high (with a slight murmur Grade 1-2/6) so being a senior I thought it prudent to see her blood levels currently. They ended up being higher this year, along with the BUN now in the high area 33 mg/dl. I noted that benazepril is also used for high blood pressure, and helps with kidney issues, but is that just redundant as reduction in bp will always help the kidneys? It seemed to me that the sildenfafil is more suited to her specific pulmonary hypertension, from what I read. I just don’t know how to get my doctor to consider it. Please know how much I appreciate your attention to this girl’s case. She was brought to a shelter after her home burned down. No name, no claim. She was 12 years old at the time. She was rescued and adopted, but less than a year later her new owner passed. We now have her as a 13 year old foster and she is just the sweetest girl, abeit a little overweight. She deserves the attention and care. Thank you again, it is so very much appreciated.

Glad you liked it!

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!

Dandelion leaf tincture is a natural diuretic. I follow a holistic vet, and he offers natural remedies. Good luck.

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.

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.

@@ValT-bg9rv I didn’t realize for a long time that it could have these kinds of side effects, but it definitely can. Weakness and ataxia (wobbly gait) and lethargy are listed as side effects observed is the safety trials, among others. While I think it has a place, the potential benefits really need to be balanced with the side effects in any given patient. I hope you ended up getting your girl off of it for good.

Thank you for the question. The first thing I’ll say is that hearts with remodeling from mitral valve disease do not get smaller once enlarged, so I am pretty confident his heart was never enlarged. I wonder if something about the positioning on the X-rays made it look larger than it is. Who knows, but I can say it definitely didn’t get smaller. Second, when he was reportedly in heart failure you said his RRR was about 15 breaths per minute (7 or 8 per 30 seconds). This is WELL within the normal range. This is not the RRR of a dog in CHF. Third, there is no fluid on his lungs currently. There will not be fluid without heart enlargement, there will not be fluid without and increased RRR. Also, if there WAS fluid, lasix is the absolute first thing he would need - not enalapril. I definitely wouldn’t be starting enalapril is this patient, first because I think it’s of little value in general, and second because if I use it at all it’s as an adjunctive med for patients in actual congestive heart failure. In my hands I wouldn’t use the enalapril. I would treat the cough as you are and get X-rays once a year. And given that the interpretations you’ve been given on the X-rays don’t make much sense (eg the heart went from big to small, or there’s fluid but a normal heart), I would request a radiologist review to get a more reliable interpretation.

​@taylorwardwelldvm8100 Thank you! You know, it's interesting that you say that about the heart not being smaller and tlmay not have been enlarged in the first place because I took him to 3 vets, and all 3 did xrays and said it was enlarged- however, the first vet was a low income vet who frankly, seemed uninterested. I didn't feel he listened to me or took it seriously at all. I didn't trust his judgment, so I went to a nicer clinic for a second opinion the same night. They looked at his graphs and said the same thing etc BUT- Ben is built strangely. He has sort of a bird chest (think Italian greyhound), in an otherwise Chihuahua/terrier like body. I even tried to get an echo for him and they couldn't get a clear image because of the way his chest was built. So that's certainly possible what you said. I've never thought about it until now. Also, the doctor he has been seeing told me he originally came in with a 3/6 murmur, but that we cured it. It went away. I even double checked his records, and in the notes she said the murmur was gone. So the next time I brought him in, his usual doctor wasn't there and I was given a new one. She looked at me crazy when I said his murmur was cured. She asked who told me that and then went on to say murmurs can't be cured or away enitrely. So say I was confused is an understatement. I wasn't sure which of these 2 doctors to trust (same clinic-a rather expensive one at that). It was the second doctor that advised I get him an echo. I'll take everything you've said under consideration. Sure wish you were in the Houston area. I'd had love for you to have a look at his xrays. I don't believe I'll put him on enalapril. I did order him some COQ10 supplements, however. I appreciate your time and advice- thank you very much

If the murmur is really a grade 2, I really doubt there’s any enlargement. If the is enlargement, I doubt pimobendan would help. Depending on the cause there could be meds that could help. Other times it’s just environmental management (ie trying to limit things that get him super excited).

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.

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.

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.

I’m so sorry to heart that. It’s such a sad disease. I’m glad you found this helpful.

Cardiologists tell me you can stop pimobendan cold turkey without any known issues.

Good question. Cardiomegaly is just the doctor word for “big heart.” I suspect that if there is enlargement, it is most likely the left atrium (one of the heart chambers) that is enlarged. Fainting can come from a number of causes, and excitement-related is one of the types. Pulmonary hypertension, high blood pressure in the lungs which can go along with heart disease, is another.

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.

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😭

Also doesn’t enalapril also help decrease fluid? Would not a dog need that if they have fluid in the lungs? I would also like to add after an X-ray his heart had not changed sizes and very little fluid in his lungs in a 9 month period.

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.

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.

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.

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

Ugh, I’m so sorry to hear about your pup

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.

All of the heart meds are safe to stop abruptly. I caution stopping lasix abruptly in animals that are on it, as if there is heart failure, it could come back with a vengeance. So I tend to taper that one, but Vetmedin is totally safe to stop cold turkey.

