By Suzanne Brown
I have had five Cavaliers since 1984, four of whom have developed Mitral Valve Disease. Since 1990, I have had no fewer than one dog with MVD, and as many as four at one time. For the most part, this has meant doing absolutely nothing on a daily basis except noticing if the dog is coughing or appears to have any shortness of breath. For those on medication, it means giving them pills once or twice a day. There are chronic eye and skin conditions which can interfer more with a dog’s quality of life, and cause the owner much greater inconvenience.
Perhaps the best way to let people know what they can expect when living with the potential of MVD developing in their Cavalier and the actual disease itself, is to describe what I do to find out if my dogs have MVD and to describe the episodes when the disease caused my dogs (and me!) great distress. I will also describe what happened to the two I lost to MVD.
1- yearly auscultation by a board certified cardiologist for ALL Cavaliers over the age of 18 months. I use the CKCSC-sponsored heart clinics to save money - it is a substantial saving over a private cardiologist or a veterinary school. The Club sponsors heart clinics in various parts of the country several times each year (look for announcements in the Bulletin and in the Show Calendar on the Club's web site). DO NOT count on your own vet to pick up low grade murmurs!
2- after the cardiologis first hears a murmur, I have my own vet do a heart x-ray to evaluate the heart for enlargement. He evaluates the x-ray using Dr James Buchanan's "Vertebral Scale System to Measure Canine Heart Size in Radiographs", Journal of the American Veterinary Medical Assoc., Vol. 206, No 2, Pages 194-199. This is one of the cheapest and easiest things you can do to help any dog with a murmur. An enlarged heart can cause a lot of trouble for a dog with MVD. Early identification and proper treatment CAN make a difference!
3- teeth cleaning (and pulling!) every 18 months for dogs with a murmur. It would be better to do this more often, but this is what I can afford. If the dog has an MVD murmur, the recommended protocol is to put the dog on antibiotics for 10 days both BEFORE and AFTER the dental work. I personally will not allow any anesthesia other than isoflurane to be used, as it is the safest, especially for dogs with heart problems. It is also important for you to check their gums regularly for any signs of inflammation (redness & bleeding). If you see any such signs, take the dog to your vet at once and put it on antibiotics! Even an elderly Cavalier with a bad heart and poorly functioning kidneys can have dental work done with the proper anesthesia and a skillful vet. For such dogs, any infection can make them go downhill very quickly. Eliminating the infection can have a positive effect that is nothing short of miraculous.
4- if the cardiologist recommends an EKG, my vet does it and sends it by modem to CardioPet where it is evaluated by a cardiologist
5- moderate exercise appears to be good for these dogs (stairs especially!). Short walks are recommended.
6- be sure to keep an eye on your dog's weight. Excess weight will surely do him no good if fighting MVD.
My first Cavalier, Alfred, was my first Cavalier to get into real trouble with his MVD. One evening right after Alfred's 10th birthday and five years after he was first diagnosed with a grade 1 MVD murmur, Alfred began to cough. He coughed all night long and I thought he would surely die before morning! I was in Fryeburg, ME and really had not yet established a relationship with a vet and there was no 24 hr emergency number. It was the longest night of my life as I held Alfred while he coughed and struggled to breathe. I was at the vet's office when he opened at 7:30 the next morning and he immediately put Alfred on Lasix and Vasotec twice daily. He also gave him a shot of something (I was too upset to even ask what it was!) and Alfred was breathing easier very quickly. Within a day, the coughing was much less severe and within 2-3 days, it had ceased completely. After 2 weeks, the vet had me reduce the Lasix and the Vasotec to once a day.
The second episode happened while on vacation on Martha's Vineyard. Alfred, then 13 1/2, had an encounter with a skunk. He received such a "direct hit" that the excitement and distress caused his heart to go into an arrhythmia, which caused a lack of oxygen to his brain, which caused him to faint. It scared me to death! I thought Alfred was dying and he could have done so. I threw a bowl of cold water on him to try to rinse off some of the skunk secretion and this revived him. I contacted a local 24 hr vet clinic immediately and was told nothing further needed be to be done. It took several days for Alfred to snap back from this experience. We took Alfred to see Dr Buchanan at a Club heart clinic in PA two weeks later to be checked, as his heartbeat seemed to be rapid. Dr Buchanan suggested that I consider putting Alfred on Digoxin. I made the decision that I did not want to put Alfred on this drug due to his age, the potential toxicity of the drug, and the difficulty in establishing the proper dosage. My decision might well have been different if Alfred had been a much younger dog.
Alfred lived another 10 months before his poor old heart finally wore out. His last 3 weeks were an emotional roller coaster as he would seem very bad (no energy and considerable weakness) and then he would bounce back and be his old self once more. He finally quit eating (I tried tempting him with just about every delicacy on earth, but anorexia is a part of end stage MVD) and he grew terribly weak. At 14 years and nearly 4 months of age, I knew I must let Alfred go and I had him put down. It nearly broke my heart as this dog still had good eyesight, good hearing, and a quick mind. His "spirit was willing but the body was weak". I have no doubt that if Alfred had not had MVD, he might well have lived another year or two more. I do know that I did all for him that I possibly could. Alfred was the love of my life.
Two weeks after losing Alfred, Merry Masker suddenly appeared to have put on considerable weight. Overnight, her sides just "ballooned" out. I took her to my vet and discovered that poor little Merry now had fluid on her abdomen (right ventricle failure). He dramatically increased her dosage of Lasix, but it did not do any good. A few days later, we had the fluid aspirated from her abdomen. Over 2 pounds of fluid was removed! Unfortunately, it came back again almost immediately. The fluid was aspirated a second time and at that time, Merry was put on triple diuretics. She never again built up any more fluid and she was so much more comfortable. Unfortunately, Merry's heart just gave out and she had to be put down just two weeks later at age 10 years, 5 months.
As of August 2000, I am living with three Cavaliers, two of whom have MVD. Only my oldest boy, Keepsake, is still clear. He is now 14 and an amazing old boy.
Merry Masker's daughter, India is nearly 9 and has a grade 3-4 murmur. She is symptomless and is on no medication. India's son Laddie, just turned 6 and has a grade 2 murmur. He, too, is symptomless and on no medication. Both are very lively, active dogs who have a very high quality of life.
I do not want to appear to trivialize MVD because this is a VERY serious problem for the breed as well as for individual Cavaliers themselves. Alfred's quality of life was excellent until the very end, and he lived to a very old age. Not all Cavaliers are as lucky as Alfred was. Many die at age 7, 8 or 9 years of age. Merry's death at age 10 was much too early. Most of our dogs can live high quality lives with this disease, but their lives are shortened. The age of the dog at the onset of MVD is an important factor as to how well and long a Cavalier will live with MVD. I believe that a dog's family history of longevity also plays an enormous part in how long and how well the dog lives with MVD.
With early diagnosis (by a board certified cardiologist) and proper care, a Cavalier can lead a good life with MVD for several years. Diligence on the part of the owner is paramount. It is far easier to postpone congestive heart failure than it is to bring a dog back from it.
CKCSC Health Registry, 5+ Year Clear Heart
CKCSC Open Health Registry
List of Cardiologists: http://www.acvim.org/Specialist/Search.aspx