So far very happy with the results in my canine patients.
Well, I’m so impressed by all these replies. 
And I’m still undecided.
Pony Fixer, a vet, wouldn’t give enalapril for an asymptomatic dog w/mitral valve regurgitation.
Marshfield, also a vet, is happy with results in canine patients.
deltawave gave interesting human comparisons. From what I understand, beta-blockers aren’t so widely used in dogs (per my vet, FWIW). Anyone know why this is?
foggybok, who knows her way around a kidney, says to monitor the kidney situation but that side effect like renal failure are unusual.
And then a number of posters report safe, or even positive, experiences in using it on their dogs.
My real reaction is this: why do dogs have to get old?
I’m going to call the vet to ask about some of the values from the tests – like cardiac ejection fraction, which deltawave mentioned – just in case there’s more info to be learned about what’s going on with my dog.
But thanks again to all. This feedback has been so helpful. :yes:
Ah yes, that IS the problem…We tend to outlive our poor pets…watch them all grow old…
Sometimes the right answer is not going to be obvious, you just have to go with your best guess and be happy that you did the best you could with the information at hand…Whatever you choose, know you are doing it because you want the best for your dog. Good luck to you and your precious pooch!
[QUOTE=deltawave;4185945]
I think we’re pretty much on the same page there, foggy. As usual.
I’m so excited to find a topic I can actually talk about with confidence! :lol:[/QUOTE]
LOL, I love cardiology. I wanted to be a cardiologist, but I just play one on TV…
Nice to hear your viewpoint!
Here’s a nice review of what the vets are doing, although a few years old (2005)…does talk about beta blockerss…
I’ve re-read JER’s stuff now and it seems the little doggie does NOT have symptoms or a bad ventricle, yes? I guess I’d probably not feel too strongly about an ACE-I in this situation; very little data suggesting benefit in either two- or four-leggeds in this scenario. It’s one of those things where you might reconsider if the dog is obviously beginning to do poorly, but maybe the natural course of things (with a conscientious and caring owner) is not so very bad after all. :sadsmile:
My human patients with severe MR don’t get pills–they get surgery, right away, symptoms or no symptoms, good ventricle or bad. Obviously not an option in an elderly doggie. :sadsmile:
[QUOTE=deltawave;4188387]
I’ve re-read JER’s stuff now and it seems the little doggie does NOT have symptoms or a bad ventricle, yes? [/QUOTE]
No symptoms, no bad ventricle. Just leaky valves.
He gets around fine and still takes regular walks 2x daily. He takes his time on our walks and I carry him for a good part of it anyway (my other dog needs some exercise). His pokiness is more about temperament than age as he is an anarchist at heart and refuses to conform to conventional walk concepts like going in any one particular direction. And he needs to be kept on a leash because, after 14 years with me, he still has misgivings about giving up the stray life and would leave me for the next person that walked by with a sandwich.
He’s had his share of lives. He started off as a stray on the mean streets of Beverly Hills. By the time I found him, he’d broken his RF and it had healed rather funky. His paw looks like a flipper and he runs on 3 legs. One day, he accidentally jumped off the 2nd story roof of my house and landed on concrete. He was fine. A few years later, he was trampled (horrifically) by a horse. He was fine. He’s left me numerous times and traveled some impressive distances but I’ve always reclaimed him. He hunts moles and mice, and would always help track down and round up my rabbits if they got loose.
So his heart has hardly been lacking. 
And I swear I’m not a lapdog person.
What a great and colorful description! He is the canine equivalent of any number of human patients I could think of, with equally colorful human versions of the same sort of temperament, physical shortcomings, and adventures.
[QUOTE=JER;4188665]
So his heart has hardly been lacking. And I swear I’m not a lapdog person.[/QUOTE]
You cannot write a post like that and not include a picture. That sounds like one cool dog - despite the leaky valves.
My old basset had a heart murmur his whole life - and I used to joke to the vet that I’m glad he had it because I couldn’t keep up with him with his bad heart - I’d hate to have seen what he was like with a good one. He had a lot of ‘adventures’ too.
Photo?
According to our school’s veterinary cardiologist (world-renowned), ACEi are useful for dogs that have already developed congestive heart failure (CHF), systemic hypertension, glomerulonephritis, or advanced heart disease BEFORE the onset of CHF. Advanced heart diseases include DCM (dilated cardiomyopathy) or HCM (hypertrophic cardiomyopathy) with marked left atrial enlargement.
Your dog does not seem to fit any of the criteria where ACEi (enalapril as an example) would be of any benefit. I don’t really know why your vet would have recommended it.
One study showed that Cavalier King Charles Spaniels (small dogs notorious for chronic valvular disease) with heart murmurs but no clinical signs did NOT benefit from Enalapril over a placebo in terms of survival.
