If your dog has been diagnosed with mitral valve disease or you want to know more about dogs with mitral valve disease, you’ve come to the right place. As always, Fidose of Reality brings you the most researched information, expert feedback, and what is and isn’t working for other dog parents with a dog who has mitral valve disease. One thing to keep in mind as you read this and any other MVD dog articles online: every dog is affected differently by mitral valve disease. Like people, dogs and the rate at which MVD progresses to congestive heart failure (or not) varies. MVD is not a death sentence and there are MANY things that can help your dog.
I know because my 10-years-young male neutered American Cocker Spaniel, Dexter, was diagnosed with mitral valve disease and has begun a preventative medication regimen. I am not happy that he has this condition but I feel very confident in his long-term prognosis (and so does his cardiologist).
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Mitral Valve Disease In Our Dog
Our Dexter has had a grade 3 heart murmur for close to two years, being followed with echocardiograms and chest x-rays, and blood work. Those who have followed this blog know that I’ve written about dogs and heart murmurs. A murmur is a disturbance in the flow of blood through the heart. When the flow of blood is any some way compromised, the noise is heard on auscultation by a veterinarian. That noise is audible to the vet and is called a murmur.
The grade of the murmur does not indicate the severity (nor presence) of disease. This is very important because a higher grade murmur does not necessarily mean the dog has worsening disease. This can only be determined with cardiologic testing.
Dexter’s cardiologic workup was due and we decided to switch his heart care from his regular veterinarian to a board-certified cardiologist. I would do the same for myself, so I want my dog to have the same specialized care. I really like his veterinary cardiologist and he encourages the pet parent to be in the room for the exam and echo.
Here is Dexter’s echocardiogram report from 12/10/18. Dexter has moderate mitral and mild tricuspid valvular endocardiosis. Keep reading. I will explain what this means and how we are attacking it.
Of note, you see the LA/AO number of 2.11 on the right hand side of the chart below? We started medications because anything over 1.7 warrants medical intervention. Our goal is to get that number down from 2.11 to something lower.
What Is Mitral Valve Disease In Dogs?
A heart has four valves that help it stay alive and function. Of the four valves, the one that is most commonly affected is the mitral valve. The mitral valve separates the left ventricle from the left atrium of the heart. As blood flows through, the mitral valve is supposed to close when the heart contracts. By closing, blood is unable to flow backward into the atrium. You want all the blood to flow forward and go to the body. You don’t want blood flowing backward.
Cornell Veterinary says that when the flow of blood is going the wrong way, this is called regurgitation. Sometimes, vets call this mitral regurgitation. The left atrium can enlarge with time and then fluid accumulates in the lungs because there is too much pressure and volume.
Think of the appearance of skin on an 18-year-old female versus that of an 85-year-old woman. There is a notable difference and gravity takes its toll. The same holds true with the heart. In some dogs, heart disease is congenital or genetic. In other dogs, usually over the age of eight, valves begin to degenerate as a part of the aging process.
When the valves cannot close properly, they leak. That thickened valve(s) flops more and begins to weaken. According to Cornell, most dogs with mitral and/or tricuspid regurgitation will have a cardiac murmur. Dexter’s was discovered on routine physical examination years ago. Our first Cocker Spaniel had a murmur later in life that required no treatment or intervention.
What Causes a Murmur In Dogs?
If the problem is congenital, as is sometimes the case in puppies diagnosed with murmurs, it can be a familial issue. There is a whole host of reasons for a canine heart murmur, which is why further testing can help.
The heart murmur is indicative of some underlying problem, so identifying that problem is important for management. Some causes of a heart murmur in dogs include, but are not limited to:
- Degenerative valve disease, common in older and smaller breeds of dogs. Our dog was diagnosed with degenerative mitral valve disease, which we are managing conservatively with observation and testing.
- Flow murmurs, which means no structural disease is present
- Heart muscle disease leading to poor pumping function
- Anemia (correcting this may eliminate the functional heart murmur)
- Low protein levels in blood (hypoproteinemia)
- Fever or infection
- Obesity (solving this issue may help the murmur!)
