- 9 year old CKCS diagnosed with Stage B1 MMVD, G 3/6 murmur, had GA/splenectomy for benign mass
- Presented 3 months later as the owner could suddenly hear the heart murmur when sitting next to the dog
- Also tachypnoeic/tachycardic and exercise intolerance reported – was started on pimobendan/furosemide
- I scanned the dog a few days later – now G 5/6 murmur (o reported could not now hear murmur)
- IMO change from previous scan was abnormal movement of the anterior mitral valve with two regurgitant jets but was not flail – my thinking is there was a rupture of a minor cordae to cause acute deterioration (I know my prf/scale is too high on doppler…apologies)
- The left atrium and ventricle were not dilated but may not have had time to dilate and was on furosemide
- The dog is quite tachycardic during examination 160-240
- My question is do you think my hypothesis is correct and do these cases tend to re-stabilise or continue to deteriorate more rapidly?
- I have asked the owner to check the heart rate at home but am unsure what to do about this tachycardia
- How do people advise prognosis for different stages of MMVD in general? Different in small vs large breed dogs?
Comments
Good case, I also share your doubts on this one
Hi
Basically, I have seen a few dogs at stage B1 who suddenly develop CHF due to chordal rupture – and I have seen such guys stabilise. These cases are rare but it happens.
Regarding the murmur: Sometimes owners recognise a high-pitched mumur (like the scream of a seagull). In my experience these are mostly B1 dogs with a jet that flows along the mitral valve leaflet causing vibrations of the leaflet. Once the MI gets worse they would not hear the murmur any more.
Peter
Thanks Peter.
If the dog has gone acutely into CHF would you expect to see a change to the mitral inflow pattern even if the left atrium is not dilated?
Would you use longterm pimo/furosemide/ace-i in this case despite it still looking like a stage B1 but appearing clinically as if stage C?