Pimobendan is only indicated AFTER onset of CHF; for chronic valvular disease, there is no benefit and only possible side effects (diabetes mellitus among them).
I’d say that ACEis are not worth your money in this case. If and when your dog does develop signs of congestive heart failure, then it would be beneficial to start him on on a regimen that includes an ACEi among other things (+/- diuretic, vasodilator). If your dog has left atrial enlargement, then it might be beneficial to start him on a beta-blocker.
What might be easiest and worth trying at this time is putting him on a low-sodium diet. Some are:
Science Adult Maintenance (dry)
Eukanuba Senior Maintenance (dry)
Iams Active Maturity (can) – beef
Cycle Senior (can)
Pro Plan Turkey/barley (dry)
So that’s my input, straight from my lecture notes…including the most up-to-date studies and current therapies.
[QUOTE=JSwan;4189266]
You cannot write a post like that and not include a picture. [/QUOTE]
Okay, I admit I’ve been feeling really guilty about not showing my dog in all his deceptive cuteness. He’s in need of a haircut and not well-coiffed right now.
May depend on the specialist. The ones I have worked with have used beta-blockers extensively.
A good food: Royal Canin Early Cardiac. We initially thought my Dane’s DCM may have had a taurine deficiency aspect (but found a genetic defect a year later on echo…). We supplemented Taurine in addition to what was in this food… couldn’t hurt, and we tested his levels and the supplement certainly brought them up into a nicer theraputic range The food was very palatable and could be bought at Petsmart with an rx card.
[QUOTE=JER;4189461]
Okay, I admit I’ve been feeling really guilty about not showing my dog in all his deceptive cuteness. He’s in need of a haircut and not well-coiffed right now.
But without further ado: here’s Spike[/QUOTE]
Good lord that’s a cute dog!
Pancake, thank you for that great summary. Will ask vet about left atrium in more detail just in case I’m missing something.
As for diet, there is no way in heck my dog is eating any of those dog foods. (And I had no idea Royal Canin made a cardiac diet.) He is a carnivore. A very determined, insistent carnivore. He eats meat and eggs. And not just any old meat. He likes raw bison and ostrich. Chicken and turkey must be cooked. Beef must be yours (he will share it with you). No fish, ever. Right now he’s eating turkey and eggs with a tiny amount of rice or sweet potato mixed in. If there’s too much rice, he complains.
When he was younger, I fed him Solid Gold dry like my other two dogs (both have since died). If he didn’t eat it, the other dogs would eat it, so he ate. But since my border collie x died, he’s learned he could hold out for the good stuff. And so he gets it – it’s his time to be the indulged old dog.
(My other dog is a happy simpleton. No agendas and no sneakiness.)
The size of the left atrium gives you an idea of the chronicity of the mitral regurgitation.
Happy simpletons–that’s what I like my dogs to be.
So I talked to the vet this morning. We reviewed the results again.
It says ‘cardiac function is adequate’ and there’s no evidence of cardiomypathy.
ECH shows ‘normal rate and sinus arrhythmia. Elevated ST segment.’
I haven’t started the enalapril yet. I’m not seeing any compelling reason to change anything in my dog’s daily regimen…
He looks like a mad Q tip! Full of personality, bless his little leaky heart. What an expressive little face.
[QUOTE=JER;4191073]
So I talked to the vet this morning. We reviewed the results again.
It says ‘cardiac function is adequate’ and there’s no evidence of cardiomypathy.
ECH shows ‘normal rate and sinus arrhythmia. Elevated ST segment.’
I haven’t started the enalapril yet. I’m not seeing any compelling reason to change anything in my dog’s daily regimen…[/QUOTE]
If you see my post (must have just posted before you), then all the things I mentioned point towards that conclusion of not starting the enalapril.
If anything, I would start your pup on a low-sodium diet. Can’t hurt.
Pancakes, I agree with you. The enilapril will stay on the shelf.
A mad Q-Tip indeed. I like that description.
As for happy simpletons, I don’t have any experience with them. My two other recent dogs were a busybody heeler and an axis-of-evil border collie mix. Those two despised each other for every second of the 14 years they lived together. It was like Mad magazine’s Spy vs. Spy. My tiny dog was the DMZ in their conflict. The heeler liked him; the evil bc mix liked to scare him.
My new younger dog is a terrier x Maltese who doesn’t appear to know her own name (after two years) and only wants to be picked up and cuddled. And I’m not the cuddly type. But my SO likes her because she’s so simple.
Big thanks (once again) for all the helpful advice. :)
Here’s a nice review from a board certified cardiologist on the use of ACEi in asymptomatic dogs with valve disease. She gives a nice analysis of the studies that were done