- Worms/parasites/fleas/ticks: When my dog was diagnosed with an immune system disease (IMT), the murmur was heard because his platelets on admission to the hospital were zero!
- Bacteria from uncared for teeth can contribute to cardiac disease, which is why is imperative to have a dog dental care plan in place. Bacteria from an uncared for mouth is scientifically linked to heart valve infections in dogs!
There are many other reasons for a heart murmur, but as you can see, a murmur may affect one dog a certain way and another dog in a completely different way depending on the cause.
How Is Mitral Valve Disease Treated In Dogs?
Each dog is treated differently, and just like people, what works for one dog may not for another. Some dogs experience side effects from medications to treat and others will not.
We highly recommend seeking the services of a veterinary cardiologist, preferably one who is board certified. According to VetSpecialists.com, “To become a board-certified veterinary cardiologist a veterinarian usually completes a one-year internship followed by extensive specialized training in an approved residency training program (usually 3-5 years).” You can ask around, join group forums on Facebook dedicated to dogs and heart disease, and also ask your regular veterinarian for recommendations.
Valve degenerative is slow and progressive. Treatment can change over the course of months or years. For some dogs, the disease advances faster than others. Early disease is not treated in the same way as advanced disease, just like people.
Commonly used Supplements for MVD In dogs include, but are not limited to:
Diuretics: These drugs allow the kidneys to remove excess fluid from the body. Commonly used diuretics include furosemide and spironolactone, the latter of which is potassium sparing so the dog does not generally need a potassium supplement.
ACE Inhibitors: Used by both humans and pets, angiotensin-converting enzyme inhibitors lower blood pressure and decrease fluid retention by dilating veins. Some commonly used ACE inhibitors include benazepril and enalapril.
Positive inotropes: Vetmedin or pimobendane has revolutionized the way leaky valve disease is managed in dogs. According to the results of the EPIC trial study that appeared in the Journal of Internal Medicine in September, 2016, the goal was to “investigate whether or not pimobendan delayed the onset of congestive heart failure (CHF) or cardiac-related death/euthanasia in dogs with asymptomatic myxomatous mitral valve disease and cardiac enlargement, as compared to placebo.”
This study is huge because 360 dogs were involved and the dogs had to be in at least stage B2 disease with at least moderate cardiac enlargement. Strikingly, the final analysis found that the median time to the primary endpoint (CHF or cardiac death) for dogs receiving pimobendan was 1228 days compared to 766 days for dogs in the placebo group.
You can read more about the EPIC study here and discuss if Vetmedin (pimobendan) is right for your dog affected by mitral valve disease. Dexter is on this.
Supplements for MVD In Dogs
Dr. Judy Morgan is one of my favorite resources because she is a straight shooter and she sees patients in the office and provides consultations. You should be certain your dog can take a supplement. I talked to our dog’s cardiologist for supplementation recommendation.
We’ve been giving Dexter:
- 4 ounces Answers brand raw fermented goats milk every morning (started 06/18)
- Harvey’s CoQ10 supplement for heart health (started 03/18)
- Nordic Naturals Omega Fish Oil capsule – increased from one per day for years to two
- One capsule Pet Releaf CBD oil daily (started 09/18)
We may add in other supplements as needed, but for now that’s what we are using. Dr. Morgan writes on her Naturally Healthy Pets website:
“Typical supplements I recommend for my dogs and my patients include:
- CoQ10– antioxidant, recommended doses are 1 mg per pound of body weight. I dose my dogs and patients much higher, at around 5 mg per pound once daily.
