Grade 5 or 6/6 heart murmur diagnosis - horse

[StevieD]

My 29 year old horse has been diagnosed with an enlarged heart after I could hear something when I was picking his front hoof and had the vet come out to see. She told me that his heart is very loud and is a 5 or even a 6 out of 6 on a murmur scale. a couple of years ago we first diagnosed him with his murmur at a 1 and since then has gone to a 3 and then 4. so obviously his condition is progressing. my horse is the first horse my vet has had with this strong of a murmur and doesn’t have an answer for a ball park of how long a horse can live with this kind of heart. she has given me some physical symptoms to be aware of in the event his heart goes into failure due to its enlarged state and at this time he is happily unaware of his heart condition.

the vet feels as though we should euthanize him in the fall and hopefully he gets to enjoy the uncoming summer. I assume that there is impending doom with his heart condition and a cold winter will not be easy on his body considering his circulation is not as good now to his extremities. also, if he does go into failure through the winter then we have to deal with the extra difficulty that poses due to the season after putting him down.

the whole topic really makes me sad to know that I will loose him. I have had him since I was 11 years old, and I sometimes feel ok and understanding of this choice to save him from potential harm. then days I retract and think am I taking his life away from him too soon? What if he can survive longer than the winter happily? This may be grief speaking… it is a struggle in my mind…

How long have your horses lived with this grade of a murmur? Did a hot summer affect their quality of life poorly because of the increased heat putting more stress on an already stressed heart? How did you manage that? I wonder if he will go into heart failure before the fall. it scares me, I hope he doesn’t. the vet just doesn’t have experience with this yet so he is her first case and doesn’t know any more than I do… or perhaps she is feeling like its a ticking time bomb and doesn’t want to tell me that it is any day really.

either way, I am working up the courage to go out into the property and choose a spot for his final resting place come fall. I am also remaining in a day by day mind set of being grateful each morning I visit him and he is well and happy. I am trying to remain looking toward the sure decision that putting him down will be necessary for his safety no later than the fall, even if on that day he looks happy alert and just fine.

have you ever put a horse down when they were happy alert and fine? when you are given the diagnosis and are trying to prevent the inevitable? in his case the inevitable being heart failure. Im not sure whats harder… seeing a horse uncomfortable so that you have to put them down, or, seeing a horse happy and putting them down to keep them from discomfort even if you don’t know how far away that discomfort will be for them…

any thoughts, experiences, advice, and stories are welcomed. thanks for being there for me during this challenging time for my horse and I. also, thanks for sharing with me any info you have about murmurs that are as advanced and your experience on that.

[Cassi1125]

My 27 year old has a murmur that has gradually gotten worse, moreso in the past 3-ish years. The equine dentist that sees all the horses in spring was the one who thought he was about a grade 5 and did not want to chance tranquilizing him. My regular vet confirmed the grade 5 murmur when she came out to give spring shots. My boy also has severe melanomas (grey horse) and either seasonal allergies or minor COPD/heaves (I think more allergies as he is fine now and on no regular medication for it - just a short course of Dex in spring and sometimes fall). He also has PPID/non-insulin resistant Cushings, and is well-controlled at this point on Prascend.

To date, he has no other heart-related issues other than the murmur and no fluid retention, and is enjoying the pasture-puff life with another older horse.

With all of my 27-year-old’s health issues, the discussion has been had several times about what to do and when. I’ve had the boy since he was 3, and he was purchased for me by my late mother - so, like you, a hard decision to make. I am hoping he will tell me when it’s time, but Arabs being what they are, he can be a bit stubborn. (Case in point, when he was gelded at 3 (on his actual birthday, no less - lol!), and even though the vet used enough drugs to knock out a moose, my boy insisted on getting up on his wobbly legs, and nothing they did would induce him to lay down until the drugs wore off more.)

Anyway - I feel that if he starts losing weight, retaining substantial fluid, falling, or something along that line, I would be inclined to make the decision for him. If he stays reasonably unchanged into fall and is happy, I would be inclined to hold off and hope that our Wisconsin winter is not too hard.

