There is a clear prolapse of

There is a clear prolapse of th eanterior mv leaflet in video one but not visible in vodeo 2 and its just an angle thing… 2 dimansional modality for a 3 dimensional degenerative defect. Just one view of prolapse = prolapse. Rutpured chordae is cause of prolapse especially that degree. Volume overload for sure and clinical signs are cardiogenic at least to some extent. I would triple therapy this dog (ace-i, lasix, pimobendan), check bp, watch renal values and reecho in 7-10 days wiht rads. This fits stage B2 or even C1 valve disease dpeending if wet lung or not.

There is no consensus on B2 treatment pimo vs no pimo but I am one of those that starts pimo in B2/C1 (FYI C1 is under discussion right now on how its defined) especially with a prolapse like this one and clearly tachycardic the heart isnt having a good time with that volume. In europe they may exclude the ace-i and just go lasix pimo but my guess is if ace-i were cheap in europe they would triple tx:)

Heres the mv disease consensuse excerpt from the Curbside Guide out next month from sonopath. The book is in final editing thank goodness:)

Treatment:The following treatment options are based on the ACVIM consensus statement regarding MVD.

Stage A: There is a high risk of cardiac disease, but as there are no clinical signs, no specific therapy—medical or dietary—is indicated. A radiograph and an echocardiogram should be conducted in one year or earlier if the patient is a large-breed dog as MVD may progress faster.

Stage B: Heart disease is present.

B1: There is a murmur, but no chamber enlargement. Treatment is the same as for stage A.

B2: There is a murmur with left atrial and left ventricular enlargement, but the patient is asymptomatic. Start angiotensin-converting enzyme (ACE) inhibitors (enalapril at 0.5 mg/kg PO Q12-24hr or benazepril0.25–0.5 mg/kg PO Q24hr). Consider beta blockers and mild sodium restriction.

Stage C: There are past or current clinical signs of heart failure.

Acute CHF:

• Lasix 2 mg/kg IV or IM hourly to a total dose of 8 mg/kg until the respiratory rate has normalized. Alternatively, for cases of life-threatening pulmonary edema, administer as a CRI (1mg/kg/hour).
• Oxygen supplementation.
• Continue with the ACE inhibitor and add pimobendan at 0.25-0.3 mg/kg PO BID.

            Chronic therapy:

• Lasix at 2 mg/kg PO BID and increase incrementally as needed.
• Continue with the ACE inhibitor.
• Pimobendan at 0.25-0.3 mg/kg PO BID.
• Consider adding spironolactone at 0.25-2 mg/kg PO BID to control congestion.
• A sodium-restricted diet is recommended, although some dogs will not eat it.
• Consider administering omega-3 fatty acids, digoxin, theophylline, and cough suppressants.
• If the dog is not already on beta blockers, then do not commence.

Stage D: This is the end-stage of the disease. Continue with the standard therapy of diuretics, ACE inhibitors, and pimobendan, and consider the following:

• Abdominocentesis when applicable to decrease discomfort if the patient is undergoing respiratory distress.
• Anti-anxiety medications for sedative purposes.
• Sodium nitroprusside and dobutamine (in a critical care facility).
• Nitroglycerin.

We recommend monitoring serum urea, creatinine, electrolytes, urine specific gravity, and possibly blood pressure for 5-7 days after therapy has commenced. A repeat ECG is warranted if an arrhythmia was present during the original assessment.

References:

Atkins C, Bonagura J, Ettinger S, et al. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. J Vet Int Med 2009; 23(6):1142-50.

Borgarelli M, Buchanan J. Historical review, epidemiology and natural history of degenerative mitral valve disease. J Vet Cardiol 2012;14:93-101.

Chetboul V, Tissier R. Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol 2012;14:127-48.

Fox P. Pathology of myxomatous mitral valve disease in the dog. J Vet Cardiol 2012;14:103-26.