- L-carnitine– 500 mg for small dogs up to 2,000 mg for large dogs daily
- Taurine(found in Rx Vitamins Feline Essentials and Rx Vitamins Formula HL) – 250 to 750 mg twice daily
- Hawthorn– increases cardiac muscle contraction strength, found in many herbal formulations of differing strengths
- Omega 3 fatty acids decrease cardiac inflammation, decrease triglycerides, and decrease muscle wasting. Give 30 mg per pound of body weight daily, along with 1 to 2 IU of vitamin E per pound of body weight
- Calcium– the diet needs to have adequate calcium, particularly when formulating home-prepared diets
- Selenium – trace mineral that supports cardiac function – found in fish, chicken, beef, and pork
- Chromium – trace mineral that supports cardiac function – found in broccoli and mushrooms
- CBD oil– anti-inflammatory and anti-anxiety effects; generally recommended dose is 1 mg per 10 pounds body weight 2 to 3 times daily
Nutritional additions for my pets and patients include:
- Fermented raw goat milk– high in taurine, medium chain triglycerides, and vitamins essential for cardiac function; Yin tonic to decrease inflammation
- Species-appropriate meat-based diet, preferably raw, that includes heart muscle meat
- Qi tonic foods – beef, dark meat poultry, rabbit, tripe, pumpkin, squash, sweet potato, and Shiitake mushrooms
- Foods to resolve stagnation and help eliminate fluid build-up – celery, watermelon, dandelion greens and roots, and parsley
- Blood tonic foods – egg yolks, sardines”
Stages of Mitral Valve Disease in Dogs
Heart failure has four stages per the American College of Veterinary Internal Medicine (ACVIM), and according to Cardiac Education Group, they are:
Stage A: Dogs with no structural disease but at high risk to develop heart disease. This includes the Cavalier King Charles Spaniel who has yet to develop a heart murmur, for example.
Stage B: Dogs with structural heart disease but not signs of heart failure yet. This stage is broken into two, stages B1 and B2.
Stage B1 refers to asymptomatic patients that have no radiographic or echocardiographic evidence of cardiac remodeling in response to CVHD.
Stage B2 refers to asymptomatic patients that have hemodynamically significant valve regurgitation, as evidenced by radiographic or echocardiographic findings of left‐sided heart enlargement. This is Dexter.
- Ironically, therapy for dogs in stage B2 is a bit controversial. Some cardiologists recommend treatment, others do not. In speaking repeatedly with our dog’s cardiologist, we opted to pursue treatment to help prevent the disease from progressing. We were recommended a low sodium diet, which our dog already consumes.
Stage C: Dogs with past or current clinical signs of heart failure.
Stage D: Dogs in end-stage heart disease with clinical signs of heart failure not responding to standard treatment. Advanced treatment strategies are employed.
One of my favorite resources for breaking news, support, revolutionary treatment, and more is the Mighty Hearts Project. These are the folks who have dogs who had mitral valve surgery overseas to save their dogs’ lives. Stay tuned, I will link to their site later in this piece.
Congestive Heart Failure In Dogs
Congestive heart failure occurs when the heart muscle becomes larger until it can no longer compensate and fluid accumulates in the lungs. Treatment of chronic valve disease centers on eliminating signs of congestive heart failure.
Former veterinary technician and fellow pet blogger, Christine Caplan, knows all too well about dogs and CHF.
“Bruiser sat for days in an oxygen tent and pulled through. He was started on Vetmedin, furosemide, and spironolactone. Our cardiologist does an echocardiogram and radiographs every six months,” she shared.
Bruiser is 14 years young and in stage C. His cardiologist says he can live a year or four years. He is stable and his mom counts on her frequent checks of Bruiser’s respirations as helping to keep him (and her) on track. Amazingly, Bruiser did not have a murmur and one night boom, the dog had labored intense breathing. Radiographs showed congestive heart failure. Caplan was shocked but is her dog’s advocate and keeping things steady in conjunction with her vet and cardiologist.
Persistent coughing and labored breathing are the general hallmarks of congestive heart failure. Treatment varies depending on the dogs, the stage, and any other number of factors. After a proper diagnosis is made, most dogs with congestive heart failure will stay on meds and require monitoring for the rest of their lives.