FWIW - My first horse had a 4+ murmur, but with fluid retention, for which we gave lasix as needed. He also had melanomas (yes, another grey ). He was diagnosed with the murmur about age 25/26, and lived until he was 30 (nearly 31 as he passed just shy of January 1). He was found next to a tree being watched over by his pasture buddies, so he picked his time himself.

Honestly - my preference is to let the horse pick his own time, but I would keep a watchful eye on him for any major changes and base my decision on that.

eta - The one I lost at 30, when his symptoms first showed, there fortunately was an equine cardiologist doing a semester at UW-M vet school (this was in the late 80s, so not common to have a cardiologist in residence). So, we hauled him up and they did an echocardiogram and other tests to confirm the vet’s diagnosis.

[beowulf]

Firstly – big hugs. This is not easy for anyone. You going through the motions is perfectly normal.

Go out now. Make your contingency plan. Pick the spot for his resting place, and make sure you go through contacts now for who will arrange burial - including any logistics about heavy machinery. If you want to seal the date, do so now - and take time off from work for these arrangements.

As for the questions about his longevity and quality of life – do you trust your vet? If you don’t (or, even if you think a second set of eyes is valuable), get a second opinion. Now, it has been a really long time since I’ve dealt with anything heart-related in a horse besides a non-performance restricting murmur; has your vet prescribed any medication to help with either fluid retention or inflammation?

You asked if anyone has put a horse down when they were happy, alert, and fine. We, as their stewards, have the most unhappy job weighing their quality of life with their longevity of life. Horses don’t know about how short or long their lives are – but they do know about suffering and pain. It is always better a day too early, versus a day too late.

I’ve put several horses (and dogs) down at this point of my life. It is never, ever easy. It sucks. We love them and only get to have them for a time that seems so short. I can tell you that I waited way too long for one of them, and it still bothers me years later. He was a special horse to me and my family, but he did not get the dignified end he deserved. I didn’t wait so long that he couldn’t get up or was in violent pain when he went, but I waited long enough that his bad days began to outnumber the good.

While it is hard for you, you get to choose the ending. For me, it is almost easier to make the decision when you(g) are dealing with something degenerative or progressive. We know it won’t get better. He can go out happy in a field with his friends while munching carrots or eating from a grain bucket; this is as close to a peaceful end as I think any horse can get.

Give your boy a carrot for me.

[frugalannie]

I’m so sorry you’re facing this. I haven’t had to deal with this particular issue with a horse, but I have euthanized an older horse when I became concerned about the quality of her life facing a seasonal change. I just didn’t want a catastrophe to be my mare’s last day.

Could your vet set up a phone consultation with an equine cardiologist, maybe with you on the line, so that you have a better idea of what to expect?

Be attentive to the small changes that can creep in without us noticing. Are there more wrinkles above the nostrils? Has the respiratory rate increased at rest? Check the capillary refill so you’ll know if it changes. With humans, heat (especially with humidity) is a significant cardiac stressor. That’s why so many elderly people die during heat waves. I don’t know if it’s the same for horses but your vet may have an answer for that.

So yes, do all of the preplanning (and if you’re like me, shed some tears in the process). Give your horse lots of hugs and treats, and be prepared for, and at peace with, a final, loving act when necessary.

[2tempe]

I had one with a murmur and atrial fib. Diagnosed at 17, still in work, no outward symptoms. Based on this and heart measurements, it was called mild-moderate congestive heart failure. He stayed healthy and in work for several years, stepped down at 20, retired from riding at 23 due to cervical arthritis progression. The heart did him in around 25+. He was dropping some weight, seemed less himself and then the ventral edema showed up. Vet put him on lasix for a few days to help that while I had time to make arrangements for burial, etc. It does suck. He was in Florida the last 6 years of his life and the heat did not seem to bother him even in the last year. I am no vet, but I think you are more likely to see a decline rather than a sudden catastrophic event.

[TBKite]

Asking your vet to consult with the cardiology service at one of the vet schools may give her and you more information, but when it comes to heart disease progression no one has a crystal ball.

