General Information
Chronic degenerative valve disease (CVD) is a progressive degeneration of the valves in the heart (primarily the mitral valve) that results in thickening of the valve leaflets and a valvular leak that eventually causes heart enlargement and signs of heart failure.
Diagnosis and Monitoring
The first sign of CVD is typically a murmur heard by your veterinarian on a routine examination. The murmur is caused by the turbulent blood flow as blood leaks backwards across the affected valve. Once a murmur is heard, thoracic radiographs are taken to evaluate for heart enlargement and evidence of congestive heart failure (fluid in the lungs or abdomen). The next step is referral to a cardiologist for an echocardiogram (ultrasound of the heart) to evaluate for specific heart chamber enlargement, to evaluate heart function, and to evaluate for other complications or sequelae of CVD. Other diagnostics, such as a blood pressure or blood work are recommended to further evaluate for other concurrent diseases or factors which may complicate management of CVD. Radiographs, blood pressure and blood work are recommended every few months to monitor progression of disease and adjust treatments as necessary.
Complications and Sequelae
Signs of heart failure include cough, difficulty breathing, weakness, lethargy, exercise intolerance, and collapse. Less commonly, abdominal distension from fluid build-up in the abdomen may occur. In some cases, arrhythmias as well as atrial rupture may develop, both of which may result in sudden worsening or sudden death. Prolapse of the valve leaflets may indicate a partial tear in the valve, and if a complete tear develops, this will result in sudden worsening and difficulty breathing.
Coughing due to compression of the major airways (mainstem bronchi) may result when heart enlargement is severe, without evidence of heart failure.
Pulmonary hypertension (PH), or high blood pressure in the lungs, may develop secondary to mitral valve disease. PH is best controlled by managing the underlying valvular disease. Medications can be added in if the PH increases in severity resulting in more pronounced clinical signs including exercise intolerance and collapse.
Treatment
The goal is to keep your pet out of heart failure without harming their kidneys and to help them maintain a good quality of life. Medications used to treat heart failure include diuretics to help remove extra fluid from the body; a medication to help improve function of the heart; and other medications to help prevent fluid retention and fibrosis (scarring) of the heart muscle. Other medications may be used to help control coughing or to control PH.
It is important your pet not be fed a diet or snacks that are very high in salt. This includes things like bacon, pig ears, sausage, etc. It is best to maintain them on a moderately sodium restricted diet. This would include any senior or kidney diet.
It is best to allow your pet to set their own pace. It is not uncommon for dogs with heart disease to be exercise intolerant, particularly in hot summer months.
Prognosis
In general, the average life span after diagnosis of heart failure (fluid in the lungs or abdomen), with appropriate treatment, is 1-2 years. Frequent monitoring is important in maximizing treatment of heart failure, to help your pet feel as good as possible, for as long as possible.
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