Certain breeds are known to have a predisposition to CHF, and those breeds are Cocker Spaniels, Boxers, and Doberman Pinschers, but any dog at any age can be affected.
Surgery for MVD in Dogs
In the United States, mitral valve surgery on dogs does not exist. Mitral valve repair surgery does exist in several places outside of the USA.
I discovered the Mighty Hearts Project years ago and recently joined their community as a resource in our own journey. On their website, they say, “Surgical treatment represents a life-long curative treatment since it corrects the mechanical defect while medical treatment can only mitigate the negative consequences of mitral regurgitation. The surgical technique was developed over 10 years ago at the Tokyo Veterinary University by Dr. Masami Uechi. This technique reduces the diameter of the mitral ring, called annuloplasty, to significantly reduce mitral regurgitation and replaces cords to avoid mitral valve prolapse. This surgery is still carried out to date with a success rate of about 90%.”
Dogs are going overseas with their devoted dog parents to have their valves repaired and regain a quality of life.
Fellow dog writer and author of over two dozen books, Kim Campbell Thornton, has written extensively on repair surgery for mitral valve disease in dogs. She’s also one of the dog moms who traveled to France for her own dog, King Charles Cavalier, Harper, to undergo life-saving surgery. Her husband snapped the photo below and shared to Facebook, “Harper saying her goodbyes to Clinique Veterinaire Bozon de Versailles. Look at the happiness on Kim’s face! Thank you so much Doctors Sabine and Jh Bozon and Uechi for giving Harper a new lease on life!”
Thornton says surgery is not a fix, but Harper requires no medications. She goes for shorter walks these days but she isn’t slowing down. Harper recently acquired the Elite title in nosework. She leads what Thornton calls a ‘pretty normal life for an 11-year-old dog.’
She has other dogs, who also take medication for various heart ailments. Her experiences with the medications have been successful for some and not so good for other dogs.
In an article for American Veterinarian, Thornton writes, “The medications used have not changed substantially over the past 10 years, but there are updates in when they are used. One example is pimobendan, which has been shown to delay death in dogs with degenerative MVD once they are in heart failure, Dr. Swift says, adding that the results of a study published in 2016 in the Journal of Veterinary Internal Medicine suggest that starting the drug in the preclinical stages once there is heart enlargement will delay the onset of heart failure itself.”
Nate Estes, a dog dad who also co-founded the Mighty Hearts Project has a lot to say on this topic. His dog, Zoey, was diagnosed with MVD in 2016. Estes learned everything he could and flew his dog from Los Angeles to France for open-heart mitral valve repair surgery, which was successfully performed on October 26, 2016.
Estes says prior to surgery, Zoey’s heart was extremely large and her left atrium vein was dilated and stretched.
Currently, no U.S. surgeon is able to perform this surgery unless they’d study abroad learning Dr. Masami’s technique, bringing it back to the United States.* (see breaking news below)
When I asked Estes if he sees dogs being managed with medications and not having surgery he shared, “I have seen dogs in stage D have the surgery and holding in B2 with no change years later. Some dogs even seven years later are doing good on medication.”
Dog mom and famed animal trainer, Laura Nativo, is another member of the Mighty Hearts community. Her dog, Preston Casanova, is in stage B2 and has been for many years. He is over 16 years old at this time with no signs of congestive heart failure.
In general, if surgery to repair the mitral valve is being considered, according to the Mighty Hearts Project, Dr. Sabine Bozon says that before 13 years of age is ideal.
Breaking News on Dogs With MVD
The week of December 17, 2018, this amazing update was posted to the Mighty Hearts Facebook page:
Happy Holidays, Mighty Hearts families! We have exciting news for you…
As many of you have heard, Dr. Simon Swift from the University of Florida College of Veterinary Medicine has been working closely with Dr. Masami Uechi for months in efforts to bring his Mitral Valve Repair Surgical technique to the US. We are excited to announce that an agreement has officially been reached with an exchange program between UF and Jasmine set to begin in Spring 2019. An official press release by UF is soon to come.