[Fiesta01]

I agree with Cassi1125. My old TB gelding was diagnosed with a heart murmur at age 29. I don’t remember what grade he was at that point. It slowly worsened over the years, but he had no change in behavior. Very happy, rambunctious horse who always got the herd running and playing.

At 36ish, I noticed he started to appear a little more tired when I brought him in from the field in the evening. (He was out all day and stalled at night). Earlier in the day, he was still his spunky self.

One evening (Feb of last year, would have been 38 in Sep), it was just me and him under the trees, grooming. Everyone else had already left for the night. He was staring out to “his” mares who overnighted in the field, eating carrots and both of us enjoying our quiet time together. For the first time ever, for some reason, I said to him “Wouldn’t it be nice, Gatsby, if you were 10 again and I was 35? Just think how many more wonderful years we would have together.” In hindsight, I think he somehow was communicating that he was ready. Of course, I didn’t consciously understand that evening.

The next day I arrived around 2 p.m. and saw him down in the field with his friends. I ran to him, but he was already gone. Barn owner had just checked on the horses at lunch time, and everyone had appeared normal. My vet came anyway, bless her, to give me some emotional support. She really felt it had been heart failure, very quick and painless. There was no disturbance to the ground around him.

I always wanted to be with him at the end, but my vet helped me see that he had been exactly where he wanted to be, with his friends, and chose his own time.

I know you know your horse well. Just keep an extra close eye on him. You’ll see if he needs you to make that dreaded decision. Barring any of those signs, if he still is eating and seeming content, I would let him tell you.

Prayers and strength to both of you in the weeks to come.

[glitterless]

No advice to give, but big hugs to you. And I agree that there is nothing wrong with letting him go when he’s still happy and asymptomatic and hasn’t known any suffering.

[CowgirlCoffee]

My late gelding was diagnosed with a grade 4 heart murmur during a routine vet exam. The only symptom he showed at the time was that we would become winded at the lope after a few minutes (we had competed in drill), which we attributed to him being in his early 20s. The vet recommended that we stick to light riding only, which we did ( I know others would have not recommended riding at all, but this horse loved to get out and go and it did not affect him at the least on the easy trails). He lived 9 more wonderful years until he passed away at 32. I didn’t do a necropsy, but I often wonder if he was in heart failure. He became a bit lethargic in the last month of his life and was very winded in light work, which I attributed to being out of shape due to having several months off when I was injured. On the day he passed away, he was down and the vet said he had a very faint pulse. I think he was in the process of dying, but we gave him pain medication and euthanized him to quicken the process, which took a while because of his weak pulse. Looking back, I wish I had called the vet when I first noticed his lethargy. If his heart was starting to fail, I would have euthanized him as soon as I found out. It was traumatizing for me to watch him stumble, fall, and not be able to get back up, plus I know that he suffered. I will always regret it. I would hate for you and your horse to go through that, better to do it a moment too soon than late. I’m sorry, this is not an easy decision. Hugs.

[mlb722]

I had a 4 year old horse who suddenly went into congestive heart failure. He had a sporadic afib, no one knew. It was pretty awful, I wouldn’t want an older horse to go through it in the middle of winter, if I could prevent it.

[freshman]

@mlb722

I had a 4 year old horse who suddenly went into congestive heart failure. He had a sporadic afib, no one knew. It was pretty awful, I wouldn’t want an older horse to go through it in the middle of winter, if I could prevent it.

But I wouldn’t want my horse to go through “it” in ANY season. The question here what is “it” and what does season have to do with it or not.

As it is, the OP feels like the vet handed her horse a death sentence that she must carry out on some artificial timeline “or else”. Or else what? I have questions and the OP should, too. Once the OP has time to think about what is no doubt a serious issue with her aged horse, then I think the most obvious and logical next step here is to ASK the vet directly was meant by this advice. I honestly find it cryptic and weird for a veterinarian to give such specific advice without attempting to explain it. Most vets would gently describe the usual general progression and timeline of whatever disease. Then most importantly, they also describe what signs and symptoms the owner should monitor and be aware of so that they can contact the vet whenever it is appropriate.