Sweet Pea is a 15 year old Cocker spaniel.

She has a history of chronic intermittent UTI and is being treated for hyperadrenocorticism with 10 mg Vetoryl q12h. 

Sweet Pea also has a grade 4/6 HSM PMI over the mitral valve and 3/6 HSM PMI over the Tricuspid.

I recently did an echo on Sweet and was able to confirm the mitral and tricuspid insufficiency. There is also an elevation 

in aortic flow. We are checking her blood pressure next week.

Her Tricuspid insufficiency was measured at 3 m/sec revealing a moderate Pulmonary hyprtension.

Sweet Pea is a 15 year old Cocker spaniel.

She has a history of chronic intermittent UTI and is being treated for hyperadrenocorticism with 10 mg Vetoryl q12h. 

Sweet Pea also has a grade 4/6 HSM PMI over the mitral valve and 3/6 HSM PMI over the Tricuspid.

I recently did an echo on Sweet and was able to confirm the mitral and tricuspid insufficiency. There is also an elevation 

in aortic flow. We are checking her blood pressure next week.

Her Tricuspid insufficiency was measured at 3 m/sec revealing a moderate Pulmonary hyprtension.

I believe this is due to the L sided volume overload. 

Sweet Pea meets the criteria of the EPIC study for treatment with Pimobendan.

Here are my questions:

1. Should I give any other medications i.e. Enalapril (once the systemic blood pressure is measured).

2. Will treating the volume overload be enough to treat the moderate pulmonary hypertension. I do not believe the pulmonary hypertension is high enough to warrant Sildenafil.