To have your dog be considered for MVR surgery with Dr. Uechi at UF, please reach out to the University directly at:
University of Florida Small Animal Hospital
2015 SW 16th Ave.
Gainesville, FL 32610
(352) 392-2235 #3
We at Mighty Hearts would like to thank Dr. Swift for his passion and hard work in bringing this program to fruition. We also warmly welcome Dr. Uechi and his team to the US, and wish their upcoming surgical students the best in their training.
Nate Estes and Carol Young
Mighty Hearts Project
Would I consider this surgery for my Dexter? Without a doubt. Hopefully, he will not need it, but if that day should come and he is physically able, then yes, we are doing it.
Home Monitoring With Respiratory Rate in Dogs
One of the key things that dog parents can do in the management of their dog with mitral valve disease is monitor the dog’s resting (sleeping) respiratory rate. This is very easy to do, too. According to petMD, at rest, healthy dogs should have a respiratory rate of between 20 and 34 breaths per minute, and they should not appear to be putting much effort into breathing. Always know what is a normal baseline respiratory rate for your dog so that when abnormal happens, you are prepared.
There are apps available to help you track and monitor your dog’s respiratory rate so that you can keep a log and report back to your dog’s cardiologist. Search your app store for dog resting respiratory rate.
Tufts Cummings School of Veterinary Medicine says that pets with heart disease may have an increase in breathing rate or breathing effort. Each breath is seen as the chest rises on inspiration and then falls on expiration. You simply watch your pet at rest. Count the number of breaths per minute, or do what we do: Use an app to record 15 seconds and then multiple how many breaths took place in 15 seconds by 4. This is your dog’s respiratory rate at rest.
Tufts also says you want to be sure your dog is not working hard to breathe. You will see the abdominal muscles move more forcefully, breathe with an open mouth, stand with legs in a wider stance, and/or outstretch their neck.
Dogs are good at hiding and masking their pain, so it is up to you, the dog parent, to know what is normal and what is abnormal.
How We Are Attacking Leaky Valve Disease In Our Dog
For us, it’s a six-part agenda:
- 4 ounces Answers brand raw fermented goats milk every morning (started 06/18)
- Dr. Harvey’s CoQ10 supplement for heart health (started 03/18)
- Nordic Naturals Omega Fish Oil capsule – increased from one per day for years to two
- One capsule Pet Releaf CBD oil daily (started 09/18)
We feed Dexter a combination of Dr. Harvey’s Veg to Bowl with organic ground beef cooked, lean and low fat for one meal and then Dr. Harvey’s Canine Health with organic ground beef cooked. His food is very low sodium, which is recommended. We watch sodium content in treats, too. Flip a bag of treats around: you will be shocked at some of the major brands who fill their treats with sugar and/or salt.
Read: === > Ten Lies Told By Dog Food Makers
We have always provided Dexter with adequate indoor and outdoor exercise. The cardiologist has no limits on him. At this point, Dexter is a dog who will play for an hour at the park chasing his squeaky ball if you play with him. We do short walks, long walks, play inside, and we do our outdoor play sessions, weather permitting. Always ask your dog’s cardiologist for exercise restrictions and/or limitations. You also do not want your dog to be overweight, so we are making sure to keep him at a healthy weight.
Here’s how to safely help your overweight dog lose weight.
Blood Draws, Echos, and More: Oh My:
Dexter has his first blood draw after starting his cardiac compounded solution (it’s a liquid) in three weeks. He will also have a chest x-ray, thyroid testing, and blood pressure check at this time. After that, I want his blood levels tested every three months. He will have a repeat echocardiogram every 3 to 4 months. A dog ages faster than a human and our cardiologist agrees on these recheck times.