@@taylorwardwelldvm8100 Wonderful, you are an amazing critical thinker! Taking your precious time to share videos like you do is so powerful - thank you for giving me back my lovely little Willa ❤️

I recommend monitoring the sleeping respiration rate to see if there’s actually fluid. There are a lot of reasons for a cough, and heart failure isn’t a very common one. What’s more, furosemide can actually treat a cough even when not caused by heart failure, so it’s hard to know if you’re treating chf or some other reason for a cough

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?

Thanks for your comment! For me it seems early to start your girl on pimobendan. There’s very little enlargement, and the regurgitation is well compensated at this time. Time will tell if the heart continues to compensate or if the enlargement progresses quickly. I would absolutely check X-rays in another 4-6 months and maybe in another 4-6 months after that. If there’s no significant change between those images l I would probably start checking just once a year. I’ve know plenty of dogs like yours that remained stable for a very long time. For dogs like that, pimobendan is at best a waste of money. That’s not to say your dog couldn’t go the other way and have significant progression, but I like more evidence that is going to happen before I start the medication. As for homeopathic approaches, I’m not well versed in many of them, but one thing I can say is there is good support for using essential fatty acids (eg fish oil) for cardiac health.

⁠​⁠@@taylorwardwelldvm8100thanks doc for the quick response!

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.

Then I would add amlodipine. It’s much more effective at lowering blood pressure than ACE inhibitors.

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.

Please doctor I really need your help

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

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.

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.

Good questions. The dose is reasonable for the sildenafil. I’m not quite sure whether the Vetmedin is indicated since it doesn’t sound like it’s the heart causing the pulmonary hypertension. What breed of dog is it? Pulmonary hypertension is caused by conditions that affect the ability of the lungs to get oxygen, so wondering if something different is underlying here. On a side note, I love cancer surgery. Sarcomas on the limb usually don’t require amputation. Unless they invade a joint or the bone, they can be removed with clean margins and the defect can either be closed with a reconstructive flap or left as an open wound (which usually takes about 8 weeks to fully heal). I’m of course not sure of the exact situation with your dog’s mass, but I wanted you to be aware of these options.

@@taylorwardwelldvm8100 He is a mix husky white German Shepherd mix. His lungs always came out clear on x-ray etc his lab works have always been good. He had the mass removed and they said they couldn't get clean margins so it grew back.. He's the type that they have to sedate to pretty much do anything on him because he gets fear aggressive... Now the heart doctor recommended that they don't give him dexamethasone I think it's called the anesthetic shot He has to be on something else before they sedate them I don't know anyways the mass looks a little bit bigger than it was or maybe about the same size but it grew in a little bit differently.. He never shows pain it's not busting open he only two times two or three times showed like it heard him if he banged into something.. He has a lot of energy. He's 11 years old He just turned 11 in June.. Thank you I'll write more later I'm playing right now with my flying squirrel Rocky 😊

I don't think it invaded a joint or bone it's high up on his arm so it's in an odd place for them to get clean margins they told me and they said it was too big for radiation... Thank you for communicating these things back to me.. I would love to just put off that amputation surgery as long as he's still running around and there's no big chance of him going into grade three or it metastasizing then I hear scary stories from people saying there's did pass away after they got the amputation saying it went to lungs.. I don't know it's just scary a lot to think about.. He had this mass since I think last summer.. the whole history journey of it

I couldn't believe Butter Bear got to his stitches one time when he had the donut cone on his head and he just ripped the whole thing open he had to go back into surgery to close it all up and he was on his way to healing and he acted like it didn't even hurt him I was like oh my God I couldn't believe my eyes when he walked up the stairs into the house and I saw the big wound open 😱

Yeah I'm cutting down the vet med in just a little bit to see how he does I'm kind of experimenting because I want to know which med is really helping him.. I know the sildenafil is definitely for that The vet met in though when I gave it to him right away he felt great so I don't know.. Not one episode since having both these meds I just don't want to give him a med he doesn't need

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.

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.

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?

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.

I’m unfortunately about a 9 hour drive from you! I’m in Boise, ID

My dog was Vetmedin from May 17 until June 17 for a stage, two heart murmur, and a enlarged heart. A week ago he started getting very weak couldn’t jump up very confused, wasn’t eating like he normally does, and then finally very fast heartbeat for two days. He was fine before that. After the racing heart episode, I stopped the medication per my vet . My vet thinks he should go back on it. Aren’t those red flags? I’m scared to put my dog on it. What’s your personal opinion? Thank you

@@Beagleylover if the murmur is really a grade 2, there’s essentially no chance there’s any heart enlargement, thus Vetmedin isn’t indicated. I’ve definitely heard of similar side effects from Vetmedin (just see the comments on this thread!), so if it’s not needed, I’d personally discontinue in my own pet and see if things improve. As an aside, there are things other than mitral valve disease than can cause abnormal heart rhythms, but Vetmedin isn’t indicated for those diseases either.

Thanks for replying. I had x-rays done, and he told me he had enlarged heart and stage two heart murmur. My dog is still having abnormal heartbeat rhythms, but acting normal. Except for the excessive, panting on his walks, he can’t go for real long walks anymore. I go back to see him Saturday. I’m confused about My dogs diagnosis from my vet.

@@Beagleylover may be its stage B2 MVD?

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.

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 😊

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.