I check Dexter’s urine weekly with ph strips at home. I buy them on Amazon, do a free catch of his urine in the morning when it is most concentrated by putting a cup under his man part and boom, sample achieved. I dip the ph strip in and wait two minutes for it to develop. I want to be sure he is doing good urine wise and that his levels are in check. You don’t want to clean the cup out with any soap products, just rinse with water and store. You can also use disposable containers and reuse them. I’ve been doing this for my entire adult like as a Cocker mom with both my Cockers to date.
Not Letting This Control Me:
This is not a death sentence. I am thinking positive, acting positive, and many dogs with MVD live normal, happy, healthy lives. Progression of the disease can be rapid or slow. Regular veterinary care, in addition to yearly heart screenings by a certified canine cardiologist, can assist in early recognition and treatment. Go to a cardiologist who has many years of experience. All dogs react differently. Some respond really well to the medications. No two dogs are alike, just like people.
My first Cocker Spaniel lived her whole life with a heart murmur and she was almost 15 when she passed, unrelated to her heart.
Cocker Parents Whose Dogs Have MVD
I founded a Facebook group called Club Cocker: Wigglebutts Worldwide. Here are what some of the many members have to say about MVD and how they manage it in their Cocker Spaniel:
Christine Lockwood says, “Demi was born with heart murmur and when I got him he was 6 years old. He still did well till he was 15.5. Just go every 3 months to re-check. Enjoy Dexter have fun with his big bones and thank God everything is fine.”
Michele Trieb shares, “My 10-year old Buddy boy (puppy mill survivor) was just diagnosed with a level 2 heart murmur and is now on a small evening dose of Enalapril (oral med for CHF). He is responding very well and is feeling very good (from my maternal perspective). Our vet and cardiovet also agree. He’s a happy wigglebutt boy once again!”
Diane McLaughlin says, “Cassie was diagnosed with a grade 4 murmur at 12 years old and CHF shortly after she turned 14. She was started on Enalapril after that. She saw a cardiologist yearly and would have an echo done every other year up until she turned 15 and then yearly after that. She didn’t start on Lasix until about 6 months before she died. I fed her homemade but instead chicken instead of beef with pretty much the same supplements. I tried taurine but it caused her blood pressure to drop dangerously low. I found by adding chicken liver to her food I could get through the food without the side effects of a separate pill.”
Lynda Benoit shares, “Sadie and Molly each have CHF. They take Vetmedin. Sadie takes Lasix for the fluid in her lungs. Absolutely no kibble. Only homemade food. Lean ground beef, veggies, Brown rice, turmeric, glucosamine, chondroitin, wild salmon oil caps. And cranberry capsules. Sadie was diagnosed with CHF on September 15, 2014. She just made it through major surgery without any issues. I tried giving her a taurine supplement a few months back, but it caused a lot of fluid in her lungs, so we stopped it. It took a while for her cough (fluid) to get better.”
Lauren Cooper tells us, “Buddy sees a cardiologist for a leaky valve. He’s on Enalapril and Vetmedim and has very early heart disease. Better than CHF, which is what my vet thought originally because he has a “hack”. The cardiologist ruled that out with his EKG and said buddy’s heart actually is in decent shape for a 13.5 year old dog and he had a bronchial disease which causes the hack episodes. He gets CoQ10, cbd oil for his arthritis, eats a mix of frozen pre-made raw and homemade + Dr. Harvey’s. We supplement with sardines (no salt added in water) which I read are high in taurine and I made a turmeric golden paste that I add to his meals.”
Al Nelson reports, “My sweet 16-1/2 year old girl Maxie has been on Enalapril and Pimobendan for almost 4 years now for a level 4 heart murmur. She seems to do well on these meds. Especially the Pimobendan.”
Kathi Schneider Alexander says, “I’ve got two (siblings but not litter mates) with murmurs. The younger female is a 6/6 and totally asymptomatic. The 13 yr old boy is 5/6 and on lasix and enalapril and Nordic Naturals fish oil. He coughs every morning but still plays a rough and tumble “bull elk” game with the younger dog every evening. And when the game is done, more often than not it’s the youngster panting, not my old guy.”
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